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"Latar Belakang. Propofol merupakan salah satu jenis obat induksi intravena yang paling sering digunakan dalam pembiusan umum tetapi propofol dapat menimbulkan rasa nyeri pada lokasi injeksi dengan angka kejadian hingga 88%. Penggunaan campuran lidokain dalam propofol dapat mengurangi nyeri tersebut, akan tetapi nyeri masih dapat terjadi, sementara penggunaan premdikasi lidokain perlakuan torniket jarang digunakan karena prosedur yang lebih lama dan tidak semudah campuran lidokain. Tujuan penelitian ini adalah untuk mengetahui perbandingan premedikasi lidokain perlakuan torniket selama 1 menit dan campuran lidokain untuk mengurangi derajat nyeri pada saat induksi anestesi menggunakan propofol.Metode. Penelitian ini merupakan uji klinis tersamar tunggal, bersifat eksperimental. Pasien dengan kriteria klinis ASA I-II sejumlah 50 orang dilakukan randomisasi sederhana menjadi 2 kelompok perlakuan dan mendapatkan perlakuan premedikasi lidokain 40 mg iv dengan perlakuan torniket selama 1 menit, diikuti injeksi propofol dan derajad nyeri dinilai berdasarkan verbal rating score. Kelompok lainnya dilakukan pemberian campuran lidokain 40 mg iv dalam propofol dan dilakukan injeksi campuran tersebut serta dilakukan penilaian Verbal Rating Score.Hasil. Hasil penelitian menunjukkan pemberian lidokain perlakuan torniket dapat menurunkan derajad nyeri yang lebih baik (96% tidak nyeri, 4% nyeri ringan)) dibandingkan kelompok campuran lidokain dalam propofol (40% tidak nyeri, 44% nyeri ringan, 16% nyeri sedang) dengan nilai p = 0.000 (p bermakna < 0.05) pada uji statistik menggunakan mann whitney.Kesimpulan. Kesimpulan dari penelitian ini bahwa premedikasi lidokain perlakuan torniket bermakna secara klinis dan statistik dalam menurunkan derajat nyeri propofol dibandingkan pemberian campuran lidokain dalam propofol.

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Background. Propofol is one of the intravenous anesthesia drugs mostly used in general anesthesia but It might cause pain during injection with the incidence until 88%. The technique using premixed lidocaine with propofol is commonly used to reduce the pain, but incidence of pain during the injection still can happen, while the use of lidocaine premedication with torniquet is not common due to complicated and longer time to perform the procedure. The aim of the study is to compare the premedication using torniquet for 1 minute and premixed lidocaine with the degree of pain during anesthesia injection with propofol.

Methods. This research is a single blind experimental study. Total of 50 Patient with ASA I-II were divided into two groups using simple randomized method and received 40 mg of iv lidocaine and torniquet performed for 1 minute, followed with propofol injection and pain evaluation using verbal rating score. The other group were given lidocaine 40 mg mixed with propofol and followed with injection of the mixing and evaluated for Verbal Rating Score.

Result. The result of this study described that premedication of lidocaine using torniquet can decrease degree of pain better than premixed lidocaine and propofol (no pain 96%, mild pain 4% versus no pain 40%, mild pain 44%, moderate pain 16%) with p value of 0.000 (significant p < 0.05) using mann whitney statistic test.

Conclusion. Conclusion of this research is that premedication of lidocaine using torniquet is clinically and statistically significant in reducing degree of propofol pain injection compare with premixed lidocaine in propofol."

