*** entry kali ni mungkin agak bosan kott... yerlaa nk share pasal perasaan ...
Pada kala semua org sibuk dengan general election yg 13 ni... YEahhh yg penting Bn Mng...
Kami pulak sibuk membicarakan soal hati ... yerr... betul aku cemburu .. tapi tak dapat nak luahkan dgn kata.. kata... aku cuba jadi seorang yang positif ... dah bagus bler dia cerita his love story before ... its sadness ... and I am jealous a bit sbb he still love that woman deep in his heart "he told me"...
Hmmm.... agak tragik la untuk aku nak buka hati lagi... takut... takut ... bila da sayang nanti .... the same thing will happen again ... I'm scared ...
Along cakap aku kena cuba ... but its my weakness .... having a heartbroken is painful. ... really hope ... hope that we will last forever ... we will getting to that stage ... I know he was a loyal man before ... but will he still be the same ? I'm wondering ...
Buat mse skang ni.... yeahh I think I love you ... but mungkin kah bila ur first love come back to you .... u will leave me ? Aku tanyer dia ... diam___________ then said " takla ... dah ada awak kan " ...but in his heart ? I'm so sad ... huhuhu ...
Just ... what should I do for now ? ...sesungguhnya aku menyayangimu kerana Allah taala... e.j .
**************END*****************
shirifuhano shah elisa
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=MED XENZIA=
welcome to my blog ... hope that we always could share and discussing some tips and issues here
" ilmu tanpa amal ibarat pokok yang tidak berbuah"
Sunday, May 5, 2013
Saturday, May 4, 2013
Permata Hati
by Zaiful Ikhram (Notes) on Thursday, June 2, 2011 at 1:16am
Suara Hati Seorang Ikhwan
Suara Hati Seorang Ikhwan
untuk Seluruh Wanita Suci di Dunia
Wanita suci,
Mungkin aku memang tak romantis tapi siapa peduli?
Karena toh kau tak mengenalku
dan memang tak perlu mengenalku.
Bagiku kau bunga, tak mampu aku samakanmu dengan
bunga terindah sekalipun.
Bagiku manusia ialah makhluk yang terindah,
tersempurna & tertinggi.
Bagiku dirimu salah satu dari semua itu,
karenanya kau
tak membutuhkanpersamaan.
Wanita suci,
Jangan pernah biarkan aku manatapmu penuh,
karena akan membuat ku mengingatmu.
Berarti memenuhi kepalaku dengan
inginkanmu.
Berimbas pada tersusunnya gambarmu
dalam tiap dinding khayalku.
Membuatku inginkanmu sepenuh hati,
seluruh jiwa,
sesemangat mentari.
Kasihanilah dirimu jika harus hadir dalam khayalku
yg masih penuh Lumpur.
Karena sesungguhnya dirimu terlalu suci.
Wanita suci,
Berdua menghabiskan waktu denganmu
bagaikan mimpi tak berujung.
Ada ingin tapi tak ada henti.
Menyentuhmu merupakan ingin diri, berkelebat selalu,
meski ujung penutupmu pun tak berani kusentuh.
Jangan pernah kalah dengan mimpi & inginku karena
sucimu kaupertaruhkan.
Mungkin kau tak peduli
Tapi kau hanya menjadi wanita biasa
di hadapanku bila kau kalah.
Dan tak lebih dari wanita biasa.
Wanita suci,
Jangan pernah kautatapku penuh
Bahkan tak perlu kaulirikkan matamu
untuk melihatku.
Bukan karena aku terlalu indah,
tapi karena aku seorang yg masih kotor.
Aku biasa memakai topeng keindahan
pada wajah burukku, mengenakan pakaian sutra emas.
Meniru laku para rahib,
meski hatiku lebih kotor dari Lumpur.
Kau memang suci,
tapi masih sangat mungkin kau termanipulasi.
Karena kau toh hanya manusia-hanya wanita.
Wanita suci,
Beri sepenuh diri pada dia sang lelaki suci yg
dengan sepenuh hati membawamu kehadapan Tuhanmu.
Untuknya dirimu ada, itu kata otakku,
terukir dalam kitab suci, tak perlu dipikir lagi.
Tunggu sang lelaki itu
menjemputmu, dalam rangkaian khitbah & akad yg indah.
Atau kejar sang lelaki suci itu,
karena itu ialah hakmu, seperti dicontohkan ibunda Khadijah.
Jangan ada ragu, jangan ada malu,
semua terukir dalam kitab suci.
Wanita suci
bariskan harapanmu pada istikharah
sepenuh hati ikhlas.
Relakan Allah pilihkan lelaki suci
untukmu, mungkin sekarang / nanti,
bahkan mungkin tiada sampai kau mati.
Mungkin itu berarti dirimu terlalu suci untuk
semua lelaki di fana saat ini.
Mungkin lelaki suci itu menanti di istana kekalmu,
yg kaubangun dengan segala kekhusyu'an tangis do'amu.
Wanita suci
Pilihan Allah tak selalu seindah inginmu,
tapi itu pilihan-Nya.
Tak ada yg lebih baik dari pilihan Allah SWT.
Mungkin kebaikan itu bukan pada lelaki yg terpilih
itu, melainkan pada jalan yang kaupilih,
seperti kisah seorang wanita sudi di masa lalu yg
meminta ke-Islam-an sebagai mahar pernikahannya.
Atau mungkin kebaikan itu terletak pada keikhlasanmu
menerima keputusan Sang Kekasih Tertinggi.
Kekasih tempat kita memberi semua cinta & menerima cinta
dalam setiap denyut nadi kita.
Suara Hati Seorang Ikhwan
untuk Seluruh Wanita Suci di Dunia
Wanita suci,
Mungkin aku memang tak romantis tapi siapa peduli?
Karena toh kau tak mengenalku
dan memang tak perlu mengenalku.
Bagiku kau bunga, tak mampu aku samakanmu dengan
bunga terindah sekalipun.
Bagiku manusia ialah makhluk yang terindah,
tersempurna & tertinggi.
Bagiku dirimu salah satu dari semua itu,
karenanya kau
tak membutuhkanpersamaan.
Wanita suci,
Jangan pernah biarkan aku manatapmu penuh,
karena akan membuat ku mengingatmu.
Berarti memenuhi kepalaku dengan
inginkanmu.
Berimbas pada tersusunnya gambarmu
dalam tiap dinding khayalku.
Membuatku inginkanmu sepenuh hati,
seluruh jiwa,
sesemangat mentari.
Kasihanilah dirimu jika harus hadir dalam khayalku
yg masih penuh Lumpur.
Karena sesungguhnya dirimu terlalu suci.
Wanita suci,
Berdua menghabiskan waktu denganmu
bagaikan mimpi tak berujung.
Ada ingin tapi tak ada henti.
Menyentuhmu merupakan ingin diri, berkelebat selalu,
meski ujung penutupmu pun tak berani kusentuh.
Jangan pernah kalah dengan mimpi & inginku karena
sucimu kaupertaruhkan.
Mungkin kau tak peduli
Tapi kau hanya menjadi wanita biasa
di hadapanku bila kau kalah.
Dan tak lebih dari wanita biasa.
Wanita suci,
Jangan pernah kautatapku penuh
Bahkan tak perlu kaulirikkan matamu
untuk melihatku.
Bukan karena aku terlalu indah,
tapi karena aku seorang yg masih kotor.
Aku biasa memakai topeng keindahan
pada wajah burukku, mengenakan pakaian sutra emas.
Meniru laku para rahib,
meski hatiku lebih kotor dari Lumpur.
Kau memang suci,
tapi masih sangat mungkin kau termanipulasi.
Karena kau toh hanya manusia-hanya wanita.
Wanita suci,
Beri sepenuh diri pada dia sang lelaki suci yg
dengan sepenuh hati membawamu kehadapan Tuhanmu.
Untuknya dirimu ada, itu kata otakku,
terukir dalam kitab suci, tak perlu dipikir lagi.
Tunggu sang lelaki itu
menjemputmu, dalam rangkaian khitbah & akad yg indah.
Atau kejar sang lelaki suci itu,
karena itu ialah hakmu, seperti dicontohkan ibunda Khadijah.
Jangan ada ragu, jangan ada malu,
semua terukir dalam kitab suci.
Wanita suci
bariskan harapanmu pada istikharah
sepenuh hati ikhlas.
Relakan Allah pilihkan lelaki suci
untukmu, mungkin sekarang / nanti,
bahkan mungkin tiada sampai kau mati.
Mungkin itu berarti dirimu terlalu suci untuk
semua lelaki di fana saat ini.
Mungkin lelaki suci itu menanti di istana kekalmu,
yg kaubangun dengan segala kekhusyu'an tangis do'amu.
Wanita suci
Pilihan Allah tak selalu seindah inginmu,
tapi itu pilihan-Nya.
Tak ada yg lebih baik dari pilihan Allah SWT.
Mungkin kebaikan itu bukan pada lelaki yg terpilih
itu, melainkan pada jalan yang kaupilih,
seperti kisah seorang wanita sudi di masa lalu yg
meminta ke-Islam-an sebagai mahar pernikahannya.
Atau mungkin kebaikan itu terletak pada keikhlasanmu
menerima keputusan Sang Kekasih Tertinggi.
Kekasih tempat kita memberi semua cinta & menerima cinta
dalam setiap denyut nadi kita.
Monday, February 11, 2013
Acute Pain Service
Article 1 :
Methodology
A. Definition of Acute Pain Management in the Perioperative Setting , acute pain is defined as pain that is
present in a surgical patient after a procedure. Such pain may be the result of trauma from the procedure or
procedure related complications. Pain management in the perioperative setting refers to actions before,
during, and after a procedure that are intended to reduce or eliminate postoperative pain
before discharge.
APS (Acute Pain Service ) Guideline Purpose:
(1) facilitate the safety and effectiveness of acute pain management in the perioperative setting;
(2) reduce the risk of adverse outcomes;
(3) maintain the patient’s functional abilities, as well as physical and psychologic
well-being; and
(4) enhance the quality of life for patients with acute pain during the perioperative period. Adverse outcomes
that may result from the undertreatment of perioperative pain include (but are not limited to)
thromboembolic and pulmonary complications, additional time spent in an intensive care
unit or hospital, hospital readmission for further pain management, needless suffering, impairment of health-
related quality of life, and development of chronic pain. Adverse outcomes associated with the management
of perioperative pain include (but are not limited to) respiratory depression, brain or other neurologic
injury, sedation, circulatory depression, nausea, vomiting, pruritus, urinary retention, impairment of bowel
function, and sleep disruption. Health-related quality of life includes (but is not limited to) physical,
emotional, social, and spiritual well-being.
*Patients with severe or concurrent medical illness such as
sickle cell crisis, pancreatitis, or acute pain related to cancer
or cancer treatment may also benefit from aggressive pain
control. Labor pain is another condition of interest to anesthesiologists.
However, the complex interactions of concurrent
medical therapies and physiologic alterations make it
impractical to address pain management for these populations
within the context of this document.
Methodology
A. Definition of Acute Pain Management in the Perioperative Setting , acute pain is defined as pain that is
present in a surgical patient after a procedure. Such pain may be the result of trauma from the procedure or
procedure related complications. Pain management in the perioperative setting refers to actions before,
during, and after a procedure that are intended to reduce or eliminate postoperative pain
before discharge.
APS (Acute Pain Service ) Guideline Purpose:
(1) facilitate the safety and effectiveness of acute pain management in the perioperative setting;
(2) reduce the risk of adverse outcomes;
(3) maintain the patient’s functional abilities, as well as physical and psychologic
well-being; and
(4) enhance the quality of life for patients with acute pain during the perioperative period. Adverse outcomes
that may result from the undertreatment of perioperative pain include (but are not limited to)
thromboembolic and pulmonary complications, additional time spent in an intensive care
unit or hospital, hospital readmission for further pain management, needless suffering, impairment of health-
related quality of life, and development of chronic pain. Adverse outcomes associated with the management
of perioperative pain include (but are not limited to) respiratory depression, brain or other neurologic
injury, sedation, circulatory depression, nausea, vomiting, pruritus, urinary retention, impairment of bowel
function, and sleep disruption. Health-related quality of life includes (but is not limited to) physical,
emotional, social, and spiritual well-being.
*Patients with severe or concurrent medical illness such as
sickle cell crisis, pancreatitis, or acute pain related to cancer
or cancer treatment may also benefit from aggressive pain
control. Labor pain is another condition of interest to anesthesiologists.
However, the complex interactions of concurrent
medical therapies and physiologic alterations make it
impractical to address pain management for these populations
within the context of this document.
Recommendations for Preoperative Preparation of the Patient.
Patient preparation for perioperative pain management should include appropriate adjustments or
continuation of medications to avert an abstinence syndrome, treatment of preexistent pain, or preoperative
initiation of therapy for postoperative pain management.
Anesthesiologists offering perioperative analgesia service should provide, in collaboration with others as
appropriate,patient and family education regarding their important roles in achieving comfort, reporting pain,
and in proper use of the recommended analgesic methods. Common misconceptions that overestimate the
risk of adverse effects and addiction should be dispelled. Patient education for optimal use of
patient-controlled analgesia (PCA) and other sophisticated methods, such as patient-controlled epidural
analgesia might include discussion of these analgesic methods at the time of the preanesthetic evaluation,
brochures and videotapes to educate patients about therapeutic options, and discussion at the bedside
during postoperative visits. Such education may also include instruction in behavioral modalities
for control of pain and anxiety.
IV. Perioperative Techniques for Pain Management
Perioperative techniques for postoperative pain management
include but are not limited to the following single modalities:
(1) central regional (i.e., neuraxial) opioid analgesia;
(2) PCAwith systemic opioids; and
(3) peripheral regional analgesic techniques, including but not limited to intercostal blocks,
plexus blocks, and local anesthetic infiltration of incisions.
Central regional opioid analgesia: Randomized controlled trials report improved pain relief when use of
preincisional epidural or intrathecal morphine is compared with preincisional oral, intravenous, or
intramuscular morphine
(Category A2 evidence).36–39 RCTs comparing preoperative
or preincisional intrathecal morphine or epidural sufentanil
with saline placebo report inconsistent findings regarding
pain relief
(Category C2 evidence).40–43 RCTs comparing
preoperative or preincisional epidural morphine or
fentanyl with postoperative epidural morphine or fentanyl
are equivocal regarding postoperative pain scores
(Category C2 evidence).44,45
Meta-analyses of RCTs46–54 report improved pain relief
and increased frequency of pruritus in comparisons of
postincisional epidural morphine and saline placebo
(Category A1 evidence); findings for the frequency of nausea or
vomiting were equivocal
(Category C1 evidence). Meta-analyses of RCTs comparing postincisional epidural morphine
with intramuscular morphine report improved pain relief
and an increased frequency of pruritus
(Category A1 evidence). 49,55–59
One RCT reports improved pain scores and
less analgesic use when postincisional intrathecal fentanyl is
compared with no postincisional spinal treatment
(CategoryA3 evidence).60
One RCT reports improved pain scores when postoperative
epidural morphine is compared with postoperative epidural
saline
(Category A3 evidence).61
Meta-analyses of RCTs62–70 report
improved pain scores and a higher frequency of pruritus
and urinary retention when postoperative epidural morphine is
compared with intramuscular morphine
(Category A3 evidence);
findings for nausea and vomiting are equivocal
(Category C2 evidence).
Findings from RCTs are equivocal
regarding the analgesic efficacy of postoperative epidural
fentanyl compared with postoperative IV fentanyl
(Category C2 evidence)71–74;
meta-analytic findings are equivocal
for nausea and vomiting and pruritus
(Category C1 evidence).72–76
PCA with systemic opioids: Randomized controlled trials
report equivocal findings regarding the analgesic efficacy of
IV PCA techniques compared with nurse or staff-administered
intravenous analgesia (Category C2 evidence).77–80
V. Multimodal Techniques for Pain Management
Multimodal techniques for pain management include the
administration of two or more drugs that act by different
mechanisms for providing analgesia. These drugs may be
administered via the same route or by different routes. SEE EXAMPLES OF CASE : http://www.penncancer.org/pdf/NETs%20and%20Surgery_Karakousis.pdf Appendix 1: Summary of
Recommendations
I. Institutional Policies and Procedures for Providing
Perioperative Pain Management
• Anesthesiologists offering perioperative analgesia services should
provide, in collaboration with other healthcare professionals as
appropriate, ongoing education and training to ensure that hospital
personnel are knowledgeable and skilled with regard to the
effective and safe use of the available treatment options within the
institution.
Educational content should range from basic bedside pain
assessment to sophisticated pain management techniques (e.g., epidural analgesia, PCA, and various regional anesthesia techniques)
and nonpharmacologic techniques (e.g., relaxation,
imagery, hypnotic methods).
For optimal pain management, ongoing education and training
are essential for new personnel, to maintain skills, and
whenever therapeutic approaches are modified.
• Anesthesiologists and other healthcare providers should use standardized,
validated instruments to facilitate the regular evaluation
and documentation of pain intensity, the effects of pain therapy,
and side effects caused by the therapy.
• Anesthesiologists responsible for perioperative analgesia should
be available at all times to consult with ward nurses, surgeons, or
other involved physicians.
They should assist in evaluating patients who are experiencing
problems with any aspect of perioperative pain relief.
• Anesthesiologists providing perioperative analgesia services
should do so within the framework of an Acute Pain Service.
They should participate in developing standardized institutional
policies and procedures.II. Preoperative Evaluation of the Patient
• A directed pain history, a directed physical examination, and a
pain control plan should be included in the anesthetic preoperative
evaluation.
III. Preoperative Preparation of the Patient
• Patient preparation for perioperative pain management should
include appropriate adjustments or continuation of medications to
avert an abstinence syndrome, treatment of preexistent pain, or preoperative
initiation of therapy for postoperative pain management.
• Anesthesiologists offering perioperative analgesia services should
provide, in collaboration with others as appropriate, patient and
family education regarding their important roles in achieving
comfort, reporting pain, and in proper use of the recommended
analgesic methods.
Common misconceptions that overestimate the risk of adverse
effects and addiction should be dispelled.
Patient education for optimal use of PCA and other sophisticated
methods, such as patient-controlled epidural analgesia,
might include discussion of these analgesic methods at the
time of the preanesthetic evaluation, brochures and videotapes
to educate patients about therapeutic options, and discussion
at the bedside during postoperative visits.
Such education may also include instruction in behavioral
modalities for control of pain and anxiety.
IV. Perioperative Techniques for Pain Management
• Anesthesiologists who manage perioperative pain should use
therapeutic options such as epidural or intrathecal opioids, systemic
opioid PCA, and regional techniques after thoughtfully
considering the risks and benefits for the individual patient.
These modalities should be used in preference to intramuscular
opioids ordered “as needed.”
• The therapy selected should reflect the individual anesthesiologist’s
expertise, as well as the capacity for safe application of the
modality in each practice setting.
