Penatalaksanaan Anestesi pada Pasien dengan Tumor Supratentorial Berukuran Besar Suspek Konveksitas Meningioma

Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration

“…26,39 The fourth step is verification, perioperative neuro-anesthesia management starting from the emergency room, in the operating room and in the ICU also affects the outcome of postoperative patient conditions. [40][41][42] To reduce postoperative risk, ETT removal was not performed, the patient had a respiratory failure due to COVID-19 symptoms. In this case, as in most neurosurgery patients, the patient was awakened from the effects of anesthesia as soon as possible, so that the neurological status can be evaluated as soon as possible due to surgery.…”

“…Delayed ETT removal can be performed on the conditions: poor preoperative level of consciousness, risk of edema or increased edema such as prolonged surgery, heavy bleeding, near vital areas, extensive surgery, and preoperative difficult airway management. 42,43 Risk management of neuro-anesthesia procedures in hemorrhagic stroke patients focused on early resuscitation, hemodynamic stabilization, and emergency surgery to evacuate bleeding. Surgery is performed by keeping the brain relaxed (by giving adequate relaxants, adequate analgesics, normal body fluid volume, and maintaining hemodynamics), lowering cerebral blood flow (CBF) thus ICP is low, protecting nerve tissue from ischemia and injury, maintaining cerebral perfusion pressure (CPP), reduce cerebral metabolic oxygen level (CMRO 2 ), and optimize brain oxygen delivery (DO 2 ).…”

“…Surgery is performed by keeping the brain relaxed (by giving adequate relaxants, adequate analgesics, normal body fluid volume, and maintaining hemodynamics), lowering cerebral blood flow (CBF) thus ICP is low, protecting nerve tissue from ischemia and injury, maintaining cerebral perfusion pressure (CPP), reduce cerebral metabolic oxygen level (CMRO 2 ), and optimize brain oxygen delivery (DO 2 ). [41][42][43] Hemorrhagic stroke is a big matter in the medical practice due to the high mortality and morbidity. There are three goals of the anesthesiologist besides facilitating surgery, namely (1) controlling intracranial pressure and brain volume, (2) protecting nerve tissue from ischemia and injury,(3) reducing bleeding.…”

“…There are three goals of the anesthesiologist besides facilitating surgery, namely (1) controlling intracranial pressure and brain volume, (2) protecting nerve tissue from ischemia and injury,(3) reducing bleeding. 9,42 Conclusions By using the basic ethical principles which are assisted by the medicolegal principles, it is concluded that in hemorrhagic stroke patients with COVID-19 complications are not given anticoagulants considering the ethical principles of beneficence and non-maleficence and are supported by prima facie principles, double effect and minus malum as well as medicolegal aspects by examining patient safety and risks management. Giving anticoagulants is controversial because it can harm the patient (non-maleficence principle), although it is beneficial for patients with COVID-19 (beneficence principle), in this case, preventing harm is of higher than providing benefits.…”