"Propofol merupakan agen anestesi intravena yang paling banyak digunakan karena menghasilkan anestesi yang baik dengan masa pulih singkat. Namun sering disertai nyeri saat injeksi sampai dengan 70-90% pasien. Di Rumah Sakit Saiful Anwar Malang, nyeri sering diatasi dengan pencampuran lidokain tetapi angka kegagalannya masih mencapai 32%. Sedangkan ondansetron (diberikan sebagai anti muntah) terbukti mengurangi nyeri akibat injeksi propofol sehingga dipilih untuk diujikan pada penelitian ini karena tidak menambah biaya tetapi hanya merubah waktu pemberian. Tujuan penelitian ini adalah mengetahui perbandingan nyeri premedikasi ondansetron dengan pencampuran lidokain saat induksi anestesi menggunakan propofol di Rumah Sakit Umum Dr. Saiful Anwar Malang. Pasien ASA I dan II sejumlah 50 orang yang menjalani operasi elektif dengan pembiusan umum menggunakan Propofol di Instalasi Bedah Sentral Rumah Sakit Umum Dr. Saiful Anwar Malang. Sampel dirandomisasi sederhana menjadi dua kelompok perlakuan yaitu kelompok Lidokain (lidokain 40 mg dicampurkan dalam 100 mg Propofol yang kemudian disuntikkan intra vena) dan kelompok Ondansetron (injeksi ondansetron 4 mg intra vena 1 menit sebelum propofol). Derajad nyeri kemudian dinilai berdasarkan Observer Pain Scale (OPS) oleh peneliti. Hasil penelitian menunjukkan bahwa ondansentron (68% pasien tidak nyeri, 20% nyeri ringan, 8% nyeri sedang, dan 4% nyeri berat) mengurangi nyeri yang sebanding dengan pencampuran lidokain (72% pasien tidak nyeri, 20% nyeri ringan, dan 8% nyeri sedang) dengan nilai p = 0,700 (p bermakna < 0,05) pada uji Mann Whitney. Kesimpulan dari penelitian ini bahwa premedikasi ondansetron mengurangi nyeri yang sebanding dengan pencampuran lidokain saat induksi anestesi menggunakan propofol di Rumah Sakit Umum Dr. Saiful Anwar Malang.

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Propofol is the most popular intravenous anesthetic agent used. Propofol is a good anesthetic agent with short recovery time but often accompanied with pain in 70-90% patient. Lidocaine mixture is often used in Saiful Anwar Hospital Malang to relief pain but still with 32% failure. While ondansetron (antivomiting agent) proven to reduce pain caused by propofol injection, therefore chosen to be used because it will not increase medical cost by only changing time of injection.

Purpose of this research is to compare pain score between ondansentron premedication with lidocaine mixture during anesthesia induction with propofol in Saiful Anwar Hospital Malang. All 50 patients diagnosed with ASA I and II undergo elective surgery in Sentral Operating Theater Saiful Anwar General Hospital with general anesthesia using Propofol is our sample. All sample undergo simple randomization into two groups. First is Lidocaine Group (Lidocaine 40 mg mixed in 100 mg Propofol and injected intravenously). Second is Ondansetron Group (Ondansetron 4 mg injected intravenously 1 minute before propofol). Pain score is evaluated with Observer Pain Scale (OPS) by the researcher.

Our result shows that ondansentron (68% patient has no pain, 20% mild pain, 8% moderate pain, and 4% severe pain) reduce pain similar with lidocaine mixture (72% patient has no pain, 20% mild pain, and 8% moderate pain) with p value = 0,700 (p significant < 0,05) with Mann Whitney test. Conclusion of this research is that ondansetron premedication reduce pain similar with lidocaine mixture during anesthesia induction using propofol in Saiful Anwar Hospital Malang."

"Latar Belakang. Propofol merupakan obat anestesi intravena yang paling sering digunakan dalam pembiusan umum tetapi propofol dapat menimbulkan rasa nyeri pada lokasi injeksi dengan angka kejadian 28-90%. Pemberian lidokain sebelumnya paling sering digunakan untuk mengurangi nyeri yang ditimbulkan propofol, akan tetapi tingkat kegagalannya 13-32. Tujuan penelitian ini adalah untuk mengetahui perbandingan pemberian pre-emptive ketamin 0,1 mg/kg dan lidokain 1 mg/kg untuk mengurangi derajat nyeri pada saat induksi anestesi menggunakan propofol. Metode. Penelitian ini merupakan uji klinis tersamar ganda, bersifat eksperimental. Pasien dengan kriteria klinis ASA I-II sejumlah 50 orang yang akan menjalani operasi elektif dengan pembiusan umum, dilakukan randomisasi sederhana menjadi 2 kelompok yaitu kelompok I (lidokain 1 mg/kg) dan kelompok II (ketamin 0,1 mg/kg) yang diberikan 1 menit sebelum induksi propofol. Derajat nyeri dinilai berdasarkan Verbal Rating Scale (VRS).Hasil. Penelitian menunjukkan pemberian pre-emptive ketamin dapat menurunkan derajat nyeri yang lebih baik (84% tidak nyeri, 16% nyeri ringan) dibandingkan kelompok pre-emptive lidokain (56% tidak nyeri, 28% nyeri ringan, 12% nyeri sedang dan 4% nyeri berat) dengan nilai p = 0.021 (p bermakna < 0.05) pada uji statistik menggunakan Mann Whitney.Kesimpulan. Pemberian pre-emptive ketamin 0.1 mg/kg BB intravena lebih baik dibandingkan dengan pemberian pre-emptive lidokain 1 mg/kg BB untuk mengurangi derajat nyeri akibat penyuntikan propofol intravena.