This capacity includes the ability to recognize and treat adverse
effects that emerge after initiation of therapy.
• Special caution should be taken when continuous infusion
modalities are used because drug accumulation may contribute
to adverse events. V. Multimodal Techniques for Pain Management
• Whenever possible, anesthesiologists should use multimodal pain
management therapy.
Unless contraindicated, patients should receive an aroundthe-
clock regimen of NSAIDs, COXIBs, or acetaminophen.
Regional blockade with local anesthetics should be considered.
• Dosing regimens should be administered to optimize efficacy
while minimizing the risk of adverse events.
• The choice of medication, dose, route, and duration of therapy
should be individualized VI. Patient Subpopulations
• Pediatric patients
Aggressive and proactive pain management is necessary to
overcome the historic undertreatment of pain in children.
Perioperative care for children undergoing painful procedures
or surgery requires developmentally appropriate pain assessment
and therapy.
Analgesic therapy should depend upon age, weight, and comorbidity,
and unless contraindicated should involve a multimodal
approach.
Behavioral techniques, especially important in addressing the
emotional component of pain, should be applied whenever
feasible.
Sedative, analgesic, and local anesthetics are all important components
of appropriate analgesic regimens for painful procedures.
Because many analgesic medications are synergistic with sedating
agents, it is imperative that appropriate monitoring be used during
the procedure and recovery.
• Geriatric patients
Pain assessment and therapy should be integrated into the
perioperative care of geriatric patients.
Pain assessment tools appropriate to a patient’s cognitive abilities
should be used. Extensive and proactive evaluation and
questioning may be necessary to overcome barriers that hinder
communication regarding unrelieved pain.
Anesthesiologists should recognize that geriatric patients may
respond differently than younger patients to pain and analgesic
medications, often because of comorbidity.
Vigilant dose titration is necessary to ensure adequate treatment
while avoiding adverse effects such as somnolence in this
vulnerable group, who are often taking other medications (including
alternative and complementary agents). • Other subpopulations
Anesthesiologists should recognize that patients who are critically
ill, cognitively impaired, or have communication difficulties
may require additional interventions to ensure optimal
perioperative pain management.
Anesthesiologists should consider a therapeutic trial of an analgesic
in patients with increased blood pressure and heart rate or
agitated behavior when causes other than pain have been excluded.
Appendix 2: Methods and Analyses
A. State of the Literature
For these updated Guidelines, a review of studies used in the
development of the original Guidelines was combined with studies
published subsequent to approval of the original Guidelines
in 2003.* The scientific assessment of these Guidelines was
based on evidence linkages or statements regarding potential relationships between clinical interventions and outcomes. The
interventions listed below were examined to assess their relationship
to a variety of outcomes related to the management of acute
pain in the perioperative setting.
Institutional Policies and Procedures for Providing Perioperative Pain
Management
Education and training of healthcare providers
Monitoring of patient outcomes
Documentation of monitoring activities
Monitoring of outcomes at an institutional level
24-h availability of anesthesiologists providing perioperative
pain management
Acute pain service
Preoperative Evaluation of the Patient
A directed pain history (e.g., medical record review and patient
interview to include current medications, adverse effects, preexisting
pain conditions, medical conditions that would influence a
pain therapy, nonpharmacologic pain therapies, alternative and
complementary therapies)
A directed physical examination
Consultations with other healthcare providers (e.g., nurses, surgeons,
pharmacists) Preoperative Preparation of the Patient
Preoperative adjustment or continuation of medications whose sudden
cessation may provoke an abstinence syndrome
Preoperative treatment(s) to reduce preexisting pain and anxiety
Premedication(s) before surgery as part of a multimodal analgesic
pain management program
Patient and family education
Perioperative Techniques for Pain Management
Epidural or intrathecal analgesia with opioids (vs. epidural placebo,
epidural local anesthetics, or IV, intramuscular, or oral opioids)
Patient-controlled analgesia with opioids:
IV PCA versus nurse-controlled or continuous IV
IV PCA versus intramuscular
Epidural PCA versus epidural bolus or infusion
Epidural PCA versus IV PCA
IV PCA with background infusion of opioids versus no background
infusion
Regional analgesia with local anesthetics or opioids
Intercostal or interpleural blocks
Plexus and other blocks
Intraarticular opioids, local anesthetics or combinations
Infiltration of incisions
Multimodal Techniques (Epidural, IV, or Regional Techniques) Two or more analgesic agents, one route versus a single agent, one route
Epidural or intrathecal analgesia with opioids combined with:
Local anesthetics versus epidural opioids
Local anesthetics versus epidural local anesthetics
Clonidine versus epidural opioids
IV opioids combined with:
Clonidine versus IV opioids
Ketorolac versus IV opioids
Ketamine versus IV opioids
Oral opioids combined with NSAIDs, COXIBs, or acetaminophen
versus oral opioids Two or more drug delivery routes versus a single route
Epidural or intrathecal analgesia with opioids combined with IV,
intramuscular, oral, transdermal, or subcutaneous analgesics versus
epidural opioids
IV opioids combined with oral NSAIDs, COXIBs, or acetaminophen
versus IV opioids
Nonpharmacologic, alternative, or complementary pain management
combined with pharmacologic pain management versus
pharmacologic pain management
Special Patient Populations
Pain management techniques for pediatric patients
Pain assessment techniques
Dose level adjustments
Avoidance of repetitive diagnostic evaluation (heel sticks) for neonates
Pain management techniques for geriatric patients
Pain assessment techniques
Dose level adjustments
Painmanagementtechniques for other special populations (e.g., cognitively
impaired, critically ill, patients with difficulty communicating)
Pain assessment methods specific to special populations
Pain management techniques specific to special populations
Saturday, February 9, 2013
Friday, December 21, 2012
Cerebral Resuscitation After Cardiocirculatory Arrest
SUMMARY
Neuronal injury is one of the key factors in determining outcome after cardiac arrest. Cerebral resuscitation starts with rapid restoration of spontaneous circulation by immediate CPR and defibrillation and continues in the postresuscitation period. Basic measures consist of good critical care practice, such as maintaining normotension, normoglycemia, and normocapnia. In addition, several more specific postresuscitation treatment options have been explored in recent years. All therapies for cerebral resuscitation must face the challenge presented by the complex pathophysiological network, which is activated by global ischemia. An effective therapy should act on multiple pathways simultaneously. This is what therapeutic hypothermia does. Two large randomized clinical trials have proven that mild therapeutic hypothermia is effective in improving both survival and neurological outcome of patients after out-of-hospital cardiac arrest. Mild therapeutic hypothermia of 32°C–34°C for 12–24 h is, therefore, clearly recommended by the 2005 international guidelines on CPR. Other cerebral resuscitation approaches are currently being investigated experimentally and/or clinically. Thrombolytic therapy, specific infusion regimens, or antiapoptotic drugs might perhaps complement mild therapeutic hypothermia in the future.
Andreas Schneider, MD*, Bernd W. Böttiger, MD* and Erik Popp, MD†
- Author Affiliations
From the *Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Germany; and †Department of Anesthesiology, University of Heidelberg, Germany.
Address correspondence and reprint requests to Andreas Schneider, Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany. Address e-mail to andreas.schneider_@uk-koeln.de.
Next SectionAbstract
Cardiopulmonary resuscitation can restore spontaneous circulation in up to 50% of patients suffering from cardiac arrest. However, most of these patients still die during the postresuscitation period. Mortality is largely due to neuronal injury after global cerebral ischemia. There is, therefore, a clear need for therapies, which restore and protect brain function after cardiac arrest. Several years ago, mild therapeutic hypothermia was introduced into clinical practice. It represents the first treatment to improve both survival and neurological outcome of patients after out-of-hospital cardiac arrest, according to randomized clinical trials. In addition to therapeutic hypothermia, various other therapeutic options are currently being investigated experimentally and/or clinically. These include thrombolytic therapy, specific infusion regimens, or antiapoptotic drugs. In this article, we review both the pathophysiological background and the efficacy of different measures that might be useful for cerebral resuscitation.
Previous SectionNext SectionCardiac arrest occurs frequently and is still often fatal. Nationwide registries are presently being installed1,2; however, data extrapolated from single studies suggest that resuscitation is attempted in about 500,000 individuals each year in North America and in the same number in the European Union.3–5 Spontaneous circulation can be restored in 20%–50% of these patients3,4 (Fig. 1). Unfortunately, although, many of these patients still die during the postresuscitation period. Two percent to 15% of patients who are resuscitated after out-of-hospital cardiac arrest are discharged alive from the hospital. Most deaths during the postresuscitation period can be attributed to neuronal damage, which develops as a consequence of global cerebral ischemia during cardiac arrest.6 Furthermore, 40%–50% of surviving patients suffer from permanent impairment of cognitive functions, such as memory, attention, and executive functioning.7,8
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Download as PowerPoint SlideFigure 1. Outcome after cardiopulmonary resuscitation (CPR). The study included 338 patients suffering from out-of-hospital cardiac arrest of cardiac etiology. ROSC = restoration of spontaneous circulation.3
Multistage algorithms have been developed for cardiopulmonary resuscitation (CPR); however, when it comes to cerebral resuscitation, i.e., restoring and protecting brain function after cardiac arrest, our possibilities are still limited. The purpose of this article is to review different approaches to cerebral resuscitation. These include not only mild therapeutic hypothermia, which is the current clinical standard, but also various experimental methods which might find their way to the clinic in the future.
Previous SectionNext SectionPATHOPHYSIOLOGY OF CARDIAC ARREST
Cascades of Death
Cardiac arrest is a state of global ischemia and the brain is extremely susceptible to this condition. Only 5–6 s after the onset of circulatory arrest, the patient loses consciousness.9 Without a supply of blood, cerebral tissue oxygen tension declines continuously reaching 0 after about 2 min.10 Simultaneously, neuronal energy in terms of adenosine triphosphate is depleted and metabolites, such as adenosine, lactate, and hydrogen ions, accumulate in the cells.11,12 Dysfunction of the cell membrane ion pumps leads to a severe breakdown in cellular homeostasis. One particular consequence is a massive accumulation of calcium in the cell cytosol when calcium efflux pumps fail, voltage-gated calcium channels open, and ligand-gated channels are activated by released excitatory amino acids, such as glutamate and aspartate.13,14 This calcium overload is considered a key factor in cellular toxicity.15
If the ischemia persists long enough, neuronal necrosis ultimately ensues throughout the brain.16 However, neuronal energy is recovered rapidly upon reperfusion because of CPR and return of spontaneous circulation.11,12 Therefore, reperfusion does stop neuronal degeneration to a certain degree; yet it does not necessarily completely restore function. During reperfusion, free radicals form when the oxygen supply is restored, which might even aggravate cellular damage.17 The main characteristic of the reperfusion period is that refueling adenosine triphosphate gives the cell the opportunity to actively react to the damage. This is associated with the expression of immediate early genes, a complex machinery involving both cell survival and cell death cascades.18–21 The morphological correlate of “subnecrotic” cellular damage is delayed neuronal death, which shows typical signs of apoptosis and occurs mainly in so-called selectively vulnerable brain areas such as the CA-1 sector of the hippocampus, the nucleus reticularis thalami or distinct layers of the cortex18–20 (Fig. 2).
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Download as PowerPoint SlideFigure 2. Selectively vulnerable areas of the rat brain. Neuronal degeneration after cardiac arrest is seen particularly in the CA-1 sector of the hippocampus, the nucleus reticularis thalami (NRT), the putamen, and distinct layers of the cortex. Neurons of the hippocampus are visualized by Nissl staining. The black arrow indicates the border between degenerated neurons in the CA-1 sector (red arrows) and the adjacent, less vulnerable CA-2 sector.128
Cerebral Circulation Disorders
Return of cardiac function does not automatically restore normal cerebral circulation. Depending on the duration of the ischemic period, cerebral vessel dysfunction develops, which likely contributes to neuronal damage. Experimentally, different phenomena can be distinguished. First, reperfusion fails completely in circumscribed areas of the brain (no-reflow phenomenon).22–24 These areas increase with the duration of ischemia.22,24 No-reflow is probably caused by capillary congestion because of edema of endothelium and perivascular glia,25 blood cell sludging,26,27 leukocyte adhesion,25,28 and disseminated intravascular coagulation.26,29–31
Local no-reflow is paralleled by global cerebral hyperemia during the early period of reperfusion.32,33 This is probably caused by the accumulation of metabolites such as adenosine, lactate, or hydrogen ions during ischemia,12 which are potent vasodilators. However, within the first hour after reperfusion, reactive hyperermia is followed by a global reduction in cerebral blood flow (delayed hypoperfusion).32–34 This phenomenon is probably caused by cerebral vasospasms because of dysfunctional nitric oxide and endothelin metabolism.35–37
Systemic Sequelae
In addition to primarily cerebral injury, ischemic damage also occurs, of course, in other vital organs, leading to so-called postresuscitation disease.38 Typically, myocardial function is markedly reduced after circulation is restored.39–41 Both systolic contractility and diastolic relaxation are impaired, leading to pronounced hemodynamic instability. The underlying pathophysiology of this myocardial stunning is often complex. Like the brain, the myocardium is particularly susceptible to the state of global ischemia.42 Additionally, as the cause of cardiac arrest is often of cardiac origin (e.g., 50%–70% of patients have myocardial infarction), this exacerbates the damage to the heart.40 Even therapeutic interventions during CPR could cause further damage to the heart, namely, electrical defibrillation43 and administration of epinephrine.44
Cardiac arrest induces systemic inflammation, whereby leukocytes and complement are activated and levels of cytokines increased.45,46 Furthermore, coagulatory cascades are activated immediately but without concomitant stimulation of endogenous fibrinolysis.29,47
Pathological changes in the different organ systems can further affect one another. Activation of coagulation contributes to cerebral no-reflow.26,29–31 Systemic inflammation impairs myocardial function.48 Hemodynamic instability worsens cerebral perfusion, because autoregulation of the cerebral vessels is often defective after cardiac arrest.49 Moreover, and irrespective of all the specific interactions, the simple truth is that the brain will only survive if the rest of the body does.
Previous SectionNext SectionBASIC THERAPEUTIC GOALS
After ischemia the brain is highly susceptible to disturbances in general physiological homeostasis.49–51 The first goal of all therapeutic measures should be to establish an optimal environment for cerebral recovery. The international guidelines on CPR recommend maintaining normotension, normoglycemia, and normocapnia.52,53 However, “normal” target values originate from healthy individuals. We do not entirely know whether they are always ideal for the injured brain too, or whether we must do even better.
Concerning arterial blood pressure, animal experimental data suggest that increasing blood pressure might improve outcome.54 This might be due to impaired cerebral autoregulation after ischemia.49 However, no data in this regard are available from clinical studies.
Concerning blood glucose levels, van den Berghe et al.55 showed that tight glucose control (80–110 mg/dL vs 180–200 mg/dL) improved outcome in the critical care setting. However, recent studies focusing on patients after cardiac arrest suggest that only slightly elevated blood glucose (<150 associated="associated" be="be" control="control" could="could" dl="dl" during="during" glucose="glucose" hypoglycemia="hypoglycemia" impair="impair" insulin="insulin" is="is" it="it" mg="mg" might="might" not="not" of="of" outcome.56="outcome.56" outcome="outcome" periods="periods" possible="possible" recognized.="recognized." that="that" tight="tight" with="with" worsened="worsened">
Previous SectionNext SectionMILD THERAPEUTIC HYPOTHERMIA
Hypothermia has been used therapeutically in cardiac and neurosurgery for more than 50 yr to protect the brain from ischemia. The first reports of postischemic therapeutic hypothermia were published in the late 1950s.58–60 Systematic investigations were initiated in the late 1980s and have produced a vast amount of both experimental and clinical data showing beneficial effects of mild therapeutic hypothermia after cardiac arrest.61–71 Evidence is provided in particular by two major randomized clinical trials that were published in 2002.61,68 Both studies investigated mild therapeutic hypothermia in comatose adult patients after out-of-hospital cardiac arrest because of ventricular fibrillation.
The European multicenter trial conducted by the Hypothermia After Cardiac Arrest study group included 275 patients, of whom 137 were cooled to 32°C–34°C for 24 h while body temperature in the control group was not decreased.68 Regarding outcome at 6 mo, mortality was reduced by 26% (41% vs 55%, P = 0.02) and the portion of patients with favorable neurological outcome increased by 40% (55% vs 39%, P = 0.09) (Fig. 3).
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Download as PowerPoint SlideFigure 3. Mild therapeutic hypothermia and outcome after cardiac arrest. The study included 275 patients successfully resuscitated after out-of-hospital cardiac arrest because of ventricular fibrillation. Patients in the hypothermia group were cooled to 32°C–34°C for 24 h.68
The Australian trial by Bernard et al.61 covered 77 patients; hypothermia of 33°C for 12 h was applied in 43 patients. At hospital discharge, the likelihood for good neurological outcome was 85% higher in the hypothermic group (49% vs 26%, P = 0.046).
In a subsequent individual patient data meta-analysis, Holzer et al.72 calculated the number-needed-to-treat to allow one additional patient to leave the hospital with no or only minimal neurological damage to be six. As a consequence, the International Liaison Committee on Resuscitation recommended in 2003 that mild therapeutic hypothermia be used in comatose adult patients after out-of-hospital cardiac arrest because of ventricular fibrillation.73 This recommendation was implemented into the revised international guidelines on CPR in 200552,53 (Table 1). In fact, mild therapeutic hypothermia currently represents the only measure which has proven efficacy in cerebral resuscitation. However, it is still underused in many hospitals.74,75
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In this windowIn a new windowTable 1. Indications for Mild Therapeutic Hypothermia53
A variety of physiological effects that are exerted by mild therapeutic hypothermia underlie the efficacy of this therapy. Hypothermia reduces metabolism, and thus cerebral oxygen demands.76 There is a decrease in reactive oxygen species77 and excitatory amino acids78,79 during hypothermia as well as direct inhibition of apoptosis.80 Furthermore, inhibition of coagulation cascades81 and inflammatory reactions82 might improve cerebral reperfusion. Finally, hypothermia alters gene expression in a complex manner, e.g., by enhancing the expression of brain-derived neurotrophic factor (BDNF)83 or the antiapoptotic protein Bcl-2,84 whereas suppressing the proapoptotic protein Bax84 or matrix metalloproteinase-9.85 Mild therapeutic hypothermia, therefore, acts broadly on different sequelae of cardiac arrest at the same time, which makes it the current clinical standard in cerebral resuscitation.
Hypothermia can be induced by different methods, e.g., surface cooling, ice-cold infusions or endovascular cooling catheters. Although there are great differences in efficacy and invasiveness among them, it is currently not clear whether one particular technique should be preferred to the others. No studies are available that have compared different cooling devices with respect to “hard” clinical end points, i.e., mortality and morbidity.
