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Dewi Yulianti Bisri , Ignatia Karina Hallis , Tengku Addi Saputra , Tatang Bisri

Abstract

The term ‘brain relaxation’ is frequenly used to describe the tension of brain tissue during craniotomy. The relaxation status of brain is an essential element of neuroanesthesia practice and is relevant to surgical condition, retractive injuries, and patient outcomes. The beneficial and detrimental effects of various interventions for brain relaxation should be considered in zpatient management.

A 63-year-old woman with a supratentorial tumor who weighed 70 kg and was 164 cm tall complained of a decrease in consciousness three days before hospital admission, and partial left-body paralysis for the last two months. The patient’s Glasgow Coma Scale (GCS) score was 12, feeling headache, nausea, vomiting, but not seizures.  Blood pressure was 146/79 mmHg, mean arterial pressure (MAP) was 99 mmHg, pulse rate was 87 x/min, respiratory rate was 20 x/min, temperature was 36.9⁰C, and SpO₂ was 97% with air. She was induced with dexmedetomidine, followed by thiopental, vecuronium bromide, fentanyl, lidocaine, ventilation with 100% oxygen, and sevoflurane 2 vol%. Before intubation, a repeat dose of thiopental was given at half the initial dose. Dexamethasone and mannitol were administered, thiopental was continued, and the dose was then lowered to 1-3 mg/kg BW, sevoflurane 1-2 vol%, oxygen/air, and continuous vecuronium bromide were also given. A slack brain with a brain relaxation score of 1 was obtained. The operation lasted 5.5 hours. Using a drug combination from the neuroanesthesia drug club, a slack brain was achieved, allowing the tumor to be entirely removed, with minimal bleeding and without the need for blood transfusions‎.

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