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Background. Propofol is a popular IV anesthetic induction drug that causes pain when given IV. The incidence of which is between 28-90%. Lidocaine pre-treatment has been commonly proposed to decrease propofol induced pain, but its failure rate is between 13-32%. The purpose of this study was to compare a pre-emptive ketamine 0,1 mg/kg and pre-emptive lidocaine 1 mg/kg to minimize the injection pain of propofol during anesthesia induction.

Methods. A comparative, randomized, double blind study of 50 patients (ASA I-II) scheduled surgery under general anesthesia were randomly allocated into two groups. Group I received lidocaine 1 mg/kg and group II received ketamine 0,1 mg/kg one minute before the anesthesia induction with propofol IV. Each patient’s pain score were evaluated by using Verbal Rating Scale (VRS)

Result. The result of this study described that pre-emptive ketamine had significantly lower incidence of pain and lower pain score (84% no pain, 16% mild pain) compared with pre-emptive lidocaine (56% no pain, 28% mild pain, 12% moderate pain and 4% severe pain) with p value = 0.021 (significant p < 0.05) using Mann Whitney statistic test.

Conclusion. Pre-emptive ketamine 0,1 mg/kg significantly in reducing degree of propofol pain injection compare with pre-emptive lidocaine 1 mg/kg IV."

"Latar belakang: Emergence agitation (EA) selama periode pemulihan anestesia umum merupakan masalah yang sering ditemukan pada pasien anak. Etiologi EA pada pasien anak belum sepenuhnya diketahui, faktor-faktor risiko yang dianggap memengaruhi terjadinya EA diantaranya usia prasekolah, penggunaan gas anestesia modern, kemampuan adaptasi yang rendah, dan kehadiran orangtua selama proses pemulihan. Penelitian ini bertujuan untuk mendapatkan angka kejadian dan faktor-faktor yang memengaruhi terjadinya EA pada pasien anak yang menjalani anestesia umum inhalasi di RSUPN Cipto Mangunkusumo. Metode: Tujuh puluh delapan anak berusia 2-12 tahun dengan status fisik ASA I, II dan III dimasukan dalam penelitian observasional ini. Perilaku anak selama induksi anestesia dinilai berdasarkan nilai Pediatric Anesthesia Behavior (PAB). Di ruang pemulihan kejadian EA dinilai berdasarkan skala Aono pada saat pasien tiba (T0), setelah 5 menit (T5), 15 menit (T15) dan 30 menit (T30). Hasil: Angka kejadian EA pada pasien anak yang menjalani anestesia inhalasi di RSUPN Cipto Mangunkusumo mencapai 39,7%. Angka kejadian EA lebih tinggi pada pasien dengan usia 2-5 tahun yang memiliki nilai PAB 2 atau 3. Midazolam, jenis gas anestesia, dan keberadaan orangtua selama pemulihan tidak berhubungan dengan kejadian EA. Kesimpulan: Usia dan perilaku anak selama induksi anestesia memiliki hubungan yang kuat terhadap terjadinya EA. Pasien anak dengan usia 2-5 tahun yang memiliki nilai PAB 2 atau 3 dan akan menjalani anestesia umum inhalasi sebaiknya mendapat terapi pencegahan untuk menurunkan tingkat kejadian EA.