However, it is commonly accepted and recommended by the guidelines that hypothermia should be initiated with minimal delay after cardiac arrest.52,53 Surface cooling or ice-cold infusions can be used preclinically. Kim et al.86 conducted a randomized clinical trial in which patients were assigned to either receiving 4°C normal saline or not in the out-of-hospital setting. After arrival at the hospital, patients were treated according to the local preferences, i.e., patients were cooled or not regardless of the randomization. Survival rates tended to be higher in patients who had received out-of-hospital cooling treatment.
Possible adverse effects of hypothermia include electrolyte and intravascular volume changes, impaired immune defense and impaired coagulation. However, these complications can usually be managed by intensive care strategies. The two large randomized clinical trials did not find a significant increase in severe complications when compared with normothermia.61,68 The safety of hypothermia treatment has also been confirmed by newer observational studies.87
Therapeutic hypothermia continues to be one of the most important topics in clinical resuscitation research today. Questions that still need to be addressed include establishing the indications for therapeutic hypothermia (intrahospital cardiac arrest and treatment in children) and cooling characteristics (target temperature, cooling rate, and duration of hypothermia) and cooling methods (external or internal). Several current clinical trials are focusing on these issues. To name only two, a trial in Germany is investigating therapeutic hypothermia in in-hospital cardiac arrest (n = 440),88 whereas a trial being conducted in France is comparing endovascular and surface cooling in a randomized fashion (n = 400).89
Previous SectionNext SectionAMELIORATING MICROCIRCULATION
Thrombolysis
There are two underlying rationales for using thrombolytics during CPR. First, cardiac arrest is caused by acute myocardial infarction or pulmonary embolism in 50%–70% of patients.90–92 In these two situations, thrombolysis represents a causal and standard therapy. Second, there is evidence that coagulation disorders are involved in the no-reflow phenomenon, and thus in impaired cerebral circulation after cardiac arrest. Cardiac arrest leads to activation of coagulation without adequate fibrinolysis.29,47 Microscopic examination of cerebral vessels shows that multiple microemboli develop during cardiac arrest and resuscitation.26 Although this was not known in detail in the 1950s, Crowell et al.30,93 had already shown at that time that pretreatment with heparin or streptokinase improved survival in dogs after cardiac arrest. Then, 40 yr later, Fischer et al.31 demonstrated a strong reduction in cerebral no-reflow in cats by postarrest thrombolytic treatment with plasminogen activator and heparin.
Clinical investigations have been less conclusive thus far. Several small studies suggest that thrombolysis during CPR might be beneficial, particularly in patients with pulmonary embolism, but also in those who suffer myocardial infarction.94–97 Randomized clinical trials investigating a general use of thrombolytics during CPR have produced differing results. Whereas Fatovich et al. found an increase in resuscitability (35 patients randomized), Abu-Laban et al. did not find any benefits from thrombolytics (233 patients randomized).98,99 The largest amount of data are provided by the European multicenter Thrombolysis in Cardiac Arrest trial.100 After inclusion of 1050 patients, the study was prematurely halted, because preliminary findings indicated that there was no likely benefit of thrombolytic therapy over placebo. Further analyses are expected soon. Nevertheless, all studies have consistently shown that thrombolysis during CPR is largely safe and not associated with increased bleeding complications.98,99
Thrombolytic therapy during CPR was included in international CPR guidelines in 2005 but only when pulmonary embolism52,53 or myocardial infarction53 is suspected.
Hypertonic, Hyperoncotic Infusions
A different approach to promoting microcirculation is the use of special infusion regimens which improve the rheological characteristics of the blood. After initial experiments with dextran 40 or isotonic saline,101,102 current research is focusing on hypertonic-hyperoncotic NaCl/hydroxyethyl starch (HES) solutions. Several animal studies have shown that hypertonic-hyperoncotic solutions given during CPR, or immediately after restoration of spontaneous circulation, decrease cerebral no-reflow.31,103,104 Some studies also investigated markers of neuronal damage. Krieter et al.105 found a decrease in release of astroglial protein S-100 after cardiac arrest in pigs after therapy with hypertonic-hyperoncotic infusion. Noppens et al.104 found improvements in both neurological deficit scores and brain histology in rats. Besides having positive effects on cerebral microcirculation, hypertonic saline also seems to ameliorate cardiac function during and after CPR.105–107
Up to now, one clinical trial has been published on the effect of hypertonic-hyperoncotic solutions in CPR.108 Bender et al. randomized 66 patients who suffered out-of-hospital cardiac arrest into two groups. The patients received 2 mL · kg−1 · 10 min−1 of either hypertonic saline with HES (7.2% NaCl with 6% HES 200,000/0.5) or HES alone during continuous CPR. Resuscitation success tended to be higher in patients receiving hypertonic saline with HES (66.7% vs 51.5%, P = 0.21) and hospital admission rates were also increased (57.6% vs 39.4%, P = 0.14). There were no severe side effects of hypertonic saline. However, larger clinical trials are needed to further elucidate the short- and long-term effects of hypertonic-hyperoncotic solutions after cardiac arrest.
Although hypertonic-hyperoncotic infusions hold potential for clinical use, hypothermia and thrombolysis already represent, at least in part, clinical routine for resuscitation. Thus, it would seem logical to combine these different approaches. However, each combination must first be carefully evaluated and experimental studies are still sparse. Lin et al.109 showed that dextran 40 and streptokinase synergistically improved cerebral recovery in dogs with cardiac arrest as measured by electroencephalogram activity. Safar et al.110 combined dextran 40 with hypothermia and arterial hypertension in dogs with cardiac arrest. This combination produced the best functional and histological outcome these investigators had ever experienced in that particular model in 15 yr of research, including experiments in which the animals had received dextran, hypothermia, or hypertension alone. Although there is still a long road ahead, these experiments suggest that the future might lie in combined therapies.
Previous SectionNext SectionINFLUENCING APOPTOSIS
Inhibitors of Apoptosis
It has been suggested that delayed neuronal death after cardiac arrest is caused by apoptosis.18,19 Apoptosis is characterized by activation of proteolytic cascades, which ultimately result in degradation of cellular components. The proteolytic enzyme, caspase 3, is one of the key executioners of apoptosis. Therefore, it seemed reasonable that neuronal damage after cardiac arrest could be ameliorated by inhibiting caspase 3.
This question was first addressed by Chen et al.19 In a rat model of global cerebral ischemia produced by four-vessel occlusion, they investigated the effects of the caspase 3 inhibitor Z-DEVD-FMK. After 7 days of reperfusion, they found an increased number of surviving cells in the selectively vulnerable CA-1 sector of the hippocampus along with a decrease in apoptotic cells in CA-1. However, other groups failed to reproduce neuroprotective effects of this or other caspase inhibitors in experimental global cerebral ischemia or cardiac arrest.111–113
It is now thought that the pathophysiology of neuronal degeneration is too complex to be reduced to only one molecule. There are probably various other “key” effectors independent of the caspases. One particular target is the calpain proteolytic system.114,115 It has been shown that inhibiting both calpains and caspases produces a synergistic effect in preventing neuronal damage after global cerebral ischemia.115 However, inhibition of apoptotic cascades is still a highly experimental endeavor. Additional studies are required to further elucidate the therapeutic effects of specific interventions.
Growth Factors
Apoptotic cell death is highly regulated. Physiologically, a variety of apoptosis-inducing factors are counterbalanced by different antiapoptotic, i.e., survival, factors. In pathological settings such as cerebral ischemia, apoptosis is induced by a massive release of death signals such as that from mitochondrial cytochrome c.116 Theoretically, if it were possible to amplify survival factors in the same way, cell death should be prevented. Such an approach might be initiated by administering growth factors, which have antiapoptotic properties. Interestingly, endogenous nerve growth factor (NGF) and BDNF are upregulated in neurons after cerebral ischemia20; the expression of BDNF is even enhanced by therapeutic hypothermia.83 Administration of exogenous growth factors after cerebral ischemia has produced inconclusive results.
One of the first such studies was conducted by Shigeno et al.117 They gave NGF or vehicle intracerebroventricularly before and after induction of global cerebral ischemia in gerbils (four-vessel occlusion). After 1 wk of reperfusion, a significant reduction in neuronal cell death was observed in CA-1 in both NGF pre- and posttreatment groups. However, subsequent work suggested that this treatment effect was transient and diminished after 4 wk, leading to the same degree of neuronal degeneration in NGF- and vehicle-treated animals.118
Kiprianova et al.119 investigated postischemic intracerebroventricular infusion of BDNF in rats with global cerebral ischemia (four-vessel occlusion). This treatment regimen completely prevented neuronal death in CA-1 after 7 days of reperfusion. In contrast, Popp et al.120 failed to show any beneficial effects of BDNF after cardiac arrest in rats.
Similarly conflicting results have been reported for other growth factors such as insulin-like growth factor I,121,122 granulocyte colony-stimulating factor123,124 or erythropoietin.125–127 Although some groups demonstrated positive effects of these growth factors,122,123,125 others failed to show any benefit for outcome.121,124,126 In conclusion, it is still not known whether any growth factor is capable of improving outcome after cardiac arrest.
It is certainly too simple to assume that it does not matter whether we reduce cellular death cascades (selectively, for example, with caspase inhibitors or in a much broader way with hypothermia) or activate cellular protection (e.g., with growth factors). Cells in a state of reduced energy and substrate levels might fail to respond to stimulation by growth factors. “Stepping on the gas” under such circumstances might perhaps even accelerate degeneration.
Update in Cerebral Resuscitation Brain edema is an excess accumulation of water in the intracellular and/or extracellular spaces of the brain and can be divided into vasogenic and cytotoxic
Vasogenic brain edema is caused by disruption of the blood brain barrier
Meanwhile, Cytotoxic edema is characterized by accumulation of water inside the neurons, microglia and astrocytes
Goal of medical management for cerebral edema is to maintain regional and global cerebral blood flow to meet the metabolic requirement and prevent secondary neuronal injury from cerebral ischemia
1) Elevation of head end of bed 15-30 degrees promote cerebral venous drainage. Head is kept in midline to limit neck vein compression. Bed is not tilted in acute carotid or basilar artery occlusion to avoid hypo perfusion distal to occlusion
2) Close monitoring of BP is important sign for increase in ICP (Cushing effect)
3) Surgical decompression and use of osmotherapy to reduce brain edema and its deleterious effect remain the mainstay of treatment even today
4) Mannitol remains as the best choice osmotic agent for osmotherapy. it decrease brain volume by decreasing overall water content, reduce blood volume by vasoconstriction, reduce CSF volume, improve cerebral perfusion by decreasing viscosity or altering red blood cell rheology and exert a protective effect against biochemical injury
5) Loop diuretic, IV Furosemide 0.7 mg/kg can be add to prolong osmotic effect
6) Hypertonic saline is about as effective as mannitol (certainly not more) and is safe and effective alternative to mannitol.
7) Prophylactic and prolonged hyperventilation maneuvers are not recommended during the first 24 hours because CBF is reduced at this time after trauma
8) Prolonged pulmonary hyperventilation must be avoided in the absence of high ICP as sustains vasoconstriction reduces CBF to deleterious levels and could generate brain ischemia
9) There is worse prognosis in severe TBI, routinely treated with hyperventilation
10) Hyperventilation becomes appropriate in the treatment of difficult to control ICH, CBF at normal level or high at onset of ICH and when brain deterioration with suspicion of intracranial mass lesion has occurred
11) Fluid restriction minimally affects cerebral edema and, if pursued to excess, may result in episodes of hypotension, which may increase ICP and is associated with worse neurologic outcome
12) Glucose containing solutions should be avoided
13) Glycerol can be given 30 ml every 4-6 hour or daily IV 50g in 500 ml of 2.5% saline solution
14) Corticosteroid is less effective in cytotoxic edema, and is not recommended in treatment of edema secondary to stroke or hemorrhage. Besides, systemic complications of steroids can worsen the patient’s condition
15) Inj. Dexamethasone 4-6 mg IM every 4-6 hours may be used if there is documented evidence of cerebral vasculitis, acute bacterial meningitis and chronic meningitis
16) Glucocorticoid are used for the management of malignant brain tumors exert their influence on brain tumors mainly by reducing tumor-associated vasogenic edema, probably by decreasing the increased capillary permeability of blood brain barrier
17) Randomized clinical trials are in progress to establish the safety and efficacy of prolonged cerebral hypothermia.
18) Barbiturates, Procaine derivatives, Indomethacin, Propofol and THAM (Thrometamine) are not being used routinely in present practice
19) EEG is not very helpful in the management of cerebral edema
Disclaimers: This writing is not fully from the author. Some of them are just straightly copy-paste from original articles. Therefore, authors are not responsible for any accusation of plagiarism.
Reference:
1) Abhishek Patro & Sureswar Mohanty, "Pathophysiology and treatment of traumatic brain edema, Indian Journal of Neurotrauma", Vol 6, No 1,2009.
2) Bhavneet Bharti, "Hypertonic Saline Treatment in Cerebral Edema –Is the Evidence Sufficient?", Indian Pediatrics, Vol 45, June 17, 2008
3) Matheus Oliveira-Abreu & Lajana de Almeida, 'Management of mechanical ventilation in brain injury: hyperventilation and positive end-expiratory pressure", Rev Bras Ter Intensiva, 21(1):72-79, 2009
4) SK Jha Lt Col (Retd), "Cerebral Edema and its Management", MJAFI 2003; 59 : 326-331
150>
Neuronal injury is one of the key factors in determining outcome after cardiac arrest. Cerebral resuscitation starts with rapid restoration of spontaneous circulation by immediate CPR and defibrillation and continues in the postresuscitation period. Basic measures consist of good critical care practice, such as maintaining normotension, normoglycemia, and normocapnia. In addition, several more specific postresuscitation treatment options have been explored in recent years. All therapies for cerebral resuscitation must face the challenge presented by the complex pathophysiological network, which is activated by global ischemia. An effective therapy should act on multiple pathways simultaneously. This is what therapeutic hypothermia does. Two large randomized clinical trials have proven that mild therapeutic hypothermia is effective in improving both survival and neurological outcome of patients after out-of-hospital cardiac arrest. Mild therapeutic hypothermia of 32°C–34°C for 12–24 h is, therefore, clearly recommended by the 2005 international guidelines on CPR. Other cerebral resuscitation approaches are currently being investigated experimentally and/or clinically. Thrombolytic therapy, specific infusion regimens, or antiapoptotic drugs might perhaps complement mild therapeutic hypothermia in the future.
Andreas Schneider, MD*, Bernd W. Böttiger, MD* and Erik Popp, MD†
- Author Affiliations
From the *Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Germany; and †Department of Anesthesiology, University of Heidelberg, Germany.
Address correspondence and reprint requests to Andreas Schneider, Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany. Address e-mail to andreas.schneider_@uk-koeln.de.
Next SectionAbstract
Cardiopulmonary resuscitation can restore spontaneous circulation in up to 50% of patients suffering from cardiac arrest. However, most of these patients still die during the postresuscitation period. Mortality is largely due to neuronal injury after global cerebral ischemia. There is, therefore, a clear need for therapies, which restore and protect brain function after cardiac arrest. Several years ago, mild therapeutic hypothermia was introduced into clinical practice. It represents the first treatment to improve both survival and neurological outcome of patients after out-of-hospital cardiac arrest, according to randomized clinical trials. In addition to therapeutic hypothermia, various other therapeutic options are currently being investigated experimentally and/or clinically. These include thrombolytic therapy, specific infusion regimens, or antiapoptotic drugs. In this article, we review both the pathophysiological background and the efficacy of different measures that might be useful for cerebral resuscitation.
Previous SectionNext SectionCardiac arrest occurs frequently and is still often fatal. Nationwide registries are presently being installed1,2; however, data extrapolated from single studies suggest that resuscitation is attempted in about 500,000 individuals each year in North America and in the same number in the European Union.3–5 Spontaneous circulation can be restored in 20%–50% of these patients3,4 (Fig. 1). Unfortunately, although, many of these patients still die during the postresuscitation period. Two percent to 15% of patients who are resuscitated after out-of-hospital cardiac arrest are discharged alive from the hospital. Most deaths during the postresuscitation period can be attributed to neuronal damage, which develops as a consequence of global cerebral ischemia during cardiac arrest.6 Furthermore, 40%–50% of surviving patients suffer from permanent impairment of cognitive functions, such as memory, attention, and executive functioning.7,8
View larger version:
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Download as PowerPoint SlideFigure 1. Outcome after cardiopulmonary resuscitation (CPR). The study included 338 patients suffering from out-of-hospital cardiac arrest of cardiac etiology. ROSC = restoration of spontaneous circulation.3
Multistage algorithms have been developed for cardiopulmonary resuscitation (CPR); however, when it comes to cerebral resuscitation, i.e., restoring and protecting brain function after cardiac arrest, our possibilities are still limited. The purpose of this article is to review different approaches to cerebral resuscitation. These include not only mild therapeutic hypothermia, which is the current clinical standard, but also various experimental methods which might find their way to the clinic in the future.
Previous SectionNext SectionPATHOPHYSIOLOGY OF CARDIAC ARREST
Cascades of Death
Cardiac arrest is a state of global ischemia and the brain is extremely susceptible to this condition. Only 5–6 s after the onset of circulatory arrest, the patient loses consciousness.9 Without a supply of blood, cerebral tissue oxygen tension declines continuously reaching 0 after about 2 min.10 Simultaneously, neuronal energy in terms of adenosine triphosphate is depleted and metabolites, such as adenosine, lactate, and hydrogen ions, accumulate in the cells.11,12 Dysfunction of the cell membrane ion pumps leads to a severe breakdown in cellular homeostasis. One particular consequence is a massive accumulation of calcium in the cell cytosol when calcium efflux pumps fail, voltage-gated calcium channels open, and ligand-gated channels are activated by released excitatory amino acids, such as glutamate and aspartate.13,14 This calcium overload is considered a key factor in cellular toxicity.15
If the ischemia persists long enough, neuronal necrosis ultimately ensues throughout the brain.16 However, neuronal energy is recovered rapidly upon reperfusion because of CPR and return of spontaneous circulation.11,12 Therefore, reperfusion does stop neuronal degeneration to a certain degree; yet it does not necessarily completely restore function. During reperfusion, free radicals form when the oxygen supply is restored, which might even aggravate cellular damage.17 The main characteristic of the reperfusion period is that refueling adenosine triphosphate gives the cell the opportunity to actively react to the damage. This is associated with the expression of immediate early genes, a complex machinery involving both cell survival and cell death cascades.18–21 The morphological correlate of “subnecrotic” cellular damage is delayed neuronal death, which shows typical signs of apoptosis and occurs mainly in so-called selectively vulnerable brain areas such as the CA-1 sector of the hippocampus, the nucleus reticularis thalami or distinct layers of the cortex18–20 (Fig. 2).
