Skip to main content Skip to main navigation menu Skip to site footer

Peningkatan glasgow coma scale yang signifikan pada pasien epidural hematome post operasi trepanasi evakuasi klot



Abstract

Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening condition. Nearly 81% of EDH cases were caused by accidental incident, 17% due to assault, and the rest due to self harm and suicidal intent. The epidural hematome occurs due to fracture of the skull in the space between the internal tabula cranii and duramater. Epidural hematoma is a serious sequela of head injury and causes a mortality rate of about 50%. Surgery is performed in 40% of cases of EDH. A 17-year-old man was diagnosed moderate head injury and right temporoparietal epidural hemorrhagic with cerebral odema and base skull fracture and closed fracture of the right lower extremity with GCS (Glasgow Coma Scale) E1 V 1 M3 and underwent trepanation, clot evacuation and debridement elevation, reconstruction. The surgery was under general anesthesia with the neuroanesthesia's technique. Hemodynamics was stable during the 3 hours 40 minutes surgery. Management of neuroanesthesia for head injuries aims to optimize brain perfusion, facilitate surgery and prevent secondary brain injury.

 

Epidural Hematom (EDH) adalah cedera otak traumatik utama dan kondisi yang berpotensi mengancam jiwa. Hampir 81 % dari kasus EDH disebabkan oleh kecelakaan yang tidak disengaja, 17 % karena penyerangan, dan sisanya karena merugikan diri sendiri dan niat untuk bunuh diri. Operasi bedah saraf dilakukan pada 40% kasus EDH. Seorang laki- laki berusia 17 tahun dengan diagnosa cedera kepala sedang dengan epidural hemoragik temporoparietal dekstra dengan odema serebri dengan fraktur basis kranii dan fraktur tertutup cruris dekstra dengan GCS ( Glasgow Coma Scale) E1 V 1 M3 dan akan dilakukan tindakan trepanasi evakuasi klot dan debridement elevasi rekontruksi. Selama operasi pasien di berikan teknik anestesi umum dengan konsep neuroanestesi. Hemodinamik stabil selama operasi 3 jam 40 menit berlangsung. Epidural Hematom adalah perdarahan intrakranial yang terjadi karena fraktur tulang tengkorak dalam ruang antara tabula interna kranii dengan duramater. Epidural hematoma merupakan gejala sisa yang serius akibat cedera kepala dan menyebabkan angka mortalitas sekitar 50%. Manajemen neuroanestesia untuk cedera kepala bertujuan untuk mengoptimalkan perfusi otak, memfasilitasi pembedahan dan mencegah cedera otak sekunder. 

Keywords: cedera kepala epidural hematoma subdural hematoma

References

  1. Sidharta P, Mardjono M,2005, Neurologi Klinis Dasar, Dian Rakyat, Jakarta.
  2. Robertson. C.S., Zager. L.E., Narayan. R.K., et all. Clinical Evaluation of a Portable Near-Infrared Device for Detection of Traumatic Intracranial s. J Neurotrauma. 2010 sep;27(9):1597-604
  3. Ertmer C, Aken HV. Fluid therapy in patients with brain injury: what does physiology tell us. Critical Care. 2014; 18: 199.
  4. Santoso. M. I. E., Rahayu. M., Balafif. Fachriy. Correlation of Severe Head Injury Epidural Hematoma Trepanation Respond Time with Outcome. MNJ.2016;2(1) : 14-18
  5. Loftus CM. Neurosurgical Emergencies, 2nd ed. Thieme, New York. 2008. p. 53-67.
  6. Mansjoer A, Suprohaita, 2000, Kapita Selekta Kedokteran, Edisi ke 3, Jilid 2, UI.
  7. University of California Los Angeles Neurosurgery. Epidural Hematoma. Diakses dari:
  8. Budiman C. 2010. Patah Tulang dan Pembidaian. Bandung: KORPS Sukarela PMIUNPAD
  9. Ul Haq, MI. Traumatic extradural hematoma. Professional Med J. 2014; 21(3): 540–43.
  10. Subekti. B.E., Oetoro. B.J., Rasman. M., et al. Manajemen Anestesi untuk Evakuasi Epidural Hemorrhage bersama dengan Operasi Fraktur Cruris Terbuka. JNI. 2017;6(1): 42-58.
  11. Saleh SC. Neuroanestesia Klinik. Surabaya: Zifatama Publisher. 2013; 47–162.
  12. Hawthorne G, Gruen RL, Kaye AH. Traumatic brain injury and long-term quality of life: findings from an Australian study. J Neurotrauma. 2009; 26: 1623–33.
  13. Miller JD, Piper IR, Jones PA. Pathophysiology of head injury. Dalam: Narayan RK, Wilberger JE, Povlishock JT, editors. Neurotrauma. New York: McGraw- Hill. 1996;61–69.
  14. Baron EM, Jallo JI. Traumatic brain injury: pathology, pathophysiology, acute care and surgical management, critical care principles and outcome. Dalam: Zasler ND, Katz DI, Zafonte RD, editors. Brain Injury Medicine: Principles and Practice. New York: Demos Medical Publishing. 2007; 265–82
  15. Sakabe T, Matsumoto M. Effects of anesthetics agents and other drugs on cerebral blood flow, metabolism and intracranial pressure. Dalam: Cottrell and Young’s Neuroanesthesia, 5th ed. Philadelphia: Mosby Elsevier; 2010, 317–26.
  16. Bisri T. Penanganan Neuroanestesia dan Critical Care: Cedera Otak Traumatik. Bandung: FK Unpad. 2012; 83–124, 143-68, 187–208.
  17. Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GWJ, Bell MJ, et al. Guideline for the management of severe traumatic brain injury 4th ed. Brain Trauma Foundation; September 2016.

How to Cite

Pratiwi, D. A. N. I., & Sutawan, I. B. K. J. (2021). Peningkatan glasgow coma scale yang signifikan pada pasien epidural hematome post operasi trepanasi evakuasi klot. Medicina, 52(1), 44–47. https://doi.org/10.15562/medicina.v52i1.1049
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
198

Total
202

Share

Search Panel

Dewa Ayu Nyoman Isma Pratiwi
Google Scholar
Pubmed
Medicina Journal

Ida Bagus Krisna Jaya Sutawan
Google Scholar
Pubmed
Medicina Journal