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Background: Emergence agitation (EA) during recovery from general anesthesia has been identified as a frequent problem in the pediatric population. The etiology of EA in children is not fully understood but possible risk factors that have been presumed to be associated with the high incidence of EA include pre-school age, newer inhalation anesthetics, poor adaptability, and parental presence during recovery. The aim of the present study was to assess the incidence of EA and the affecting factors in children undergoing inhalation anesthesia in RSUPN Cipto Mangunkusumo.

Methods: Seventy-eight American Society of Anesthesiologists I, II and III, aged between 2-12 years undergoing inhalation anesthesia were included in this observational study. Children’s behavior during induction of anesthesia was assessed with Pediatric Anesthesia Behavior (PAB) score. In post anesthesia care unit (PACU) the incidence of EA was assessed with Aono’s four point scale upon admission (T0), after 5 min (T5), 15 min (T15) and 30 min (T30).

Results: The incidence of EA in children undergoing inhalation anesthesia in RSUPN Cipto Mangunkusumo in 39,7%. The incidence was higher in 2-5 years old children with PAB score 2 or 3. Midazolam, type of inhalation anesthetic agents and parental presence during recovery do not appear to have any bearing on the incidence of EA.

Conclusions: Age of the children and the behavior during induction of anesthesia have a strong correlation with the incidence of EA. Children with the age 2-5 years and have a PAB score 2 or 3 undergoing inhalation anesthesia should have a prophylactic treatment for decreasing the incidence of EA."

"Buku yang berjudul "Handbook of local anesthesia" ini ditulis oleh Stanley F. Malamed. Buku ini membaha tentang anesthesi, neurophysiology, dan paharmacology."

"Menelaah efek dari premedikasi ketamin rektal dalam memfasilitasi pemisahan dari orang tua dan pemasangan kateter intravena pada anak-anak , 66 orang anak berumur 3,4 + 1,8 ( mean + SD ) tahun secara acak dibagi dalam 2 kelompok sama banyak. Grup pertama mendapat ketamin per rektal ( 8 mg/kg ) dikombinasi dengan atropin rektal ( 0,02 mg/kg ) dan sebagai kelompok kontrol menerima diazepam per oral dengan dosis 0,4 mg/kg. Lebih dari setengah dari anak-anak pada kelompok ketamin (57,6%) dapat dipisahkan dari orang tua dengan mudah tanpa gelisah, memberontak ataupun menangis, dibandingkan dengan kelompok kontrol diazepam (42,4%; P>0,05). Akan tetapi secara statistik perbedaan tersebut tidak berbeda secara signifikan. Ada sekitar 78,8% dari anak-anak pada kelompok ketarnin yang menangis pada saat pemasangan kateter intravena, yang secara bermakna lebih sedikit dibandingkan dengan kelompok kontrol (97,0%). Efek samping dan komplikasi tidak berbeda bermakna antara kedua kelompok. Tidak ada satupun anak pada kelompok ketamin yang mengalami desaturasi oksigen (SP02<90%) atau mengalami hipersalivasi. Ketamin 8mg/kg per rektal yang dikombinasikan dengan atropin 0,02 mg/kg per rektal tidak cukup efektif untuk premedikasi anak sebelum induksi meskipun dari segi keamanan tidak berbeda dengan diazepam oral.

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Background: Good premedication in pediatric anesthesia have always been a problem in providing good anesthesia services. Many choices of-drugs prevail with their advantages and shortcomings.Objective: To evaluate the effect of rectal ketamine preoperatively in facilitating parental separation and intravenous cannulation in young children.Design: A randomized, double-blinded clinical trial.Methods: 66 children 3.4 ± 1.8 ( mean ± SD) year of age were randomly assign to two equal groups. One group received rectal ketamine ( 8 mg/kg }combine with rectal atropine (0,02 mg/kg) and for control sedation group received oral diazepam 0.4 mg/kg.Result : Many children in ketamine group (57,6%) are separated easily from their parents without struggling, crying or restlessness, however not significantly more than in diazepam control group (42,4%; P<0.05). However the effectiveness of ketamine to provide adequate analgesia during intravenous cannulation is poor, which is shown by the evidence about 78,8 % of children in ketamine group cried during intravenous catheter insertion. Nevertheless it is significantly less than control group (97,0%). Complication was not significantly different between groups. None of the children in ketamine group had SPO2 < 90% or hyper salivated.Conclusion: Rectal ketamine 8 mg/kg combine with atropine 0.02 mg/kg rectally are unreliable as premedication and when intravenous catheter cannulation is desired before induction of anesthesia is desired."