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Download as PowerPoint SlideFigure 2. Selectively vulnerable areas of the rat brain. Neuronal degeneration after cardiac arrest is seen particularly in the CA-1 sector of the hippocampus, the nucleus reticularis thalami (NRT), the putamen, and distinct layers of the cortex. Neurons of the hippocampus are visualized by Nissl staining. The black arrow indicates the border between degenerated neurons in the CA-1 sector (red arrows) and the adjacent, less vulnerable CA-2 sector.128
Cerebral Circulation Disorders
Return of cardiac function does not automatically restore normal cerebral circulation. Depending on the duration of the ischemic period, cerebral vessel dysfunction develops, which likely contributes to neuronal damage. Experimentally, different phenomena can be distinguished. First, reperfusion fails completely in circumscribed areas of the brain (no-reflow phenomenon).22–24 These areas increase with the duration of ischemia.22,24 No-reflow is probably caused by capillary congestion because of edema of endothelium and perivascular glia,25 blood cell sludging,26,27 leukocyte adhesion,25,28 and disseminated intravascular coagulation.26,29–31
Local no-reflow is paralleled by global cerebral hyperemia during the early period of reperfusion.32,33 This is probably caused by the accumulation of metabolites such as adenosine, lactate, or hydrogen ions during ischemia,12 which are potent vasodilators. However, within the first hour after reperfusion, reactive hyperermia is followed by a global reduction in cerebral blood flow (delayed hypoperfusion).32–34 This phenomenon is probably caused by cerebral vasospasms because of dysfunctional nitric oxide and endothelin metabolism.35–37
Systemic Sequelae
In addition to primarily cerebral injury, ischemic damage also occurs, of course, in other vital organs, leading to so-called postresuscitation disease.38 Typically, myocardial function is markedly reduced after circulation is restored.39–41 Both systolic contractility and diastolic relaxation are impaired, leading to pronounced hemodynamic instability. The underlying pathophysiology of this myocardial stunning is often complex. Like the brain, the myocardium is particularly susceptible to the state of global ischemia.42 Additionally, as the cause of cardiac arrest is often of cardiac origin (e.g., 50%–70% of patients have myocardial infarction), this exacerbates the damage to the heart.40 Even therapeutic interventions during CPR could cause further damage to the heart, namely, electrical defibrillation43 and administration of epinephrine.44
Cardiac arrest induces systemic inflammation, whereby leukocytes and complement are activated and levels of cytokines increased.45,46 Furthermore, coagulatory cascades are activated immediately but without concomitant stimulation of endogenous fibrinolysis.29,47
Pathological changes in the different organ systems can further affect one another. Activation of coagulation contributes to cerebral no-reflow.26,29–31 Systemic inflammation impairs myocardial function.48 Hemodynamic instability worsens cerebral perfusion, because autoregulation of the cerebral vessels is often defective after cardiac arrest.49 Moreover, and irrespective of all the specific interactions, the simple truth is that the brain will only survive if the rest of the body does.
Previous SectionNext SectionBASIC THERAPEUTIC GOALS
After ischemia the brain is highly susceptible to disturbances in general physiological homeostasis.49–51 The first goal of all therapeutic measures should be to establish an optimal environment for cerebral recovery. The international guidelines on CPR recommend maintaining normotension, normoglycemia, and normocapnia.52,53 However, “normal” target values originate from healthy individuals. We do not entirely know whether they are always ideal for the injured brain too, or whether we must do even better.
Concerning arterial blood pressure, animal experimental data suggest that increasing blood pressure might improve outcome.54 This might be due to impaired cerebral autoregulation after ischemia.49 However, no data in this regard are available from clinical studies.
Concerning blood glucose levels, van den Berghe et al.55 showed that tight glucose control (80–110 mg/dL vs 180–200 mg/dL) improved outcome in the critical care setting. However, recent studies focusing on patients after cardiac arrest suggest that only slightly elevated blood glucose (<150 associated="associated" be="be" control="control" could="could" dl="dl" during="during" glucose="glucose" hypoglycemia="hypoglycemia" impair="impair" insulin="insulin" is="is" it="it" mg="mg" might="might" not="not" of="of" outcome.56="outcome.56" outcome="outcome" periods="periods" possible="possible" recognized.="recognized." that="that" tight="tight" with="with" worsened="worsened">
Previous SectionNext SectionMILD THERAPEUTIC HYPOTHERMIA
Hypothermia has been used therapeutically in cardiac and neurosurgery for more than 50 yr to protect the brain from ischemia. The first reports of postischemic therapeutic hypothermia were published in the late 1950s.58–60 Systematic investigations were initiated in the late 1980s and have produced a vast amount of both experimental and clinical data showing beneficial effects of mild therapeutic hypothermia after cardiac arrest.61–71 Evidence is provided in particular by two major randomized clinical trials that were published in 2002.61,68 Both studies investigated mild therapeutic hypothermia in comatose adult patients after out-of-hospital cardiac arrest because of ventricular fibrillation.
The European multicenter trial conducted by the Hypothermia After Cardiac Arrest study group included 275 patients, of whom 137 were cooled to 32°C–34°C for 24 h while body temperature in the control group was not decreased.68 Regarding outcome at 6 mo, mortality was reduced by 26% (41% vs 55%, P = 0.02) and the portion of patients with favorable neurological outcome increased by 40% (55% vs 39%, P = 0.09) (Fig. 3).
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Download as PowerPoint SlideFigure 3. Mild therapeutic hypothermia and outcome after cardiac arrest. The study included 275 patients successfully resuscitated after out-of-hospital cardiac arrest because of ventricular fibrillation. Patients in the hypothermia group were cooled to 32°C–34°C for 24 h.68
The Australian trial by Bernard et al.61 covered 77 patients; hypothermia of 33°C for 12 h was applied in 43 patients. At hospital discharge, the likelihood for good neurological outcome was 85% higher in the hypothermic group (49% vs 26%, P = 0.046).
In a subsequent individual patient data meta-analysis, Holzer et al.72 calculated the number-needed-to-treat to allow one additional patient to leave the hospital with no or only minimal neurological damage to be six. As a consequence, the International Liaison Committee on Resuscitation recommended in 2003 that mild therapeutic hypothermia be used in comatose adult patients after out-of-hospital cardiac arrest because of ventricular fibrillation.73 This recommendation was implemented into the revised international guidelines on CPR in 200552,53 (Table 1). In fact, mild therapeutic hypothermia currently represents the only measure which has proven efficacy in cerebral resuscitation. However, it is still underused in many hospitals.74,75
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In this windowIn a new windowTable 1. Indications for Mild Therapeutic Hypothermia53
A variety of physiological effects that are exerted by mild therapeutic hypothermia underlie the efficacy of this therapy. Hypothermia reduces metabolism, and thus cerebral oxygen demands.76 There is a decrease in reactive oxygen species77 and excitatory amino acids78,79 during hypothermia as well as direct inhibition of apoptosis.80 Furthermore, inhibition of coagulation cascades81 and inflammatory reactions82 might improve cerebral reperfusion. Finally, hypothermia alters gene expression in a complex manner, e.g., by enhancing the expression of brain-derived neurotrophic factor (BDNF)83 or the antiapoptotic protein Bcl-2,84 whereas suppressing the proapoptotic protein Bax84 or matrix metalloproteinase-9.85 Mild therapeutic hypothermia, therefore, acts broadly on different sequelae of cardiac arrest at the same time, which makes it the current clinical standard in cerebral resuscitation.
Hypothermia can be induced by different methods, e.g., surface cooling, ice-cold infusions or endovascular cooling catheters. Although there are great differences in efficacy and invasiveness among them, it is currently not clear whether one particular technique should be preferred to the others. No studies are available that have compared different cooling devices with respect to “hard” clinical end points, i.e., mortality and morbidity.
However, it is commonly accepted and recommended by the guidelines that hypothermia should be initiated with minimal delay after cardiac arrest.52,53 Surface cooling or ice-cold infusions can be used preclinically. Kim et al.86 conducted a randomized clinical trial in which patients were assigned to either receiving 4°C normal saline or not in the out-of-hospital setting. After arrival at the hospital, patients were treated according to the local preferences, i.e., patients were cooled or not regardless of the randomization. Survival rates tended to be higher in patients who had received out-of-hospital cooling treatment.
Possible adverse effects of hypothermia include electrolyte and intravascular volume changes, impaired immune defense and impaired coagulation. However, these complications can usually be managed by intensive care strategies. The two large randomized clinical trials did not find a significant increase in severe complications when compared with normothermia.61,68 The safety of hypothermia treatment has also been confirmed by newer observational studies.87
Therapeutic hypothermia continues to be one of the most important topics in clinical resuscitation research today. Questions that still need to be addressed include establishing the indications for therapeutic hypothermia (intrahospital cardiac arrest and treatment in children) and cooling characteristics (target temperature, cooling rate, and duration of hypothermia) and cooling methods (external or internal). Several current clinical trials are focusing on these issues. To name only two, a trial in Germany is investigating therapeutic hypothermia in in-hospital cardiac arrest (n = 440),88 whereas a trial being conducted in France is comparing endovascular and surface cooling in a randomized fashion (n = 400).89
Previous SectionNext SectionAMELIORATING MICROCIRCULATION
Thrombolysis
There are two underlying rationales for using thrombolytics during CPR. First, cardiac arrest is caused by acute myocardial infarction or pulmonary embolism in 50%–70% of patients.90–92 In these two situations, thrombolysis represents a causal and standard therapy. Second, there is evidence that coagulation disorders are involved in the no-reflow phenomenon, and thus in impaired cerebral circulation after cardiac arrest. Cardiac arrest leads to activation of coagulation without adequate fibrinolysis.29,47 Microscopic examination of cerebral vessels shows that multiple microemboli develop during cardiac arrest and resuscitation.26 Although this was not known in detail in the 1950s, Crowell et al.30,93 had already shown at that time that pretreatment with heparin or streptokinase improved survival in dogs after cardiac arrest. Then, 40 yr later, Fischer et al.31 demonstrated a strong reduction in cerebral no-reflow in cats by postarrest thrombolytic treatment with plasminogen activator and heparin.
Clinical investigations have been less conclusive thus far. Several small studies suggest that thrombolysis during CPR might be beneficial, particularly in patients with pulmonary embolism, but also in those who suffer myocardial infarction.94–97 Randomized clinical trials investigating a general use of thrombolytics during CPR have produced differing results. Whereas Fatovich et al. found an increase in resuscitability (35 patients randomized), Abu-Laban et al. did not find any benefits from thrombolytics (233 patients randomized).98,99 The largest amount of data are provided by the European multicenter Thrombolysis in Cardiac Arrest trial.100 After inclusion of 1050 patients, the study was prematurely halted, because preliminary findings indicated that there was no likely benefit of thrombolytic therapy over placebo. Further analyses are expected soon. Nevertheless, all studies have consistently shown that thrombolysis during CPR is largely safe and not associated with increased bleeding complications.98,99
Thrombolytic therapy during CPR was included in international CPR guidelines in 2005 but only when pulmonary embolism52,53 or myocardial infarction53 is suspected.
Hypertonic, Hyperoncotic Infusions
A different approach to promoting microcirculation is the use of special infusion regimens which improve the rheological characteristics of the blood. After initial experiments with dextran 40 or isotonic saline,101,102 current research is focusing on hypertonic-hyperoncotic NaCl/hydroxyethyl starch (HES) solutions. Several animal studies have shown that hypertonic-hyperoncotic solutions given during CPR, or immediately after restoration of spontaneous circulation, decrease cerebral no-reflow.31,103,104 Some studies also investigated markers of neuronal damage. Krieter et al.105 found a decrease in release of astroglial protein S-100 after cardiac arrest in pigs after therapy with hypertonic-hyperoncotic infusion. Noppens et al.104 found improvements in both neurological deficit scores and brain histology in rats. Besides having positive effects on cerebral microcirculation, hypertonic saline also seems to ameliorate cardiac function during and after CPR.105–107
Up to now, one clinical trial has been published on the effect of hypertonic-hyperoncotic solutions in CPR.108 Bender et al. randomized 66 patients who suffered out-of-hospital cardiac arrest into two groups. The patients received 2 mL · kg−1 · 10 min−1 of either hypertonic saline with HES (7.2% NaCl with 6% HES 200,000/0.5) or HES alone during continuous CPR. Resuscitation success tended to be higher in patients receiving hypertonic saline with HES (66.7% vs 51.5%, P = 0.21) and hospital admission rates were also increased (57.6% vs 39.4%, P = 0.14). There were no severe side effects of hypertonic saline. However, larger clinical trials are needed to further elucidate the short- and long-term effects of hypertonic-hyperoncotic solutions after cardiac arrest.
Although hypertonic-hyperoncotic infusions hold potential for clinical use, hypothermia and thrombolysis already represent, at least in part, clinical routine for resuscitation. Thus, it would seem logical to combine these different approaches. However, each combination must first be carefully evaluated and experimental studies are still sparse. Lin et al.109 showed that dextran 40 and streptokinase synergistically improved cerebral recovery in dogs with cardiac arrest as measured by electroencephalogram activity. Safar et al.110 combined dextran 40 with hypothermia and arterial hypertension in dogs with cardiac arrest. This combination produced the best functional and histological outcome these investigators had ever experienced in that particular model in 15 yr of research, including experiments in which the animals had received dextran, hypothermia, or hypertension alone. Although there is still a long road ahead, these experiments suggest that the future might lie in combined therapies.
Previous SectionNext SectionINFLUENCING APOPTOSIS
Inhibitors of Apoptosis
It has been suggested that delayed neuronal death after cardiac arrest is caused by apoptosis.18,19 Apoptosis is characterized by activation of proteolytic cascades, which ultimately result in degradation of cellular components. The proteolytic enzyme, caspase 3, is one of the key executioners of apoptosis. Therefore, it seemed reasonable that neuronal damage after cardiac arrest could be ameliorated by inhibiting caspase 3.
This question was first addressed by Chen et al.19 In a rat model of global cerebral ischemia produced by four-vessel occlusion, they investigated the effects of the caspase 3 inhibitor Z-DEVD-FMK. After 7 days of reperfusion, they found an increased number of surviving cells in the selectively vulnerable CA-1 sector of the hippocampus along with a decrease in apoptotic cells in CA-1. However, other groups failed to reproduce neuroprotective effects of this or other caspase inhibitors in experimental global cerebral ischemia or cardiac arrest.111–113
It is now thought that the pathophysiology of neuronal degeneration is too complex to be reduced to only one molecule. There are probably various other “key” effectors independent of the caspases. One particular target is the calpain proteolytic system.114,115 It has been shown that inhibiting both calpains and caspases produces a synergistic effect in preventing neuronal damage after global cerebral ischemia.115 However, inhibition of apoptotic cascades is still a highly experimental endeavor. Additional studies are required to further elucidate the therapeutic effects of specific interventions.
Growth Factors
Apoptotic cell death is highly regulated. Physiologically, a variety of apoptosis-inducing factors are counterbalanced by different antiapoptotic, i.e., survival, factors. In pathological settings such as cerebral ischemia, apoptosis is induced by a massive release of death signals such as that from mitochondrial cytochrome c.116 Theoretically, if it were possible to amplify survival factors in the same way, cell death should be prevented. Such an approach might be initiated by administering growth factors, which have antiapoptotic properties. Interestingly, endogenous nerve growth factor (NGF) and BDNF are upregulated in neurons after cerebral ischemia20; the expression of BDNF is even enhanced by therapeutic hypothermia.83 Administration of exogenous growth factors after cerebral ischemia has produced inconclusive results.
One of the first such studies was conducted by Shigeno et al.117 They gave NGF or vehicle intracerebroventricularly before and after induction of global cerebral ischemia in gerbils (four-vessel occlusion). After 1 wk of reperfusion, a significant reduction in neuronal cell death was observed in CA-1 in both NGF pre- and posttreatment groups. However, subsequent work suggested that this treatment effect was transient and diminished after 4 wk, leading to the same degree of neuronal degeneration in NGF- and vehicle-treated animals.118
Kiprianova et al.119 investigated postischemic intracerebroventricular infusion of BDNF in rats with global cerebral ischemia (four-vessel occlusion). This treatment regimen completely prevented neuronal death in CA-1 after 7 days of reperfusion. In contrast, Popp et al.120 failed to show any beneficial effects of BDNF after cardiac arrest in rats.
Similarly conflicting results have been reported for other growth factors such as insulin-like growth factor I,121,122 granulocyte colony-stimulating factor123,124 or erythropoietin.125–127 Although some groups demonstrated positive effects of these growth factors,122,123,125 others failed to show any benefit for outcome.121,124,126 In conclusion, it is still not known whether any growth factor is capable of improving outcome after cardiac arrest.
It is certainly too simple to assume that it does not matter whether we reduce cellular death cascades (selectively, for example, with caspase inhibitors or in a much broader way with hypothermia) or activate cellular protection (e.g., with growth factors). Cells in a state of reduced energy and substrate levels might fail to respond to stimulation by growth factors. “Stepping on the gas” under such circumstances might perhaps even accelerate degeneration.
Update in Cerebral Resuscitation Brain edema is an excess accumulation of water in the intracellular and/or extracellular spaces of the brain and can be divided into vasogenic and cytotoxic
Vasogenic brain edema is caused by disruption of the blood brain barrier
Meanwhile, Cytotoxic edema is characterized by accumulation of water inside the neurons, microglia and astrocytes
Goal of medical management for cerebral edema is to maintain regional and global cerebral blood flow to meet the metabolic requirement and prevent secondary neuronal injury from cerebral ischemia
1) Elevation of head end of bed 15-30 degrees promote cerebral venous drainage. Head is kept in midline to limit neck vein compression. Bed is not tilted in acute carotid or basilar artery occlusion to avoid hypo perfusion distal to occlusion
2) Close monitoring of BP is important sign for increase in ICP (Cushing effect)
3) Surgical decompression and use of osmotherapy to reduce brain edema and its deleterious effect remain the mainstay of treatment even today
4) Mannitol remains as the best choice osmotic agent for osmotherapy. it decrease brain volume by decreasing overall water content, reduce blood volume by vasoconstriction, reduce CSF volume, improve cerebral perfusion by decreasing viscosity or altering red blood cell rheology and exert a protective effect against biochemical injury
5) Loop diuretic, IV Furosemide 0.7 mg/kg can be add to prolong osmotic effect
6) Hypertonic saline is about as effective as mannitol (certainly not more) and is safe and effective alternative to mannitol.
