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Penanganan edema serebri berat dan herniasiserebri pada cedera kepala traumatik (Management of savere cerebral edema and cerebral herniation in traumatic brain injury MANAGEMENT OF SEVERE CEREBRAL EDEMA AND CEREBRAL HERNIATION IN TRAUMATIC BRAIN INJURY

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Traumatic brain injury is one of life-threatening condition to victims of serious accidents, and is the leading cause of disability and death in adults and children. Subdural hematoma is a focal intracranial lesions are most common, about 24% of patients with severe closed head injury. Oedema cerebral commonly encountered in clinical practice and is a major cause of morbidity and mortality in critically ill patients and neurosurgical patients experiencing acute brain injury. Cerebral herniation is a state of emergency, where the therapeutic goal is to save patients' lives. Prognosis greatly depends on where the herniation occurs. Deaths would occur if the herniation is not addressed.
A 27 years old woman with a subdural hematoma frontotemporoparietal D, severe edema cerebral and cerebral herniation, with a history of unconscious after falling from the motor due to being hit. Plans for craniotomi clot evacuation and decompression. When the patient arrived, the assessment is being established, immediate intubation for airway control and provide adequate oxygenation, fluid resuscitation and mannitol administered to control the rise in intracranial pressure. Operations performed in general anesthesia, using ETT No 7,5, controlled ventilation. Stomach decompression with NGT No.16. Premedication with midazolam 2 mg. Co induction using fentanyl 100 mg, induction with propofol 100 mg. Lidocain 1.5 mg / kg administered 3 minutes before intubation. Vekuronium 0.1 mg / kg for intubation fascilitation. Maintenance of anesthesia with 02 + N20 + sevoflurane. Given a continuous propofol 4-6 mg / kg / hour, vekuronium 6mg / hour. The operation lasted for 3 hours, clot evacuation in the region frontotemporoparietal right, after the evacuation of clot, occurs reperfusion to the area that had contained clot, resulting in swelling of the brain (bulging) that can not be controlled by hyperventilation, mannitol and furosemide administration. It was decided to perform craniectomy decompression. The hemodynamics relatively stable during the operation, systolic blood pressure range 100-130 mmHg, diastolic blood pressure 60-90mmHg, pulse rate (HR) 87-110 x / mnt, Sa02 99-100 25-30 EtCO2. Postoperative care of patients in the ICU, with ventilator control ventilation, full sedation. Nine days later the patient died
Neurological dysfunction and mortality in traumatic brain injury (TBI) are associated with (a) injury to the brain itself, (b) a prolonged coma and its complications, (c) infection of open wounds or fractures of the skull base, (d) hidrocephalus because of SAN, and (e) an increase in ICP. Very high intracranial pressure (ICP) can lead to cerebral herniation which can be fatal even death.

Keywords: Traumatic Brain Injury, Subdural Hematoma, Cerebral Edema, Cerebral Herniation

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Jurnal Neuroanastesia Indonesia, 1 (2) 2012 : 110-

Publisher

Bandung : FK UNPAD., 2012

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10p

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ISBN/ISSN

2088-9670

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Subject(s)

brain injuries
ENCEPHALOCELE
BRAIN ENDEMA

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