"[ABSTRAKLatar Belakang. Manajemen jalan nafas merupakan salah satu tahap yang paling penting dalam bidang anestesiologi. Salah satu jenis Alat bantu jalan nafas yang telah dipergunakan secara luas adalah Laringeal Mask Airway (LMA/Sungkup Laring). Pada pemasangan sungkup laring tanpa menggunakan pelumpuh otot membutuhkan kedalaman anestesi yang cukup, Tes klinis yang mudah, akurat dan aplikatif diperlukan untuk menghindari terjadinya komplikasi. Penelitian ini bertujuan untuk membandingkan trapezius squeezing test dan jaw thrust sebagai indikator kedalaman anestesi pada pemasangan sungkup laring dengan propofol sebagai agen induksiMetode. Sebanyak 128 pasien di randomisasi ke dalam 2 kelompok yaitu jaw thrust dan trapezius squeezing test. Seluruh pasien mendapatkan premedikasi dengan midazolam 0.05 mg/kgBB dan Fentanyl 1 mcg/kgBB. Induksi menggunakan propofol titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saat respon motorik hilang dilakukan pemasangan sungkup laring. Dicatat keberhasilan pemasangan, dosis propofol, tekanan darah, laju jantung, dan insiden apneu.Hasil. Keberhasilan pada kelompok jaw thrust 93.8%, sedangkan trapezius squeezing test yang 90.6%. Penggunaan rerata propofol pada kelompok jaw thrust yaitu sebesar 120.34 mg, sedangkan pada kelompok trapezius squeezing test yaitu sebesar 111,86 mg. Insiden apneu yang pada kelompok jaw thrust terjadi pada 10 (15.6%) pasien, sedangkan pada kelompok trapezius squeezing test sebesar 11 (17.2%) pasien. Tidak terdapat perubahan hemodinamik yang berarti pada kelompok jaw thrust sedangkan sedangkan pada kelompok trapezius squeezing test terdapat perubahan hemodinamik yang berarti di menit ke 3 dan ke 4Kesimpulan. Trapezius squeezing test tidak lebih baik daripada jaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring.

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ABSTRACTBackground. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.;Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion., Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.]"

"Akhir-akhir ini efek analgatik daun jambu meta mulai diteliti orang, bahkan penelitian ini sudah sampai pada sukarelawan sehat dan uji klinik, dan perusahaan jamu telah ada yang memasukkan daun jambu mete ke dalam komposisi jamu pegel Iinu. Selama ini sediaan yang dipakai untuk penelitian masih berupa infusum, sehingga dosis pemberian cukup besar (25 9/50 kgBB) serta ada rasa kurang enak yang menyebabkan mual dan muntah. Bertitik tolak dari hal-hal tersebut di atas, maka tujuan penelitian ini adalah menyiapkan sediaan bentuk ekstrak sehingga dosis pemberian menjadi lebih kecil.Penelitian ini dilakukan dalam 3 tahap. Pada tahap I, diuji efek analgetik 3 macam ekstrak yaitu ekstrak nonpolar, ekstrak semipolar dan ekstrak polar, pada tikus sebagai hewan coba. Tikus dibagi secara acak menjadi 6 kelompok perlakuan. Kelompok I tidak diberi apa-apa, kelompok II diberi suspensi povidon 5%, kelompok III diberi ekstrak alkohol 190 mg/kgBB, kelompok IV diberi ekstrak petroleum eter 190 mg/kgBB, kelompok V diberi ekstrak kloroform 190 mg/kgBB dan kelompok VI diberi dipiron 300 mg/kgBB.Hasil uji tersebut membuktikan bahwa ekstrak semi polar (kloroform) menunjukkan efek analgetik paling kuat. Disamping itu masing-masing ekstrak dilihat profil kandungan senyawa didalamnya dan ternyata ekstrak kloroform mengandung golongan polifenol dan triterpenoid. Pada tahap II, diuji efek analgetik ekstrak kloroform pada tikus. Metode pengujian sama dengan metode pada tahap I, perbedaannya adaIah kelompok III diberi ekstrak kloroform 45,5 mg/KQBB, kelompok IV diberi ekstrak kloroform 91 mg/kgBB, dan kelompok V diberi ekstrak kloroform 182 mg/kgBB. Pada tahap III yaitu tahap prediksi zat aktif, dilakukan isolasi noda terbesar golongan senyawa polifenol (Rf 0,5) dan golongan triterpenoid (Rf O,4), kemudian meIarutkannya ke dalam metanol. Larutan yang diperoleh diidentifikasi dengan gabungan kromatografi gas-spektrometri infra merah-spektrometri massa, juga dengan kromatografi cair kinerja tinggi.Dari hasil analisis statistik, terbukti bahwa ekstrak kloroform menunjukkan efek analgetik paling kuat dibandingkan dengan ekstrak yang lain tetapi masih lebih lemah dibandingkan dengan dipiron 0,300 9/kgBB dan kemungkinan ada hubungan antara dosis pemberian dengan efek analgetik yang terjadi. Sedangkan prediksi zat kandungan aktif belum dapat dilakukan karena senyawa yang diisolasi belum senyawa tunggal (belum murni).