7) Prophylactic and prolonged hyperventilation maneuvers are not recommended during the first 24 hours because CBF is reduced at this time after trauma
8) Prolonged pulmonary hyperventilation must be avoided in the absence of high ICP as sustains vasoconstriction reduces CBF to deleterious levels and could generate brain ischemia
9) There is worse prognosis in severe TBI, routinely treated with hyperventilation
10) Hyperventilation becomes appropriate in the treatment of difficult to control ICH, CBF at normal level or high at onset of ICH and when brain deterioration with suspicion of intracranial mass lesion has occurred
11) Fluid restriction minimally affects cerebral edema and, if pursued to excess, may result in episodes of hypotension, which may increase ICP and is associated with worse neurologic outcome
12) Glucose containing solutions should be avoided
13) Glycerol can be given 30 ml every 4-6 hour or daily IV 50g in 500 ml of 2.5% saline solution
14) Corticosteroid is less effective in cytotoxic edema, and is not recommended in treatment of edema secondary to stroke or hemorrhage. Besides, systemic complications of steroids can worsen the patient’s condition
15) Inj. Dexamethasone 4-6 mg IM every 4-6 hours may be used if there is documented evidence of cerebral vasculitis, acute bacterial meningitis and chronic meningitis
16) Glucocorticoid are used for the management of malignant brain tumors exert their influence on brain tumors mainly by reducing tumor-associated vasogenic edema, probably by decreasing the increased capillary permeability of blood brain barrier
17) Randomized clinical trials are in progress to establish the safety and efficacy of prolonged cerebral hypothermia.
18) Barbiturates, Procaine derivatives, Indomethacin, Propofol and THAM (Thrometamine) are not being used routinely in present practice
19) EEG is not very helpful in the management of cerebral edema
Disclaimers: This writing is not fully from the author. Some of them are just straightly copy-paste from original articles. Therefore, authors are not responsible for any accusation of plagiarism.
Reference:
1) Abhishek Patro & Sureswar Mohanty, "Pathophysiology and treatment of traumatic brain edema, Indian Journal of Neurotrauma", Vol 6, No 1,2009.
2) Bhavneet Bharti, "Hypertonic Saline Treatment in Cerebral Edema –Is the Evidence Sufficient?", Indian Pediatrics, Vol 45, June 17, 2008
3) Matheus Oliveira-Abreu & Lajana de Almeida, 'Management of mechanical ventilation in brain injury: hyperventilation and positive end-expiratory pressure", Rev Bras Ter Intensiva, 21(1):72-79, 2009
4) SK Jha Lt Col (Retd), "Cerebral Edema and its Management", MJAFI 2003; 59 : 326-331
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Tuesday, August 7, 2012
kamus sleng Perak ^^
kawan2 yg cube mahu memahmi sleng perak mari le membce....idok le tesalah makne dah terase ati bile berbicare......keh4...... ( actly ni dari abg saya , koi xtaw la la betoi ker idok ejaannya , mintak halal-beralal la ek ^_^, peace yaw )
keme/aye/saye/teman/awak/kume = saya
(name teman peon...)
mike/kome/kamu/ = awak
(kome udah makan??)
ate = abis tu
(ate.. kome tak reti-reti nak mandi ke??)
raban teben =tak tentu arah
(ape kene raban teben budak ni??)
angat pijo = panas
(mak oii.. angat pijo rase badan..)
hakap = tamak
(gile hakap budak nie makan..sampai 4 ketui ayam dalam pinggan..)
ngelewor = terumbang ambing kekiri kekanan..
(ate ape kene bawak moto mengelewor ni??)
kebulor = lapar
(makk... adik tak larat nak puase.. dah kebulo bebeno dah ni...)
bolen = telanjang bulat
(ate abang ace pakaikan seluor anak tu jap.. apekehai keluor romah bolen aje..)
nyelap sador = seorang yang seperti dirasuk@ diluar kawalan
(tgk tu, pantang sebut hal kawen.. nyelap sador die..)
mengelenyor = gatal/ menengada/ sopannya
(yang nie lagi sorang... jumpe muke hensem siket mule le mengelenyor.)
biot = degil
(kome jangan biot beno pun kenape.. kang apak rotan kang..)
perok = jakun/ tak pernah tgk benda
(ate... tak usah le perok bebenor.. esok kite pun beli rope itu)
muncah = banyak duit atau berharta
(auuww.. moncah le mike.. anak2 sume kroje gomen..)
toben = tua bangka
(tok tu dah toben... renti kan le kluor.. dudok romah je..)
merambu = joli sana sini
KEMIN = kemas
NYEGHOGIN = tersenyum sorang diri
REBEN TEYBEN = seluin jer – selekeh
TAK AJAP = TAK layan/ tak jadi hal
MENTEKEDAGHOH = makan
menterchiker = makan
MEROLOH = Tidor.
(adi tgh meroloh...)
GHODI/KODI = repair/belek
(haaa.. yai gitu.. ghodi-ghodi kerete abah tu.. kang kena penampor ngan dia..)
YA’NGAT = minuman panas (tea, kopi, melo, neskepe dll)
CIK CIBOR = pepatung
(cik cibor boleh makan ke???)
KALA LIPIT = kala jengkin (scorpions)
(tangan aku bengkak kene kala lipit)
CENCOGHOT = tikuih ketughi
JELEBOR = labi²
(nak tgk jelebor datang le bote..)
LABUN = cakap
SEMUT GATEY = semut api
(uwwaaa... adik kene gigit semut gatey)
MENGKIOK = besar sikit dari anai2 selalunya menjadi kalkatu..
BEDAGHOH = berdarah
CENANGOR = serangga yg berbau busuk selalu dijumpai berhampiran dgn lampu
(oiii bebudak cinangor.. gie balik..)
MENTONG = makan sampai due kali atau tambah 2 kali
PAKA@ PAKEI = pakai atau guna
(elehh... henset nokia n95 teman dah lame pakei..)
LECAH = Lumpur
(ya Allah budak nie, yang kamu main lecah kenape?? kan dah koto baju kamu..)
NGETIT /ngokak = gigit ketip
CONONGGENG = bontot ayam
ENCONOT = atau tongken ayam
LIBANG LIBU = perasaan resah gelisah....
MEGHEDANG-GHEDANG = (meredang-redang) maksud dia membuta-tuli
SENTEN = menarik kaki seluar ke atas.....ataupun singkat dlm bahasa pekan nya
SIUT = cucuh / menyalakan
NYARIGH = mujor
(nyarigh lagik aku tak eksiden tadik.. kalo tak beterabor gigi..)
BENGKIN = garang
(ate abahnye pon.. ngan anak pun nak bengkin)
GETAK =jatuh / luruh
GEGHOTOK/GEROTOK = jambatan
MENTELUN = seluar panjang (pantaloon)
KAYU ROL = kayu pembaris
PORES = pekerja jabatan hutan tu, forest
PUIH OPES = pejabat pos
GOMEN = kerajaan
MENTOKA = Kereta
SELAIT = lampu suluh / torch light
SEPEROH = alas / lapik meja
JEGHOLONG = tempat buang sampah kat tepi hutan
PIOR = tulin asli
ACEKEME = macamana kalau
PENGGE = lontar, baling
HAMBAT = kejar
GHULU GHELO = hulu hilir
NGELAT = menipu
SELE’WIN = kira buat asal siap, comot
HINCIT = Ketepi, ngeysot
GETIK = nyampoh (menyampah)
GANJEI = terkena / naya / terkejut
REBER = sesak, beriya, sopannya, poyo..
SA-NGEIYR atau SANGEI = tudung saji
SI-YAR* (sengorkan bunyi..yar.. tu..) = mangguk tingkat
MENYENGKET - mengintai, mengendap
GILA SEPEREGHE = separuh gile
BEBEY = degil tahap batu gajah
NIN = jernih...
GENYII = geli geleman
MENYELEBIUR= terjuih bibir
NYADIN = buat derk aje
MELENGKO = membelit (ater komer lekas nengok ulor beso melengko ataih pago rumoh pak bako.)
MENEBEN MUKE = melangok kat kedai kopi
TAK SIOR = tak ingin
BERDANO = kotor sangat
NYENDIN = tumpang sekaki
SEMBAI = pasir halus yang basah/pasir sungai (cher miker pegi kaup sembai kat sungei tu, elok bebeno mbuat
bancuh simen)
LIMBAH = air kotor/Lumpur
MENGEROGHNYOT = berdenyut-denyut
MEMBANGAO BAU = busuk baunya
BERDA'AH = bohong/menipu/kelentong
TERPEROGHONGO = berlubang besar
PETIA = memang sudah direnung/ memang yakin
NYIOR KUTEY = kelapa yang dah kering kat atas pokok kelapa
BERONGGOK = berkumpul
TAWO LEYSYUR = masakan terlalu tawar
JENUH = lama sangat..
BONYEH = berlendir/berlendior
MELANTUNG KOHONG = busuk sesangat
Tumpo =Tak bergerak,mati,habis nyawa.
Moh = Jom
Ngerengken = Kurus kering tak ada isi langsung
Sompeh = Serpih,picisan,ada cacat sikit.
SAMO = Merah Jambu
SOH = Sunyi sepi/ senyap
PAN/NYANG =Panggilan utk moyang
BESIT = Memukul dgn sesuatu spt rotan dan sbg
NGELATOK = Berdebar2 akibat terkejut
motokar = kereta
mutu = motorsikal
tak mandang = takde
gebor = selimut
limaih = tepung pelita
ce /ace = cuba /try
gostan = undur belakang
beransor = mintak diri
Friday, August 3, 2012
Midnight Sun
I could still feel Bella's warmth in the car, though I'd already put miles between us. I drove quickly towards home to make my nightly appearance, knowing that soon I would leave again, to take solace in Bella's dreams. Although a part of me still felt voyeuristic, the quiet comfort I had found in watching her sleep, hearing her whisper my name, was not something I could easily give up .As soon as I walked into the house, I heard chattering in the living room. My family was arguing, and yet again I found myself the center of their attention. Of course they all knew of my plans to spend the day with Bella on Saturday, and were currently in loud dispute over whether or not such a thing should be allowed.
~ to be continued ;Edward’s point of view ~
Thursday, August 2, 2012
PUASAKU IBADAHKU
bulan puasa datang lagi ...
haha ... da lama tak jenguk blog ni ^_^
so ... untuk entry kali ni , apa agaknya elisa nak celotehkan yer ... hmmm
- cosmetic ?
- photography ?
- anatomy and science again ?
- recipies ? haha ... seems synonym with ramadhan :D
tanak .. tanak .. tanak
memandangkan sekarang as officially penganggur .., hihi , memang byk buang masa kat rumah ni :) teruk kan ... haha
tapi bila da menjelang ramadhan , byk yg perlu di topup , yg menarik tertarik .. carik2 lagi di sini ,
elisa nak share sikit dr sebahagian pembacaan dr buku fikah harian by Dato' Dr Haron Din
dlm menjawab persoalan mengenai LAILATULQADAR . jom :)
Apakah yang dimaksudkan malam AL-QADAR ( Lailatul-qadar) ?
malam al-qadar adalah satu malam dlm bln Ramadhan yg ditentukan di mana Allah shj yg mengetahuimya. Malam itu yg mempunyai pelbagai kelebihan dan keistimewaan yg melebihi 1000 bulan. Ini ditegaskan Allah di dalam surah al-Qadr, ayat 1 hingga 3 , yg bermaksud :
Apakah tanda-tanda yang menunjukkan berlakunya malam al-Qadar ?
antara tanda2nya adalah malam itu jelas dan tenang , udaranya tidak panas dan tidak pula dingin , keesokkan harinya kelihatan sinaran matahari tidak bercahaya . Ada juga pendapat mengatakan pd malam al-Qadar itu tidak akan kelihatan bayang-bayang.
kami turunkan Quran pada malam al-Qadar . Tahukah kamu apakah malam al-Qadar itu lebih baik dr seribu bulan .
Apakah tanda-tanda yang menunjukkan berlakunya malam al-Qadar ?
antara tanda2nya adalah malam itu jelas dan tenang , udaranya tidak panas dan tidak pula dingin , keesokkan harinya kelihatan sinaran matahari tidak bercahaya . Ada juga pendapat mengatakan pd malam al-Qadar itu tidak akan kelihatan bayang-bayang.
jadi suka saya nak tegaskan di sini , dalam pada kita mengerjakan ibadah puasa , marilah kita merebut peluang keemasan ini dgn memperbanyakkan amalan ibadah yang lain . moga dengan rahmatNya kita beroleh hati yang baru , suatu ilmu malah sebuah kehidupan yang lebih bermakna :)
~selamat beramal~
Friday, June 15, 2012
Resipi Seribu Satu
ayam masak halia.puan2 mesti tahu masak ni kan tapi admin saje jew letak resepinya kat cni ye.
bahan2...
1keping dada ayam
1/2 bj bawang merah*
4 ulsa bawang putih*
halia 3 inci dihiris halus2...
cili padi sedikit.kalo nak pedas boleh tambah ye..*
2sdb sos tiram.
air sedikit
hiasan..
bawang besar
daun bawang
daun sup
cara2....
tumbuk bahan2 yg bertanda.selepas tu tumis ye hingga naik bau..dah tu masukkan dada ayam tadi...gaul seketika dan masukkan sedikit air.tutup kuali dan biarkan dalam beberapa minit tuk bg masak ayam tu.bila dah ok bolehlah masukkan sos tiram,garam n ajinamoto.gaul selepas tu bolehlah masukkan bahan hiasan.bawang besar,daun sup dan daun bawang sedikit.siap.boleh makan...masakan yg simple tapi sedap....
AYAM MASAK BOMBAY
recipe dari fren FB.tqvm pd PN Rita Norlitah Hashral krn share dis recipe..it's so simple & mmg sesuai utk pn2 yg bekerja dan x suka spend bnyk masa kat kitchen
AYAM MASAK BOMBAY
1 KG KEPAK AYAM
2 BIJI BAWANG BESAR
5 ULAS BAWANG PUTIH
2 INCI HALIA
1 SENDOK CILI KISAR
3 SUDU BESAR KICAP MANIS
3 HELAI DAUN KARI
2 BATANG SERAI DITITIK
1 SUDU TEH LADA SULAH/PUTIH
CARA NYA
KISAR BAWANG, BAWANG PUTIH DAN HALIA.
PERAPKAN KESEMUA BAHAN TERSEBUT DENGAN KEPAK AYAM SELAMA 1/2 JAM.
PANAS KAN KUALI,PANASKAN MINYAK &
MASOKKAN AYAM DAN KESEMUA BAHAN YANG DIATAS.
TUTUP KUALI, MASAK DENGAN API KECIL SEHINGGA PEKAT JANGAN DILETAK AIR...AYAM ITU SENDIRI AKAN MENGELUARKAN AIR DENGAN SENDIRI NYA..BUBUH GARAM DAN PERASA..SETTLED!
Joha Hassan
Resepi Ayam Panggang - Lemak Manis.
Ingredient
1 whole Chicken cut in halves.
15 - 20 shallots (Blend)
4 Red Chillies (Blend)
4 pcs Kafir Lime leaves (Daun Limau perut)
...4 candle nuts
200gm Coconut Milk
2 cm Galangal (Lengkuas)(Blend)
2 cm Fresh Tumeric (Blend)
3 pcs Lemon grass (Serai)
3 pcs of screwpine leaves (Pandan Leaves)
Salt & Sugar for taste
4 tbspn of Vegetable Oil
Blend all the spices above
Heat the oil, add lemon grass and pandan leaves
Add the spices and cooked till the aroma rises
Add the chicken, cook for 15/20 mins on medium heat
add the coconut milk and cook for another 10mins
Take the chicken out and place on baking tray.
Grilled chicken for 20 to 25 mins in the oven @180C
or grilled on charcoal.
Garnish with coriander leaves and fresh salad.
For Best result, grill on BBQ charcoal.
Joha Hassan BBQ, saya selalu gunakan serbuk ketumbar, kunyit, jintan, halia & bawang putih, cili boh.garam & gula peramkan 2jam. Gaulkan dengan minyak sedikit..Kalau seafood kunyit, cili paste, garam & gula.
Fan photos from Kongsi Resepi
Ayam masak USEK.......resipi mak mentua mlong (org jawa)
bahan2nya
1 ekor ayam . potong 12...goreng separuh masak dulu
2 biji kentang belah 4
2 biji tomato belah 4
2 tangkai cili merah belah 2
bahan utk blender
2 sudu rempah biji/ketumbar
6 ulas bawang merah
3 ulas bawang putih
2cm halia
1cm lengkuas
4 batang serai...hiris2 dulu
rempah serbuk
2 sudu serbuk jintan putih
3 sudu serbuk jintan manis
3 sudu serbuk lada putih
4 sudu asam jawa yg pekat
garam dan gula secukup rasa
1 cawan santan pekat+1cawan air
Cara2nya
tumis bahan blender hingga wangi masukkan ayam yg digoreng tadi
masukkan kesemua serbuk rempah gaul rata
masukkan santan .kentang.garam .gula dan air asam jawa
tutop seketika sampai kentang empok
masukkan tomota dan lada hijau
biarkan kuah nya pekat dan hidangkan
selamat mencuba
ayam goreng mama'k...resepi dari kak Zuraini Alias..
bhn2
10 ketul ayam
1 sd bsr serbuk cili
1 sd bsr serbuk kunyit
1 sd bsr jintan halus
1 sd bsr serbuk kari
garam/gula
bhn tumbuk
5 ulas bwg merah
2 inci halia
daun kari
tpg jagung
caranya
perap ayam dgn kesemua bhn kecuali tpg jagung dan daun kari..
masa nk goreng baru campurkan tpg jagung..goreng hingga msk keemasan....siapppp
sedap ni kalo makan gan nasi putih atau nasi goreng..
bahan2
-daging dihiris nipis (direbus hingga empuk dan dicampur pewarna merah sedikit)
-bawnag merah, bwang putih, halia (tumisan)
-sos cili, sos tomato, sos tiram, cili kisar
-gula n garam
-bawnag besar n cili utk hiasan
cara2
1-panaskn minyak tumis bahan tumisan
2-masukkan cili kisar anggran 3sudu besar-biar wangi
3-masukkan sos, cili, sos tomato dan sos tiram biar hingga mendidih
4-masukkan air (ikut suka nak kuah pekat atau tak)
5-perasakan dgn gula dan garam
6-masukkan daging yg telah direbus biar dalm 3minit
7-masukkan bahan hiasan biar seminit.
8-siap!!
Wani Khairul dging msk merah cm kt kdai 2 kn???bestnye..yummy2
Fiza Syamri a,ah yg selalu makan gan nasi goreng USA tu..
Chicken Chop, Loncong & Asam Gupal
Assalamualaikum
Hi everyone! How was your day? I have uneasy feeling today,sigh.. Maybe because day after tomorrow I'll be back to Melaka. My mental and physical are not fully ready yet :( Tonight, we had chicken chop as our dinner and after that we had 2 desserts,yummmmyy~~ Here's the recipe!