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Many studies dealing with the effect of analgetic cashew nut leaves had been done in animals as well as in human being. Meanwhile, some Herbal medicine companies included cashew nut leaves as one of the component of their product to relieve muscle and back pain. So far infusion is the preparation used in previous studies, so the dose given is high enough (25 g/50 kgBW), it had unfavourable taste and may caused nausea and vomiting. Due to the reason mentioned above, the purpose of this study is to prepare an extract form which can be used in smaller dose.This study is carried out in 3 stages. The first stage, was, preparing 3 kinds of extract namely nonpolar extract, semipolar extract and polar extract; then each of them was tested in rats to see it?s analgetic effect. The rats were randomly divided into 6 treatment groups. First group was given nothing, second group was given povidon suspension 5%, third group was given 190 mg/kgBW alcohol extract, fourth group was given 190 mg/kgBW petroleum ether extract, fifth group was given 190 mg/kgBW chloroform extract and sixth group was given 300 mg/kgBW dipyrone.The result show that semipolar extract (chloroform) gives the strongest analgetic effect. Besides that, each extract showed it?s compound profile, infact chloroform extract contains polyphenol and triterpenoid. The second stage, the chloroform extract was tested in rats. The analgesic test method was similar to the first stage. The difference was that the third group was given 45,5 mg/kgBW chloroform extract, the fourth group was given 91 MQ/KQBW chloroform extract,the fifth group was given 182 mg/kgBW chloroform extract. In the third stage, the active compound of chloroform extract was predicted, the biggest spot of polyphenol (Rf 0,5) and triterpenoid (Rf O,4) could be isolated and then dissolved it into methanol. The solution was identified by combined gas chromatography-infra red spectrometry-mass spectrometry and also high pressure liquid chromatography.From statistical analysis, it was proven that chloroform extract had the strongest analgesic effect and there might a dose-effect relationship. Unfortunately, the active compound still could not predicted because the isolated product was not pure yet."