Oriental Sauce
Fried Chicken
French Fries
• 1 whole chicken ( cut into big pieces- thigh, wing, drumstick)
• Kentucky flour
• 5 cloves garlic (sliced)
• 2 onions (sliced)
• 1/2 bottle chili sauce
• 2 cans red beans
• 1 cup water
• 2 basils
• A pinch of salt and pepper
• French fries ( side dish)
1. Mix kentucky flour to the chicken. Spread well.
2. Deep fried the chicken in hot oil using large wok.
3. Meanwhile, saute garlic and onion until light brown.
4. Add in chilli sauce, red beans and water.
5. Add in basils and season with salt and pepper. Wait until it simmering.
6. Using the same oil that you fried chicken, now deep fried the fries.
7. Enjoy while still hot!
Squid Sambal
Tadaaaaa..!
ayam panggang serba rasa
seperti yang saya cerita pada entri sebelum ini...semalam saya macam terlebih rajin...yelah mood tu kadang-kadang ok, kadang-kadang tak ok...
lepas buat kek pisang...saya memanggang ayam pula...banyak idea-idea masakan saya, saya perolehi dari rancangan-rancangan masakan channel AFC dan LI...dan resepi ayam panggang serba rasa ni saya garapkan dari rancangan masakan 'best Wan' yang dihostkan oleh chef wan.
tapi saya tak dapat nak ingatkan seratus peratus bahan-bahan yang digunakan oleh chef wan....oleh itu saya main agak-agak je...
tapi hasilnya memang sedaplah pada saya dan anak-anak...
untuk resepi ini saya gunakan
6 potong paha ayam
2 helai daun pandan, simpulkan
3 batang serai, ketuk
1/2 cawan santan pekat
bahan blender;
15 biji bawang merah
5 biji bawang putih
1 inci halia
10 biji cili padi
5 biji cili merah
1 inci kunyit hidup
5 helai daun limau purut
3 biji air limau kasturi
cara;
1) panaskan 1/2 cawan minyak dan tumis daun pandan dan serai hingga wangi. masukkan bahan blender dan kacau hingga wangi. masukkan ayam dan kacau hingga rata. masukkan santan, garam, perisa dan gula. kacau lagi hingga kuah pekat (dalam 5 ke 10 minit).
2) keluarkan ayam dan ketepikan. masak kuah gravy hingga pekat. tambahkan garam, gula, asam limau dan perisa jika perlu (ikut selera anda). ketepikan.
3) susun ayam tadi dalam bekas pemanggang dan panggang dalam oven sehingga masak kedua-dua belah...lebih kurang sejam ke sejam setengah.
4) keluarkan dari oven dan hidang panas di sapukan dengan gravy sauce tadi....
acar ikan tenggiri
acar ikan tenggiri ni sebenarnya sama seperti masak ikan tenggiri bercuka cuma bezanya, untuk acar ini saya campurkan sedikit santan pekat. saya pernah makan hidangan ini dirumah seorang kawan ketika beliau buat kenduri arwah. daripada rasanya saya tahu lebih kurang akan bahannya.
untuk resepi ini saya gunakan beberapa keping ikan tenggiri. gaul dengan garam dan kunyit dan goreng seperti biasa.
lain-lain bahan terpulang kepada anda. saya guna timun dan carrot sahaja. anda boleh tambahkan kacang panjang, terung, tomato, bawang besar (potong wedges). cili hijau/merah belah dan sebagainya.
tumbuk halia, kunyit, cili padi, bawang merah dan bawang putih hingga lumat. tumis dengan sedikit minyak hingga wangi. masukkan beberapa sudu besar santan pekat dan sedikit biji sawi (jika ada/suka). tambah sedikit air jika perlu. biarkan mendidih. masukkan sayuran. biar mendidih sebentar. masukkan sedikit cuka, garam, gula dan perisa. akhir sekali masukkan ikan dan kacau sebentar.
siap dihidang. rasanya mesti sedikit masam, pedas dan lemak.
Anis Ad salam n slamat mowning sume...cadangnye menu tgh nnt 'ayam masak paprik'...sesape yg tahu resepi sbijik cm kat warung ala thai..,mintak la share....
ike puyyu pakk samah..tqvmah.....
Munie Yusoff bwg besar, bwag putih,bwg merah, halia,blender, cili giling,, tumis semua tu... tambah serai dan daun limau purut.. sos ikan/ sos tiram, kicap skit, yg lain secukup rasa.. saya blajar dari kwn yg asal org thai..
Munie Yusoff sayur tambahan tu ikut suka kitalah.. nak letak putik jgung, kcng pnjang, bunga kobis.
Mazni Mohamed nie versi sya..memula tumisserai dgn daun limau purut yg dicarik2...naik bau bru tumis bwg putih+merah....naik bau, msk 2 sudu cili boh, n sos tiram, biar kehap masuk sos cili n apa2 perasa n sos yg suka agak2 dkt nak msk msk kan cili api ketuk 2 biji n perah limau nipis....
SUP YONG TAU FOO
Bahan-bahannya
Fishball atau bahan2 yong tau foo
Pes bawang putih dan pes bawang merah
Kiub ikan bilis Maggie
Bawang goreng
Daun sup
Garam secukupnya
Air secukupnya
Minyak untuk menumis
Sos cili thai ataupun cili padi merah hiris dan tuangkan kicap cair
LET DO IT:
1. Panaskan minyak dalam periuk. Tumis pes bawang putih dan bawang merah sehingga wangi.
2. Masukkan pula kiub ikan bilis Maggie secukupnya, hancurkan dan tumis sekejap. Kemudian tuangkan air secukupnya (ikut banyak mana sup yang anda hendak sediakan).
3. Masukkan garam dan bila kuah mendidih, masukkan bahan-bahan yong tau foo atau fishball/ crabmeat dan biarkan ia reneh selama 5 minit. Sup pun dah siap.
Cara untuk menghidang
1. Masukkan bahan yong tau foo kedalam mangkuk, tuang sup yong tau foo.Taburkan dengan bawang goreng dan daun sup jika mahu.
2. Hidangkan bersama sos cili thai atau pun jika mahu cili padi merah yang telah dihiris dan tuangkan kicap cair.
Nota: Bila anda menumis pes bawang putih dan bawang merah, hendaklah tumis sehingga ia betul masak dan bangkit baunya baru supnya jadi powerrr!
Tahu Goreng
Tahu memang sudah tidak asing lagi bagi kita terutama masyarakat melayudengan rasa yang lezat , mula dari digoreng biasa hingga diolah menjadi masakan jenis lainya. Tidak semua tahu diproses dengan bahan berbahaya tersebut, terbukti masih ada saja tahu yang dibuat secara alami.
Di balik kelezatannya, ternyata tahu menyimpan khasiat medis tersendiri. Sebuah studi oleh tim medis dari Kanada membuktikan bahwa tahu dapat menurunkan kolesterol jahat dalam tubuh. Selain menurunkan kolesterol, tahu juga terbukti dapat mencegah Cancer payudara.
Bahan-bahan
4 keping tahu biasa
1 biji timun, dihiris nipis dan dimayang
100 g taugeh, buang ekor dan celur sekejap - aku ngan mat tk celur
1/2 biji sengkuang, kupas, hiris nipis dan dimayang
4 ulas bawang putih*
5 - 6 biji cili padi*
200 g kacang tanah*
3 - 4 camca besar gula melaka*
3 camca besar kicap pekat*
1 1/2 - 2 camca besar cuka makan @ jus asam jawa*
Sedikit air*(*bahan sos kacang)
LET DO IT:
Kacang tanah digoreng tanpa minyak hingga perang, buang kulit dan tumbuk separuh halus. Kisar cili padi dan bawang putih. Campurkan semua bahan2 sos kacang dan kacau hingga rata. Tambah sedikit air jika perlu, jangan terlalu cair atau pekat, sesuaikan rasa dan tambah gula@garam@asam jika perlu. Ketepikan.
Tauhu dilumur dengan sedikit garam, goreng terendam hingga kuning keemasan, jangan goreng lama sangat. Keluarkan dan tos.
Ambil sekeping tauhu goreng tadi. Potong kepada 9 bahagian (bergantung pada saiz tauhu masing2), alihkan ke dalam pinggan, tabur atas tauhu tadi dengan hirisan timun, sengkuang dan taugeh. Tuang sos kacang secukupnya dan hidangkan segera...Makan macam tu pun sedap!!!!!
Sambal Goreng Udang
Bahan2:
8-9 batang cili kering (nak sambal lebih banyak dan lebih pedas, boleh lebihkan)
4-5 ulas bawang kecil
2 ulas bawang putih
Udang Segar (saiz mengikut keperluan)
Air asam-1/2 cawan hingga 1 cawan (agak-agak)
Minyak untuk menumis, gula, garam..
(Jika suka..tambah petai 1/2 mangkuk)
1 Labu Bawang Besar-Dihiris
Let DO IT!:
1- Blend bawang putih, bawang merah dan cili kering (cili kering yg telah direndam didlm air)..kisar shingga hancur bersama-sama dengan air..
2- Panaskan minyak..bile sudah panas masukkan bahan yg telah dikisar.. 3-Tumis sehingga garing dan naik minyak..masukkan udang..gula dan garam..lebihkan gula utk mendapatkan rase yg lebih manis..
4- Jika suka masukkan petai..
5- Masukkan air asam..biarkan mengelegak dan masukkan bawang besar yang telah dihiris..tunggu hingga sambal naik minyak dan pekat..(kepekatan sambal ikut suka..)
Hidangkan..
ALL THE BEST, Ady greatsword
TOM YAM
Tom Yam merupakan sejenis sup yg terkenal bukan saja dari negara asalnya Thailand tetapi di seluruh dunia. Rasanya masam2 pedas dgn keharuman aroma dari herba yg digunakan seperti serai, daun limau purut, lengkuas, air limau nipis, sos ikan dan sebagainya.
Di negara Thai, sup tom yam ni selalu dimasak dgn menggunakan bahan utama seperti udang (tom yam kung), ayam (tom yum gai), ikan (tom yum pla), ataupun campuran makanan laut (mixed seafood) (tom yum talay atau tom yum po taek) dan cendawan – selalunya straw atau oyster mushrooms. Sup ini selalunya dihias dgn hirisan daun ketumbar.
Hah... yg atas tu adalah petikan dari Wikipedia yg telah saya terjemahkan ke dalam bahasa Melayu. Saya rasa ramai yg dah tau camner nak buat sup tom yam ni. So di sini saya sekedar nak berkongsi ttg sup tom yam yg saya buat semalam. Jom lihat resipi dan cuci mata ya...
TOM YAM
Bahan-Bahan
1 ekor ayam, seberat 1.2 -1.3 kg (dibuang kulit & dipotong 12)
15 tangkai cili kering (direndam)
5 ulas bawang putih
1 cm halia ....... dikisar halus
8 batang cili padi (ditumbuk kasar)-boleh dikurangkan ikut citarasa
10 batang cili padi (utk dimasukkan sebiji-biji)
4 batang serai (dititik)
3 cm lengkuas (dititik)
1 biji bawang besar (dihiris kasar)
5-6 kiub pes tom yam
8 helai daun limau purut
sedikit daun ketumbar
1 biji limau nipis (diambil jusnya)
3 biji tomato (dipotong 2 atau 4)
1 – 1½ liter air (atau ikut citarasa)
1 sudu teh gula
garam secukup rasa (atau jika perlu)
80 -100 ml minyak utk menumis
1 batang lobak merah (potong ikut suka)
100 gm bunga kobis/broccoli
1 tin kecil button/straw mushroom (potong ikut suka)
1 tin jagung muda
Cara-cara
Panaskan minyak dlm periuk. Masukkan campuran cili kering, bawang putih, halia, serai, lengkuas dan cili padi (tumbuk) dan tumis hingga garing dan wangi. Kalau perlu bubuh sedikit air.
Masukkkan kiub pes tom yam, (hancurkan sedikit agar mudah larut), potongan2 ayam dan 1½ liter air. Bubuh sekali daun limau purut. Masak sebentar (kira-kira 8-10 minit) sehingga ayam ½ masak. Kemudian masukkan bawang hiris, lobak merah, cendawan, bunga kobis, jagung muda dan cili padi. Masak lagi sehingga ayam empuk.
Kemudian, masukkan tomato, gula, garam (jika perlu) dan air limau nipis. Sesuaikan rasanya mengikut citarasa anda dan tambahlah apa yg perlu. Akhir sekali, masukkan daun ketumbar, kacau sebentar lalu matikan api.
Nota :
1) Saya tak gunakan sos nampla (ikan) krn penggunaan sos ikan ni optional.
2) Sukatan air yg diberi adalah sebagai garis pandu & jenis sayur-sayuran dan sukatannya tergantung kpd citarasa anda.
3) Anda boleh hidangkan sup ini dgn mee, kue teow atau pun bee hoon.
AYAM PENYEK/PENYET
Pernah satu ketika dulu ada seorang pengunjung yg bertanyakan ttg resipi Ayam Penyek. Di sini saya ingin berkongsi satu resipi yg saya tukil dari Buku ALMAS. Diharap sesiapa yg berhajat bolehlah mencubanya. Pastu, bolehlah feedback ya!
AYAM PENYEK
(sumber resipi & foto : Pn Asmah Laili)
Bahan-Bahan
1½ kg peha ayam (kira-kira 6 keping, jangan buang kulitnya, cuci bersih dan toskan
2 - 3 liter air
3 batang serai, bahagian putihnya sahaja, dititik
3 hiris lengkuas, dititik
6 biji bawang putih, dihiris
1 sudu makan ketumbar, ditumbuk kasar
½ sudu makan jintan halus (jintan putih), ditumbuk kasar
1 ibu jari halia, dititik
4 helai daun salam
4 sudu makan rata, gula Tanjung
2 sudu makan rata garam
Cara
Masukkan semua bahan kedalam periuk, kecuali ayam. Gaul rata dan rasa. Jika kurang garam tambah sedikit lagi. Setelah puas dengan rasanya. barulah dimasukkan ayam. Tentukan airnya cukup setakat menutup ayam. Jerang periuk diatas dapur dengan api yang sederhana besarnya. Rebus ayam sehingga ¾ masak, selama 15 hingga 20 minit. Matikan api. Keluarkan kepingan ayam dan masukkan didalam tapisan. Biarkan sehingga ia benar-benar sejuk. Bersihkan ayam.
Sementara itu tapis air rebusan ayam. Air yang jernih diketepikan untuk membuat sup, tetapi bekas ketumbar dan jintan halus dilumurkan dengan kepingan ayam. Ayam
yang sudah direbus, sebaik-baiknya disimpan semalaman didalam peti sejuk dengan sedikit air rebusan. Goreng ayarn mi, pada keesokkan hari. Tetapi boleh juga digoreng
bila kepingan ayam sudah betul-betul sejuk. Goreng dengan banyak minyak, sehingga masak dan garing.
Setelah masak, dihentak sedikit dengan anak lesung. Sajikan segera dengan sup asam, nasi panas, serta tempe dan tauhu goreng, kangkung rebus, Sambal Kicap Lada Padi serta Sambal Lonteh.
NASI AYAM PENYET PALEMBANG
Sumber: Hajah Rohanna Abu (Berita Harian 1 Sept 2006)
Bahan A (untuk merebus ayam)
1 ekor ayam (belah empat)
1 batang serai
2 ibu jari halia
5 ulas bawang putih
2 liter air
Garam secukup rasa
Cara-caranya
1. Ketuk halia, serai dan bawang putih kemudian masukkan ke dalam sebuah periuk yang besar, bersama air, garam dan ayam.
2. Rebus ayam selama 20 minit atau sampai ayam timbul.
3. Keluarkan ayam dari air rebusan dan segera pindahkan ke dalam bekas berisi air batu. Tujuannya ialah untuk menghentikan proses memasak supaya ayam tidak hancur apabila digoreng. Ketepikan air rebusan ayam untuk sup dan nasi.
4. Biarkan ayam dalam air batu selama beberapa minit kemudian toskan.TIP: Setelah anda keluarkan ayam daripada air rebusannya, segeralah masak nasi. Apabila nasi tanak, ayam pun sudah siap untuk digoreng dan dihidangkan bersama.
Bahan B (untuk goreng ayam)
2 biji telur
175 gram tepung beras
50 gram jintan biji (boleh ditambah jika suka) -cuci, toskan dan sangar jintan kemudian ditumbuk)
1 sudu teh serbuk kunyit
1 sudu teh rempah kari daging
1 sudu teh serbuk lada
Garam dan air secukupnya
Cara-caranya
1. Dalam sebuah bekas yang besar, satukan semua bahan yang kering.
2. Pecahkan telur ke dalam adunan bahan kering ini dan adun hingga rata.
3. Tuang air sedikit-sedikit ke dalam adunan sambil mengacaunya. Pastikan adunannya tidak terlalu pekat dan tidak cair.
4. Panaskan secukup minyak dalam kuali kemudian celup ayam ke dalam tepung dan gorenglah ayam hingga masak.
Nota:
Oleh kerana ayam sudah direbus, anda tidak perlu menggorengnya terlalu lama agar ayam tidak keras. Setelah masak, ayam hendaklah diketuk atau dipenyetkan sebelum dihidangkan.
Bahan C (Untuk nasi dan sup)
1 kilo beras (cuci dan toskan)
150 gram mentega
1 cawan minyak masak
½ cawan minyak bijan
6 – 8 helai daun pandan
1 batang serai
5 ulas bawang putih (ketuk)
Garam secukup rasa
Air rebusan (stok) ayam secukupnya
Cara-caranya
1. Tapiskan secukup air rebusan ayam dan tuang ke dalam periuk nasi. Masukkan mentega, minyak, beras, daun pandan, serai, bawang putih dan garam. Kacau sedikit supaya bahan rata dan masaklah nasi seperti biasa.
2. Untuk supnya, tapis baki air rebusan ayam tadi, tuangkan ke dalam periuk dan campurkan dengan sebuku kiub stok ayam. Masak hingga kiub larut. Masukkan secukup hirisan daun sup, daun bawang dan bawang goreng. Hidangkan bersama ayam dan nasi.
Bahan D (untuk sambal dan ulam)
3 batang lada merah
3 biji lada padi
10 ulas bawang kecil
3 labu tomato
100 gram ikan bilis goreng
100 gram belacan
Secukup ulam (kacang botol, ulam raja, timun, pengaga)
Cara-caranya
1. Goreng lada padi, lada merah, bawang kecil dan belacan selama lima minit. Angkat dan toskan minyaknya kemudian tumbuk bersama ikan bili sgoreng hingga lumat.
2. Sajikan bersama ulam, nasi dan ayam penyet.
Nota:
Jika suka anda boleh juga buat sambal belacan.
Anda boleh menggunakan 5 batang lada merah, 3 biji lada padi, ½ sudu teh gula melaka, 1 biji tomato dan 1 sentimeter belacan bakar. Satukan semua bahan ini dan tumbuk hingga lumat.
Bahan D (untuk sos hitam)
½ botol sos tiram
½ botol air
Segenggam gula paisr
Sedikit minyak bijan
Cara-caranya
1. Satukan semua bahan dalam periuk kecil dan masak hingga sos mendidih.
Posted By Bro Rozzan
Topic: Mushroom Soup HOme made
SEha Jarudi
1.5 liter air
450 mlm susu segar/rendh lemak
cendawan butang tin/segar (ikut nk bnyk mne)
dada ayam
kiub ayam
garam/gula
lada sulah
kentang 4bji
1 sudu tepung jagung
cara2nya :
1. rebus kentg then blend. cendawan pula blend kasar n hiris nipis.
2. masakkn air n dada ayam gingga mendidih..masukkan kiub ayam...
3. then,susu...kacau mesra.. masukkan kentg,cndawan,lada sulah,garam n gula... kacau mesra...lastly masukkan bancuhan tepung jagung n kacau sebati sampi sup tu mask n likat sdikit...
Topic: ayam percik
Intan Liana
bahan2:-
ayam 1 ekor
bahan tumis dan blend
cili api 15 biji
cili kering 10 tangkai
bawang putih 4 ulas
bawang besar 4 biji
halia 1 inci
lengkuas 1 inci
jintan kasar dan halus setengah sudu
serai 7 ikat ( 6 ikat di ricik dan blend ) 1 ikat ketuk dan tumis bersama
santan bersama 1/2 biji kelapa saja...mesti cair.....
gula pasir 1 sudu
gula merah 1 sudu
asam keping 1 keping
2 btg serai yg direndam bersama minyak..utk digunakan sewaktu memanggang..
cara membuatnya:-
tumis bahan tumis hingga garing...kemudian masukkan santan dan masukkan ayam . Taburkan gula merah,gula pasir dan garam....biar secukup rasa ( pastikan ada rasa pedas manis )... Biarkan sehingga ayam masak...tapi jangan terlampau lembik ayamnya....asingkan ayam utk dipanggang...semasa memanggang sapukan kuah ayam yg dimasak tadi ke atas ayam...dan percikkan dengan minyak yg telah direndam bersama serai tadi...panggang kehitaman....makan bersama kuah tadi...
* masak ayam sehingga masak supaya masa utk memanggang sekejap saja..
selamat mencuba...
opic: Kuah yong tau foo sedap
Rohaida Rasdi
bahan-bahanny:-
10 tangaki cili kering -(klu nak wat lebih tambahkan)
2 ulas bawag putih
belacan
air, minyak masak.
gula merah
bijan yang telah di goreng tanpa minyak.
sikit tepung jagung utk pekatkan kuah.
asam keping.
caranya:-
-kisar cilikering+ belacan+ bawang putih dan tumis dgn sedikit minyak hingga naik bau.
-masukkan air + gula merah+ garam +asam keping secukup rasa.
-masukkan tepung jagung utk memekat kan kuah ( di bancur dgn sedikit air)
-akhir sekali masukkan bijan yg telah digoreng tanpa mnyak.
-dah siap... boleh leh di jadikan pececah Yong Tau Foo yg telah siap di wat sup @ direbus.
selmat mencuba..
Topic: Satay Goreng Berkuah
Rafidah Hashim
Satay Goreng Berkuah
1kg daging lembu @ ayam
5 batang serai (dikisar halus)
1 1/2 sb biji ketumbar
1 1/2 sb jintan manis
1 sb serbuk kunyit
3/4 cwn gula
1/2 sb garam
2 sb minyak masak
Bersihkan daging @ ayam kemudian di potong dadu.
Campurkan semua bhn2 yg telah dikisar halus, gula, serbuk kunyit, garam dan minyak masak ke dlm daging @ ayam td.
Perap 1 mlm di tempat beku. Esoknya boleh digoreng dengan minyak yg sedikit.
Kuah Kacang
1/2 kg kacang tanah (digoreng tnpa minyak dan di mesin kasar)
4 ulas bwg kecil (dikisar halus)
3 ulas bwg putih (dikisar halus)
1 senduk cili mesin
1 mangkuk gula
3/4 mangkuk minyak
1 sb nestum
2 keping asam
garam secukup rasa
Tumiskan bhn2 dikisar dan cili hingga garing.
Masukkan air, asam keping dan kacau rata.
Masukkan kacang, gula, garam dan nestum, kacau rata kecilkan api dan masak hingga mendidih.
BAKED HONEY LEMON ROSEMARY CHICKEN
by Fauziah Abd Samad on Tuesday, 11 January 2011 at 21:02
aduh panjang lebar nama resipi kali ni. tak daapek den nak nolong. hari ni nadia yang buat. kjee tak pernah buat ayam panggang guna resipi yang kjee tengok dalam blog Dapur Tanpa Sempadan. Chef Mat Gebu punya resipilah, sapa lagi kan. Kjee percaya Nadia yang buat kerana simple sangat. mama dia sibuk buat skrip, anak didera ke dapur. apapun, memang sedaplah. kalah ayam mas. resipi ni sihat sangat sebab guna minyak zaiton. tapi kalau tak de, minyak apapun ok lah yer. kjee buat setengah ekor sebab ingatkan cukuplah untuk 3 beranak. hampeh. kene komplen ngan unclepali. ok kita tengok menunya.
BAHAN2NYA
½ ekor ayam
1½ sudu kecik rosemary kering (kalau dpt fresh mesti sedap)
2 sudu besar lada hitam biji (ditumbuk kasar)
2 sudu besar madu lebah
2 sudu besar minyak zaiton (minyak apapun boleh kot)
1 biji lemon
garam secukup rasa
CARA:
Bersihkan ayam dan lap dengan tisu towel hingga kering. sagat kulit lemon (kuning jer. jangan sampai putih nanti pahit) dan ketepikan. perah air lemon ke dalam mangkuk. tumbuk kasar lada hitam, ramas rosemary dan campur. pastu masukkan dalam mangkuk yang ada jus lemon tadi. campurkan minyak, madu dan garam. lumurkan ke seluruh ayam yang telah dicucuk2 manja dengan garfu. akhir sekali lumurkan dengan kulit lemon. perapkan dalam peti ais selama sekurang-kurangnya dua jam. kalau lebih lama lagi elok. bungkus ayam yang telah diperap dalam alluminium foil kemas-kemas. pastu bakar dalam oven bersuhu 200 darjah selama sejam. selepas itu, keluarkan dari foil dan bakar lagi selama 10 minit supaya nampak garing. kalau ayam itu besar dan berisi, tambahlah masa memasak sehingga puas hati. makanlah dengan sos cili. hidangkan bersama baked potato skins. resipi baked potato skin dah lama ada dalam Notes. selamat mencuba.
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1 ekor ikan siakap (ikan merah/kerapu atau ikan bawal putih pun ok)
1/2 camca teh garam
1/2 camca teh tepung jagung
1/2 camca teh lada sulah
3 camca besar jus limau kasturi*
1 1/2 camca besar minyak masak*
1 1/2 camca teh gula*
1/2 camca teh garam*
5 - 10 biji cili padi, dihiris*
2 batang serai, dihiris halus*
1/2 kuntum bunga kantan, dihiris*
1 helai daun limau purut, dihiris halus*
1/2 inci halia muda. dihiris halus*
2 ulas bawang putih, dihiris halus*
1/2 camca teh tepung jagung*
1/2 camca teh serbuk pati ikan bilis atau 1/2 kiub pati ikan bilis maggi*.
CARA-CARA:-
Ikan dicuci bersih dan lumurkan dgn garam, tepung jagung dan serbuk lada sulah. Ketepikan sementara membuat sosnya.
Dalam satu bekas satukan kesemua bahan sos (yang bertanda '*") hingga sebati. Ketepikan.
Panaskan kukusan dan sediakan bekas tahan panas. Letak ikan tadi ke dalam bekas tahan panas dan tuangkan sosnya rata termasuk bahagian dalam belahan perutnya.
Kukus kurang lebih 10 minit bergantung pada saiz ikan atau apa bila daging ikan bertukar menjadi putih.
Makcik tambah kubis bunga & daun bawang sebagai penyeri majlis.
.
Lemon Rosemary Grilled Chicken
Resepi nama omputih tapi masaknye tak de le sesusah mana cuma nk tunggu masak je yg agak menguji ketabahan terutama ketabahan anak-anak. Kejap2 berlari ke dapur, tanya dah masak ke belum. Lepas masak nk make-up ayam pun tak sempat. Diorang dah mengeletek kat belakang. Nasib le sempat tangkap sebagai bukti penyiaran.
Rasa dia......mmmmm, yummy yummy.
Sumber : The Naked Chef (Jamie Oliver)
1 ekor ayam sederhana besar
2 biji lemon
3 ulas bawang putih
2 sudu besar olive oil
20 gm Rosemarry Kering. Saya guna 1 1/2 sudu teh rata measurement spoon. Kalau terlebih sangat nanti pahit
Garam 2 sudu kecik (sudu plastik kfc)
Cara:
Lemon direbus sehingga empuk..agak agak lembut gitu dalam 15 minit. - Saya tak rebuspun, terus cucuk2 and sumbat dlm ayam b4 bakar
Tumbuk bawang putih dan rosemarry sehingga lumat
Gaulkan bahan yg ditumbuk tadi dengan olive oil dan campur sedikit garam.
Lemon tadi dicucuk cucuk dengan garfu..dan disumbat kedalam perut ayam
Lumurkan ayam tadi dengan bahan yg digaul tadi dan bakar didalam oven 180'c selama 1 jam atau sehingga masak.
Note: Seeloknya kalau nak makan dinner..buat petang atau pagi..perap semua dan bungkus dengan foil..pastu simpan peti sejuk..nak guna baru bakar..lagi sedap sebab herbs tu dah mesra dengan ayam
Sumber : The Naked Chef (Jamie Oliver)
1 ekor ayam sederhana besar
2 biji lemon
3 ulas bawang putih
2 sudu besar olive oil
20 gm Rosemarry Kering. Saya guna 1 1/2 sudu teh rata measurement spoon. Kalau terlebih sangat nanti pahit
Garam 2 sudu kecik (sudu plastik kfc)
Cara:
Lemon direbus sehingga empuk..agak agak lembut gitu dalam 15 minit. - Saya tak rebuspun, terus cucuk2 and sumbat dlm ayam b4 bakar
Tumbuk bawang putih dan rosemarry sehingga lumat
Gaulkan bahan yg ditumbuk tadi dengan olive oil dan campur sedikit garam.
Lemon tadi dicucuk cucuk dengan garfu..dan disumbat kedalam perut ayam
Lumurkan ayam tadi dengan bahan yg digaul tadi dan bakar didalam oven 180'c selama 1 jam atau sehingga masak.
Note: Seeloknya kalau nak makan dinner..buat petang atau pagi..perap semua dan bungkus dengan foil..pastu simpan peti sejuk..nak guna baru bakar..lagi sedap sebab herbs tu dah mesra dengan ayam
POSTED BY IDASHAZANA
AYAM MASAK HALIA ( Sumber : Chef Hanieliza )
Bahan
500 gm ayam [potong kecil dan basuh bersih]
3 s/b sos tiram ]
1/2 cawan air ] bancuh
1 s/k tepung jagung ]
1 s/k serbuk lada hitam
1 pokok daun bawang [potong pendek] – tak de, saya tukar daun ketumbar
1 biji buah tomato [belah 4]
minyak
garam
Bahan Hiris
5 cm halia
3 ulas bawang merah
3 ulas bawang putih
3 tangkai cili merah
Cara
1. Panaskan minyak dan tumiskan bahan hiris sehingga layu.
2. Masukkan ayam dan kacau rata. Masukkna sikit air dan tutup
3. Masakkan ayam sehingga lembut.
4. Masukkan bancuhan tepung jagung dan sos tiram. Biarkan sehingga pekat.
5. Masukkan tomato buah dan daun bawang. Kacau rata.
6. Hidangkan.
AYAM GORENG Kedai Mamak
by Resepi Masakan Melayu
1 ekor ayam (potong 4 atau 6 )
5 sudu makan pes bawang putih
5 sudu makan pes halia
5 sudu makan serbuk cili
2 sudu teh serbuk ketumbar
2 sudu teh serbuk jintan manis
1 biji telur
Tepung beras secukupnya
Garam secukup rasa
Minyak untuk menggoreng
Daun kari (digoreng sekejap dan ditabur pada ayam)
Caranya:
1. Gaul ayam bersama pes bawang putih, pes halia, serbuk ketumbar, serbuk ketumbar dan garam hingga sebati.
2. Perap selama 30 minit.
3. Kemudian salutkan ayam dengan telur dan tepung beras.
4. Panaskan minyak dan gorengkan ayam dalam deep fryer pada suhu 160 darjah celsius selama 15 minit atau hingga masak.
5. Angkat dan toskan. Taburkan dengan daun kari goreng dan sedia untuk dihidangkan.
Resepi AYAM PAPRIK
by Resepi Masakan Melayu
Bahan-Bahan:
½ ekor ayam - dipotong kecil-kecil
4 ulas bawang merah - ditumbuk
2 ulas bawang putih - ditumbuk
1 labu bawang besar - dimayang
2 btg serai - dititik
2 biji buah tomato - dipotong 4
5 biji cili padi - ditumbuk
bunga kobis, kacang buncis/panjang, karot dan jagung muda
sedikit sos tomato, sos cili, sos tiram dan kicap manis
bahan-bahan perasa
Cara:
1. Panaskan kuali. gorengkan ayam (agak-agak sampai masak, jangan terlalu garing).
2. Masukkan bawang merah, bawang putih dan cili yang ditumbuk, kacau sekejap.
3. Masukkan sos tomato, sos cili, sos tiram dan kicap manis Biarkan mendidih sekejap dan masukkan pula sedikit air. Masukkan serai, daun limau purut dan sayur-sayuran.
4. Apabila sudah mendidih, masukkan bawang besar dan buah tomato. Semasa menghidang, perahkan limau kasturi.
AYAM MASAK MERAH
bahan2;
1 ekor ayam[potong sedang2 la,bersihkan letak garam n kunyit dan goreng]
10 biji cili kering
2 biji bawang besar
5 ulas bawang putih
1 inci halia
1 btg kulit kayu manis
1 1/2 cwn sos cili kimball
2 cwn air
2 biji bawang besar potong bulat
cara2;
1; tumis bahan blender hingga naik minyak ,masukkan kulit kayu manis.
2;masukkan sos cili dan air
3;masukkan ayam yg digoreng tadi dan masukkan bawang besar
4;masak hingga agak pekat dan perasakan garam dan ajinomoto.
5;hidangkan.
SIAKAP SWEET SOUR
bahan2;
1 ekor ikan siakap dibersihkan dan digoreng
1 cwn sos cili kimball
air secukupnyer
sedikit nenas potong kecil2
sedikit bunga kobis
sedikit lobak merah
sedikit putik jagung
1 biji bawang besar dibelah 6
bawang putih 2 biji
sedikit minyak tuk menumis
hiasan;daun bawang n daun sup
cara2;
1;panaskan minyak,ketuk bawang putih dan tumis hingga kekuningan
2;masukkan air, sos,bunga kobis,putik jagung,lobak merah, bawang n nenas,perasakan dgn garam n ajino
3;masak hingga kuah nyer pekat dan tuangkan keatas ikan tadi,dan hiaskan dgn daun bawang n daun sup
4; hidangkan...
TAHU BAKAR
by Fauziah Abd Samad on Saturday, 27 November 2010 at 23:51
Oka y kita cerita lak pasal resipi nk buat tahu bakar. Kjee mmg suka sgt tahu bakar...tapi sekarang dh tak suka cos dh terlalu exposed kat tahu bakar sejak meniaga selama 6 tahun. Malah bukan sahaja tahu bakar, tetapi Kjee dh hilang semangat nk makan laksa johor dan penang fried kwayteow sejak tahu membuatnya. Bukan nAk kata apa yg kjee buat tak sedap tapi bila dah mengadapnya hari2, maka yg sedap jadi tak sedap. ntahlah. okay bercerita pasal tahu bakar ni. mula2 niaga dulu kjee buat sos hitam pekat yg guna base taucu manis. ala macam sos yong taufu tu. lama gak kjee guna resipi tu. resipi dia ala rasa cina. satu hari ada member datang gerai. dia bagi resipi ni untuk sos tahu bakar. semuanya ada lima item...sama sukatan. kalu guna cawan make sure yg sama. 1. cili kisar 2. gula. 3. air asam jawa. 4. petis. 5 air sejuk (paip). campur semua bahan ni pastu masak atas api sampai dia melegak dan pelankan api sampai dpt kepekatan yg kita nak. itu resipi asal member tu. tapi kjee ni buat sikit perubahan. sebenarnya, cili kering yg diblend tu boleh nak agak kepedasannya. so kjee hati2 bila mencampurnya. kekadang tiga suku cawan dan kekadang setengah jer. gitu juga ngan petis. kekadang setengah cawan jer takut masin sangat. pastu kjee ubah lagi. cili yg dah blend tu sebelum dicampurkan ke dalam periuk, kjee campur dulu ngan air sejuk satu cawan tadi dan kjee tapiskan ke dalam periuk. sebab? kan masa kita blend cili tadi walaupun nampak halus tapi tak halus sgt sebenarnya. so bila ditapis ngan air tadi kita akan dpt result sos yg halus dan cantik. ok bab sos dh siap. skrg camner nk buat tahu bakar. korang mesti ada tempat membakar. kalau ada oven toaster lagi baik. belilah tahu yg dah goreng. cina panggil taupok yg empat segi. pastu belah ikut tepi tapi jgn sampai putus. susun kat pembakar dan bakar. bila dh puas hati ngan kegaringannyer, korang angkat dan susunkan timun dan sengkuang yg telah diricik halus ditengah2 tahu tadi. tutup atau kepitkan tahu tu dan potong dua ke empat ker. pastu siram sos dan tabur kacang tanah yg telah ditumbuk halus. yg dh siap pun ada jual. selamat mencuba. kalo dh buat pls bagitau...jadi ke tidak yer. Oh ya lupa nk bagitau. sos ni bleh simpan lama dlm fridge dengan syarat korang x abiskan...juga diguna untuk sos sotong kangkung ker or rojak buah.
CHICKEN DRIED CHILI
BHN:
isi ayam-dpotong dadu dan dgaul ngn tpong gandum dan serbuk lada putih
daun bawang-asingkan bahagian bawah dan atas daun bawang
bawang besar-hiris kasar
halia muda-hiris kasar
segenggam cili kering
DAUN KARI
serbuk lada putih
sos tiram(lee kum kee)
kicap pekat
stok ayam
garam
gula
air
CARA:
goreng isi ayam td
angkat dan ketepikan
panaskan minyak
bile dh minyak btul2 panas,tutupkan api
masokkan cili kering
gaul n on kan api semula
*untuk elakkan cili kering hangus
trus masokkan halia muda,bahagian bawah daun bawang,bawang besar,DAUN KARI dan ayam td-gaul sampai naik bau dgn api besar
• kemudian boh sume bhn perasa dan air
renih ngn api yg besar
then,pas tutup api,trus boh daun bwg bahagian atas td kemudian tutup 5 minit
sedia dihidang...