"Latar belakang. Teknik Target Controlled Infusion untuk anestesia umum semakin banyak digunakan. Jumlah pasien geriatri yang harus menjalani prosedur operasi semakin bertambah, serta memerlukan pertimbangan khusus mengingat risiko operasi dan pembiusan yang lebih tinggi pada golongan ini. Penelitian ini bertujuan untuk membandingkan konsentrasi plasma (Cp) dan konsentrasi effect site (Ce) propofol menggunakan rumusan Marsh pada pasien geriatri ras Melayu di RSCM dengan dan tanpa pemberian premedikasi fentanil. Metode. Empat puluh pasien geriatri orang Indonesia Asli status fisik ASA 2, usia > 60 tahun dan BMI 18-30 kg/m2 dirandomisasi. Satu kelompok (20 pasien) mendapatkan Fentanil-Propofol, lainnya (20 pasien) mendapatkan NaCl-Propofol. Pemberian propofol menggunakan TCI rumusan Marsh dengan target konsentrasi plasma. Target Cp dimulai dari 1 µ/ml dinaikkan 1 µ/ml tiap menit sampai tercapai loss of consciousness (LoC) dan diteruskan sampai nilai BIS 45-60 selama 5 menit (steady state). Hasil. Pada kelompok Fentanil-Propofol saat LoC didapatkan Cp 3,15+0,35 µ/ml dan Ce 1,53+0,53 µ/ml dan saat BIS stabil didapatkan Cp 4,14+0,59 µ/ml dan Ce 2,63+0,60 µ/ml. Pada kelompok Nacl-Propofol saat LoC didapatkan Cp 4,20+0,61 µ/ml dan Ce 2,26+0,56 µ/ml dan saat BIS stabil didapatkan Cp 4,78+0,38 µ/ml dan Ce 3,30+0,52 µ/ml. Pasien-pasien yang mendapatkan fentanil terlebih dahulu memiliki Cp dan Ce yang lebih rendah baik saat LoC maupun saat nilai BIS stabil (P < 0,05). Kesimpulan. Terdapat perbedaan bermakna antara Cp dan Ce propofol yang diberikan premedikasi fentanil dan yang tidak.

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Background. The application of Target Controlled Infusion (TCI) technique in general anesthesia is progressively growing. Number of geriatric patients scheduled for operations increases every year, while this group needs special consideration following the higher risk of surgery and anesthesia. The purpose of our study was to compare the estimated plasma concentration (Cp) and the effect site concentration (Ce) of propofol using Marsh pharmacokinetic model for geriatric patients in Cipto Mangunkusumo Hospital with and without the administration of fentanyl premedication.

Methods. Forty patients, physical status ASA 2, aged > 60, BMI 18-30 kg/m2 randomly assigned to a fentanyl-propofol group or a saline-propofol group. TCI propofol was initiated using Marsh pharmacokinetic model. Initial plasma concentration in each group was 1 µ/ml and increased by 1 µ/ml every minute until there was no eyelash reflex, which defined as loss of consciousness (LoC). Propofol plasma concentration was increased and decreased to reach a stable BIS value between 45-60, considered as Cp and Ce at steady state.

Results. In the fentanyl-propofol group the estimated Cp at loss of consciousness was 3,15+0,35 µ/ml and Ce 1,53+0,53 µ/ml. At steady state, Cp was 4,14+0,59 µ/ml and Ce 2,63+0,60 µ/ml. In the saline-propofol group Cp 4,20+0,61 µ/ml and Ce 2,26+0,56 µ/ml. At steady state, Cp was 4,78+0,38 µ/ml and Ce 3,30+0,52 µ/ml. The estimated Cp and Ce in the fentanyl-propofol group were lower than saline-propofol group (p < 0.05).

Conclusion. There is a significant difference between Cp and Ce in the salinepropofol group and fentanyl-propofol group."