•
Resepi sedap: Ayam goreng berempah
Bahan 1 (dikisar)
1 inci Halia
1 inci Kunyit hidup
3 batang serai
5 ulas bawang putih
Bahan 2
Beberapa ketul Ayam (4 atau 5)
½ sudu jintan manis
½ sudu jintan putih
1 sudu ketumbar
1 biji telur
daun kari
garam
Cara-cara memasak
1. Perap ayam dengan semua bahan 1 yg dikisar dan bahan 2 selama 45 minit atau sejam.
2. dengan api yg sederhana, goreng ayam tadi sehingga garing
3. Sedia dihidang ! sedap dimakan ketika masih panas
p/s : jintan manis, jintan putih dan ketumbar boleh juga ditumbuk (mengikut selera masing2) dan boleh juga digantikn dgn rempah kari ayam..
Balas | Petikan
tumbuk halia dengan bawang putih, pastu perap kat ayam.. letak garam kunyit sikit.. pastu goreng. pun sodap jugak.. wangi.. (^_^) but kena hati2.. bahan perap tu senang hangit.. hee..
Balas | Petikan
kalo goreng dgn tepung adabi + telur, lg best..! masyuk cam kt KFC..hehe
Balas | Petikan
em.. saya dah buat tapi tak guna bawang putih..
saya blendkan daun kari. , gaulkan dgn serbuk kari dan sedikit sebuk cili .pasti ada kelainan. lain2 sama aje. Ingat daun kari kena banyak. Baru baunyer…. tak terhingga..ummmpph
cam sedap resepi nie.tapi klau isi banyak daun kari,lagi best.jadi rangup.eym…yummy
ayam tu kalau boleh kelar2 kan bru rmpah masuk kat dalam!!
cooks something simple today :)) TQVM to TA Rita Norlitah Hashral for d recipe.
cha twisted frm chic to udang...so TA cha C&P d recipe yea?
Bahan nya..
Ayam (potong kecil dn perap dgn lada sulah) - cha gunakan udang
Bawang merah yang kecil lagi elok.. (guna byk jugak bawang nie,ayam setengah ekor, bawang dlm 10ulas ditumbuk halus)
Serbuk kari ikan
Kicap pekat/ kicap biasa secukupnya
Daun kari secukupnya
Gula sedikit( lebih kurang 2 sudu makan gitu)
Caranya;
-ayam yg diperap tadi digoreng dulu biar masak jugak lah..tapi jngn terlalu kering..lalu ketepikan.(pakai lah non -stick pan supaya elok jer tak lekat kat kuali)
-minyak masak taruk dalam kuali dalam 5 sudu makan ,lalu tumis daun kari dulu,kemudian-tumis bawang merah yg ditumbuk tadi, tumis hingga bawang lembut dan kuning sedikit, dah layu bawang tuh, masokkan gula sikit je supaya tak lah pahit sangat ada balance kan rasa dia.
-kemudian masukkan ayam tadi,gaul dulu biar rata then taburkan serbuk kari secukup rasa....serbok kari masokkan macam tu jer..agak agak lah..takmo bnyk dan takmo sikit sngat..
-gorengkan sekejap kemudian masukkan kicap biasa /kicap pekat dan gaulkan rata.kalau masukkan kicap biasa kena agak agak sikit..jngn terlalu bnyk,rasa rasa lah pastu gaul gaul kejap..Bole jg klu nk tmbh garam dn perasa.
***** UTK UDANG VERSION
cha tumis as above method (biarkan sedikit pekat..then addkan udang kerana udang cepat masak )..
Hari ini saya masak briyani KAMBING..mbekkkmbekkkk
NASI BRIYANI
Bahan nya
3 kilo beras briyani (beli jenis yg baik di rendam 1/2 jam dan ditoskan buang air nya)
1 tin kecil minyak sapi 500gram (Ta tak guna semua, Ta guna 1/2 then campor ngan canola oil) health reasons.
2 biji bawang besar dihiris
rempah tumis 4 beradik (kayu manis 1 btng, bunga cengkih 6 biji, pelaga 6 biji, lawang 2 biji
1 tin susu cair
paste bawang besar kisar, halia kisar dan bawang putih kisar..
daun pandan
Cara nya
Panaskan periuk, taruk minyak sapi, tumis bawang hiris, rempah 4 beradik, lalu masokkan sekali 1 sendok kecil halia kisar,
1 sedok kecil bawang besar kisar, 1 sendok kecik bawang putihl kisar.
Tumis semua biar sebati, kemudian taruk air dan daun pandan 1 ikat. Dah didih, masokkan susu cair, beras, garam daun ketumbar dan daun pudina yg sudah dipetik petik. Masak biar nasi tanak,NASI DAH MASAK... lastly masokkan saffron (koma koma) yg sudah direndam dngan sedikit air mawar. saffron ngan air mawar nie masokkan buat kan satu putaran jer..pastu biarkan nasi tu tanak dulu..jangan dikacau dulu ye NANTI NASI HANCUR TAK CANTIK!! dah lama sikit nasi tu kerok dari tepi dan tolak ketengah..(KALO TAKDE SAFFRON BLEH SAJE LETAK PEWARNA KUNING ATAU OREN SEDIKIT JER)
(SUKATAN UNTUK NASI 1CUP BERAS BRIYANI=1 1/2 CUP AIR) AIR NYA PULA NAK KIRA NGAN SUSU TU SEKALI YE.
DAGING MASAK MASALAHHH
Bahan nya
untuk 1 kilo daging
1 kilo daging kambing atau lembu
4 biji bawang besar dihiris halus dan digoreng seperti bawang goreng dan ketepikan.
4 batang lada hijau dikisar halus
4 batang lada merah dikisar halus
5 biji tomato dipotong kecil
2 sudu besar bawang besar kisar(paste)
1 sudu besar bawang putih kisar(paste)
1 sudu besar halia kisar(paste)
2 sudu besar rempah briyani
2 genggam badam dikisar
2 genggam gajus di sangrai atau digoreng
3 sudu besar tairu(yogurt)
secekak daun ketumbar
garam dan perasa
minyak untuk menumis
Cara nya
Dalam kuali, panaskan minyak, tumis bawang hiris lalu ketepikan..
Tumis semua bahan yng dikisar. Biarkan sebentar, kemudian masokkan buah tomato.Masokkan pula bawang yg dah digoreng, tairu,rempah briyani,badam kisar dan gajus.
Masokkan kan pula daging dan kacau hingga rata.Masok garam, perasa dan daun ketumbar.Masak hingga daging empuk dan kuah menjadi pekat...kemudian bolehlah di dam kan ke nasi briyani tadi...
kakbesah@myresipi.com
sekali lg.. hb suruh tempek respi kt sini lauk pebret dia.. akk okeh je lah.. (isteri yg taat la katakan.heheh)
ra Azmira Syah
as-salam...rakan KR..sy nk tnya pada sesapa yg tahu resepi nk buat udang butter,jika ada yg tahu minta share resepi ye thnks....jasa mu di kenang... (^^,)
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Ezza Aziz udang gaul ngan tepung jagung/ubi...goreng 1/2 masak. panaskan butter..tumis bawang puith cincang@tumbuk...cili padi cincang/hiris..daun kari....dah garing masukkan telur yg dipukul hingga sikir kembang...kacau laju2...& masukkan udang...gaul rata & toskan butter tadi...
Bahan-bahan ( 6 ekor )
• 3 biji bawang merah, 3 ulas bawang putih, segenggam cili api, segenggam ikan bilis - kesemuanya ditumbuk.
• 2 biji tomato - dicincang halus
• 1/2 biji limau nipis diambil jusnya @ 1/2 sudu teh asam jawa
• garam & gula secukup rasa
Cara-cara
1. gaul rata semua bahan2. suaikn rasanya. sumbatkan ke dalam perut ikan hingga padat. ikat perut ikan dgn benang kapas supaya sambal x terkeluar.
2. goreng dalam minyak yg sedikit hingga masak. halakan belahan ikan ke tepi kuali supaya sambal x kelur semasa digoreng
3. siap.. bleh mkn..!
Tag
ra Azmira Syah
as-salam...rakan KR..sy nk tnya pada sesapa yg tahu resepi nk buat udang butter,jika ada yg tahu minta share resepi ye thnks....jasa mu di kenang... (^^,)
5 hours ago • Like •
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Ezza Aziz udang gaul ngan tepung jagung/ubi...goreng 1/2 masak. panaskan butter..tumis bawang puith cincang@tumbuk...cili padi cincang/hiris..daun kari....dah garing masukkan telur yg dipukul hingga sikir kembang...kacau laju2...& masukkan udang...gaul rata & toskan butter tadi...
ayam masak halia.puan2 mesti tahu masak n kan tapi amy saje jew letak resepinya kat cni ye.
bahan2...
1keping dada ayam
1/2 bj bawang merah*
4 ulsa bawang putih*
halia 3 inci dihiris halus2...
cili padi sedikit.kalo nak pedas boleh tambah ye..*
2sdb sos tiram.
air sedikit
hiasan..
bawang besar
daun bawang
daun sup
cara2....
tumbuk bahan2 yg bertanda.selepas tu tumis ye hingga naik bau..dah tu masukkan dada ayam tadi...gaul seketika dan masukkan sedikit air.tutup kuali dan biarkan dalam beberapa minit tuk bg masak ayam tu.bila dah ok bolehlah masukkan sos tiram,garam n ajinamoto.gaul selepas tu bolehlah masukkan bahan hiasan.bawang besar,daun sup dan daun bawang sedikit.siap.boleh makan...masakan yg simple tapi sedap....
AYAM MASAK BOMBAY
recipe dari fren FB.tqvm pd PN Rita Norlitah Hashral krn share dis recipe..it's so simple & mmg sesuai utk pn2 yg bekerja dan x suka spend bnyk masa kat kitchen
AYAM MASAK BOMBAY
1 KG KEPAK AYAM
2 BIJI BAWANG BESAR
5 ULAS BAWANG PUTIH
2 INCI HALIA
1 SENDOK CILI KISAR
3 SUDU BESAR KICAP MANIS
3 HELAI DAUN KARI
2 BATANG SERAI DITITIK
1 SUDU TEH LADA SULAH/PUTIH
CARA NYA
KISAR BAWANG, BAWANG PUTIH DAN HALIA.
PERAPKAN KESEMUA BAHAN TERSEBUT DENGAN KEPAK AYAM SELAMA 1/2 JAM.
PANAS KAN KUALI,PANASKAN MINYAK &
MASOKKAN AYAM DAN KESEMUA BAHAN YANG DIATAS.
TUTUP KUALI, MASAK DENGAN API KECIL SEHINGGA PEKAT JANGAN DILETAK AIR...AYAM ITU SENDIRI AKAN MENGELUARKAN AIR DENGAN SENDIRI NYA..BUBUH GARAM DAN PERASA..SETTLED!
udang mentega.my fav n.hehehe
resepi by nurzuhaila.tqvm bab dah share resepi n...
resepinyer:
-udang +serbuk kunyit n garam pas2 grg.....
-grg daun kari n cili padi...pas2+ngan udang td...
-sy letak telur sebiji tp ada org letak merah telur jerk...so sy + susu cair+garam sket.....
-pas2 grg telur ngan mentega(sy bubuh lebih kurang 5-6 sudu bsr)kacau sedikit demi sdikit....ada org ltk 1sb bsr mentega....
-bila telur dh garing,tapiskantelur td cz byk minyak.....
-pas2 gaulkan telur td ngan udang yg dh grgr td....
-hidangkan mkn ngan nasi panas.
Ieka Aleeya
nk tnya pada kwn2 kt KR ni blh tk bg resepi untk buat perap dgng,ayam,ikn dll sbb hr ahad ni nk buat BBQ kt rmh emk ngn family...tk tau lh bahan2 nk buat perap BBQ tu....plzzzzz
5 hours ago • Like •
Nanie Erney Perap...biasa ja..
Serbuk kunyit,bwg putih/kisar,gula mau byk,garam,minyak ckit ja...klu perap lma lg bgus n sdp 2,3ari perap
5 hours ago • Like
Seri Yazi klo gne madu x sdp ke?
Nanie Erney Buli jua tem bkar sapu madu..
Inna Azlina bawag puth, halia, kunyit, jintan manis, ketumbar, gula melaka/nise(bhs kelate) dan garam.........semua di blend
Marizah Miza try cara ni...sy tgk chef wan wat...sy dah try...mmg sedappp....sos tomato...mustard...serbuk cili...myk masak...bawang merah dicincang...garam...gula...cuka sket...perap semalaman...air dari perapan tu...amik...masak jap smpai mendidih...wat siram msa bakar ayam
Laily Saleh versi belasah saye...bawang putih,bawang merah,halia,oyster sos, rempah kari skit, gula, garam, kasi blend sume...jgn lupe lada hitam...buh air coke tau...perap semalaman.....bile buh air coke..rasa dia lain tau...sedap...
20 minutes ago • Like
2. Satay dan Kuah Satay
Satay. Kjee dibesarkan dengan satay. Arwah mak kata, Kjee dilahirkan dalam dulang satay. Yelah tu. Kononnya masa dia dah sarat sangat mengandungkan Kjee, dia masih bantu ayah dia cucuk satay. Tup2 masa tengah cucuk satay, sakit nak beranak. Pastu masuk dlm rumah terus Kjee keluar.
Ya ker...jadi taklah beranak dalam dulang satay...Merepeklah mak.. risau kjee dengar. Datuk Kjee dulu jual satay. Memang famous satu Malaya. Di Kuala Lumpur, sebut Majid Satay semua kenal. Satay dia sedap sangat.
Dulu masa kecik, datuk Kjee meniaga di Campbell Road. Setelah dia tiada, kami membuka Restoren Satay Anika di Bukit Bintang Plaza.. Sekarang Satay Anika dan datuk dah tak de. Tapi sepupu2 Kjee ramai yg masih jual satay ikut resipi datuk kita. Nasib baiklah dia orang jual. Kalau tidak, susahnya Kjee sebab susah nak selera makan satay orang lain...hehehe maaf ya.
Hari ni Kjee nak bagi resipi Raja Satay Malaysia iaitu Majid Satay.Rahsia buat satay ialah kita mesti gunakan daging batang pinang. Memanglah mahal sikit tapi kalau daging biase, keras. Resipi yang ada pada Kjee guna kati so Kjee tukar ke kilo ya. Kita tengok resipi dia.
Bahan2nya: (SATAY)
600 gram daging batang pinang.
1 cawan gula pasir
2 batang serai
2 sudu besar kacang tanah
1 sudu besar garam
1 sudu besar serbuk kunyit
caranya:
Daging dibersih2kan urat2 dan lemaknya dan dihiris halus dalam sebesar ibu jari. Kacang tanah disangai tanpa minyak dan dibuang kulitnya. Ricik serai dan tumbuk halus, asingkan dan tumbuk pulak kacang tanah. Masukkan dalam besen semua bahan seperti gula, garam, kunyit serbuk dan serai serta kacang tumbuk tadi. Gaul rata. Pastu masukkan daging tadi dan gaul sampai rata betul2. Perap selama dua jam. Jangan bubuh sebab air daging tu akan keluar setelah diperap hampir dua jam. Pastu, cucuklah guna lidi daun kelapa atau sekarang orang pakai lidi buluh. Kemudian bakarlah atas tempat bakar yang guna arang. Amik sebatang serai diketuk2 sikit, Kemudian bubuh sikit minyak dalam mangkuk campur air sesudu. Pastu celupkan serai dalam minyak dan tepuk atas satay masa bakar. Balik2kan. Hati2 jangan terbakar lidinya atau daging hangus. Satay ayam pun sama caranya. Beli isi dada ayam.
(KALAU NAK BUAT SATAY GORENG, TAK PAYAHLAH CUCUK DAGING PERAP. GORENG SAHAJA DAN CURAHKAN KUAH DIATASNYA. ATAU DIMASUKKANA SATAY YANG TELAH DIGORENG DALM PERIUK KUAH)
KUAH SATAY
Ada macam2 versi kuah sate. Keluarga sebelah bapak Kjee kat Melaka pun jual sate. Dia orang bubuh biskut Marie sebab nak bagi kuah dia pekat. Ntahlah Kjee dah lupa rasenyer. Tapi kuah sate Majid Satay guna kacang tanah 100% so very de ori. Pastu kita orang guna gula Melaka bukan gula putih. Gula melaka lagi lemak kata arwah mak. Resipi untuk kuah ialah:
bahan2nya
600 gm kacang tanah yang telah disangai
5 biji bawang besar
½ cawan cili kering dikisar
1 cawan gula melaka
1 cawan minyak
garam secukup rasa
Cara:
Kacang tanah mestilah cukup masak sewaktu disangai. Dibuang kulit, disejukkan dan direndam seketika sebelum dikisar. Ketika kisar dalam blender, guna air secukupnya untuk gerakkan blender. Jangan terlalu banyak sangat air.
Bawang besar di mayang. Kemudian panaskan periuk guna 1 cawan minyak dan tumislah bawang hingga wangi. Kemudian masukkan cili kering kisar dan goreng sampai naik minyak. Apabila sudah naik minyak, masukkan kacang yang telah diblend. Air juga dimasukkan sebenyak kira2 dua cawan. Bila sudaha melegak, masukkan gula melaka dan garam.
Kuah satay akan menjadi pekat apabila ia sudah sejuk. Jadi, pandai2lah nak agak banyak mana air yang hendak diletak.
Selain makan satay dengan kuah dan nasi himpit, sedap jugak kalau dihiris bawang, cili api bubuh kicap dan dimakan bersama satay. Hmmm sedapnya. Selain itu, hirisan timun juga suatu kemestian. Selamat mencuba.
Posted by Kjee at 3/21/2011 10:08:00
Ayam Masak Merah Madu
Ayam Masak Merah Madu
Resepi : DayangJack@DapurKu SaYang
bahan-bahan :
• 1 ekor ayam (dipotong ikut suka dan digoreng hingga 3/4 masak)
• rempah 4 sekawan (buah pelaga, kayu manis, bunga lawang dan cengkih)
• cili giling secukupnya
• sos cili secukupnya
• 2 keping asam gelugur
• 4-5 sudu besar madu (dibancuh dengan sedikit air)
• 1 labu bawang besar (dihiris bulat)
• 1 sudu besar sos tiram
• garam
bahan-bahan kisar :
• 10 biji bawang merah
• 4 ulas bawang putih
• 1 inci halia
• 1 inci lengkuas
• 2 batang serai
Cara-cara :
1. Panaskan minyak secukupnya di dalam kuali atau periuk. Tumis bahan-bahan kisar dan rempah 4 sekawan hingga wangi. Kemudian masukkan cili giling dan tumis lagi hingga pecah minyak.
2. Masukkan sos tiram dan sos cili secukupnya. Kacau rata-rata. Kemudian masukkan air secukupnya. Kacau lagi hingga mendidih.
3. Masukkan ayam, bancuhan madu, garam dan asam gelugur. Gaulkan sebati. Akhir sekali masukkan bawang besar.
4. Setelah ayam masak, tutupkan api. Angkat dan hidangkan bersama nasi putih atau nasi tomato.
5.
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