"Sevofluran adalah obat anestetik inhalasi yang relatif baru, tetapi harganya lebih mahal daripada halotan. Apakah dengan mengurangi aliran gas kurang lebih duapertiga dari yang biasa dipakai di RSUPN CM yang berarti penghematan obat anestetik inhalasi sebesar 66% dan tanpa obat intravena, sevofluran dapat dipakai sebagai teknik anestesia yang lebih murah dan lebih baik. Tujuan penelitian ini membandingkan biaya - keefektifan sevofluran-N20-02 (0,6L/0,3L) untuk induksi dan pemeliharaan anestesia dengan anestesia propofoi-N20-02 (2L/1L)-halotan Penelitian ini melibatkan 17 pasien laki-laki dan 37 pasien perempuan, usia 15-65 (28,57±15,60 tahun), berat badan 26-70 (50±10,56 kg), tinggi badan 145-180 (160±6,70 sm), ASA I, yang menjalani tindakan bedah umum, ortopedik atau ginekologik ringan, tanpa obat premedikasi, lama tindakan antara 30-120 (50,28±5,46 menit) dan tanpa obat pelumpuh otot. Pasien dibagi dalam dua kelompok secara proposif. Kelompok S ( n = 27 ) diberi anestesia dengan gas N20/02 (0,6L/0,3L)-sevofluran, kelompok H ( n = 27) diberi anestesia dengan prcpofol iv-N20/02 (2L/1L)-halotan. Dicatat waktu induksi ( hilangnya refleks bulu mata dan perintah verbal ), waktu pulih ( pertama kali membuka mata, mengikuti perintah verbal, orientasi personal, waktu dan tempat ), efek samping selama prosedur, serta jumlah total pemakaian obat anestetik. Selama tindakan dilakukan pemantauan terhadap tekanan darah, laju nadi, laju nafas, saturasi oksigen dan konsentrasi tidal akhir C02. Waktu induksi lebih singkat dengan propofol. Hilangnya perintah verbal : 7,33±2,60 detik, hilangnya refleks bulu mata : 1 0,26±2, 70 detik. Untuk sevofluran hilangnya perintah verbal : 27,26±3,25 detik, hilangnya refleks bulu mata : 29,85±3,03 detik. Waktu pulih sevofluran lebih singkat daripada halotan. Untuk membuka mata : 4,15±0,66 menit, mengikuti perintah verbal : 4, 78± 1, 12 menit, melakukan orientasi personal, tern pat dan waktu : 6,63±1,04 menit. Sedangkan waktu pulih halotan untuk membuka mata : 23,48±4,57 menit, mengikuti perintah verbal : 26,70±6,91 menit, melakukan orientasi personal, tempat dan waktu : 33,70±10,75 menit. Kekerapan efek samping lebih tinggi pada kelompok H daripada kelompok S. Biaya anestesia per pasien ternyata lebih rendah dengan teknik sevofluran (Rp 1{)1,452,-) dat;pada teknik propofol-halotan (Rp 181.201,37,-).

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Sevoflurane is a relative new anaesthetic inhalation agent which is more expensive than halothane. It is a question whether sevoflurane can be used as a better and cheaper anaesthesia technique by reducing two-third of fresh gas flow, which means that it will also cut the cost of anaesthetic drug to 66% and without iv drug. The purpose of this study is to compare the cost-effectiveness between sevoflurane-N20-02 (0,6L/0,3L) for induction and maintenance of anaesthesia with anaesthesia propofol-N20-02 (2L/1L )halothane. This study involved 17 male patients and 37 female patients between 15-65 ( 28,57±15,60 ) years old of age, 26-70 ( 50±10,56 ) Kg of body weight, 145-180 ( 160±6,70 ) CM of height, physical status ( ASA ) I whom underwent general surgery, orthopaedic surgery and mild gynaecology surgery without premedication, the action took between 30-120 ( 50,28±5,46) minutes oftime and without muscle relaxant. The patients were divided into two groups in a proposif way. Group S (n=27) was given anaesthesia with N20-02 (0,6L/0,3L)-sevoflurane, group H (n=27) was given anaesthesia with propoflol-N20-02 (2LIIL)-halothane. We recorded time of induction (the disappearance of eye lashes reflex and verbal response ), time of recovery ( first time patients open their eyes, following verbal order, personal orientation, time and place ), side effect during the procedure and the total dose of the anaesthetic drug. During the action, we monitored the blood pressure, heart rate, respiration rate, 02 saturation and EtC02. Induction time of propofol is much shorter. The disappearance of verbal response is 7,33±2,60 seconds, eye lashes reflex is 10,26±2,70 seconds. For sevoflurane the dissapearance ofverbal rensponse is 27,26±3,25 seconds, eye lashes reflex is 29,85±3,03 seconds. The recovery time of sevoflurane is quicker than halothane. For eyes opening, the time taken is 4,15±0,66 minutes, following verbal order is 4,78±1,12 minutes, having personal, time and place orientation is 6,63±1,04 minutes. With halothane eyes opening took 23,48±4,57 minutes, following verbal order is 26,70±6,91 minutes, having personal, time and place orientation is 33,70±10,75 minutes. Side effects appeared more on the group H than group S. The cost of anaesthesia with sevoflurane for each patient is less ( 161.459 IDR) than with propofol-halothane ( 181.201,37 IDR )."