Hasil Pencarian  ::  Simpan CSV :: Kembali

"Pendahuluan: Perdarahan intraoperatif menjadi penyebab utama terjadi henti jantung di ruang operasi. Perdarahan dapat ditangani dengan pemberian transfusi. Pemberian transfusi berisiko menyebabkan infeksi dan reaksi alergi sehingga tidak semua pasien dengan perdarahan diberikan transfusi. Jumlah transfusi dapat dipengaruhi oleh berbagai faktor seperti kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik serta perkiraan allowable blood loss. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesis terdapat hubungan antara faktor-faktor tersebut terhadap jumlah transfusi pada pasien perdarahan intraoperatif Metode: Penelitian ini bersifat analitik observasional dengan desain potong-lintang. Data diperoleh dari 84 rekam medis pasien di Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik, perkiraan allowable blood loss dan jumlah transfusi intraoperatif. Uji yang dilakukan adalah uji bivariat pada masing-masing faktor dengan uji korelasi Pearson, Spearman dan uji komparatif Mann Whitney menggunakan perangkat lunak SPSS versi 20. Hasil: Didapatkan bahwa jumlah perdarahan (p=0,000) mempengaruhi jumlah transfusi. Pada kelompok dengan gangguan hemodinamik didapatkan perbedaan jumlah transfusi dibandingkan dengan kelompok tanpa gangguan hemodinamik (p=0,009). Hb praoperasi dan perkiraan allowable blood loss tidak mempengaruhi jumlah transfusi (p=0,794, p=0,250). Kesimpulan: Jumlah perdarahan berhubungan dengan jumlah transfusi. Nilai Hb praoperasi dan perkiraan allowable blood loss tidak berhubungan dengan jumlah transfusi intraoperatif.

---

Introduction: Intraoperative haemorrhage is the leading cause of cardiac arrest in surgery. Transfusion can be given to replace intraoperative blood loss. Transfusion can trigger infection and allergy reactions. Hence it must be given cautiously. Blood transfusion volume can be related to many factors, ie, preoperative hemoglobin value, blood loss volume, the presence or absence of hemodynamic instability, and allowable blood loss value. This study aimed to know the relationship between those factors and the blood transfusion volume. Method: This was an observational analytic study with a cross-sectional design that included 84 patients who had received an intraoperative blood transfusion in Ciptomangunkusumo Hospital, Jakarta. Preoperative hemoglobin, blood loss volume, estimated allowable blood loss, hemodynamic instability, and intraoperative blood transfusion volume data were obtained from medical records and analyzed. Bivariate test (Pearson, Spearman correlation test, and the Mann Whitney comparative test, was performed using SPSS ver. 20.0. Results: Blood loss volume (p=0,000) was significantly associated with the blood transfusion volume. Blood transfusion volume was significantly different in patients with hemodynamic instability than patients with stable hemodynamic (p=0.009). Preoperative hemoglobin level and estimated allowable blood loss value were not significantly associated with blood transfusion volume (p=0.794 and p=0.250, respectively). Conclusion: Blood loss volume was significantly related to blood transfusion volume. Preoperative hemoglobin level and estimated allowable blood loss were not significantly associated with blood transfusion volume."

"[ABSTRAKLatar Belakang: Penghitungan Estimated Blood Loss (EBL) berdasarkan rumus Allowable Blood Loss (ABL) dengan target hemoglobin tertentu, kerap dijadikan panduan untuk memutuskan secara cepat transfusi intraoperatif. Penghitungan EBL mengandalkan penilaian visual sulit untuk distandardisasi. Seiring perkembangan teknologi, Point of Care Testing (POCT) makin memudahkan pemeriksaan hemoglobin. Penelitian ini bertujuan membandingkan akurasi penghitungan hemoglobin intraoperatif antara EBL dan POCT, dibandingkan dengan Hematology Analyzer yang merupakan pengukuran baku di laboratorium. Metode: Penelitian ini menggunakan Uji Bland-Altman pada pengukuran hemoglobin intraoperatif terhadap pasien yang menjalani operasi elektif yang diperkirakan mengalami banyak perdarahan dan memerlukan transfusi, di Instalasi Bedah Pusat (IBP) RSUPN Cipto Mangunkusumo, antara Desember 2014 hingga Maret 2015. Subjek penelitian dipilih dengan metode consecutive sampling. Saat penghitungan EBL mencapai ABL dengan target Hb 7 g/dL sebelum transfusi diberikan, sampel darah diambil untuk pengukuran hemoglobin dengan Sysmex XE-2100® sebagai Hematology Analyzer dan HemoCue® Hb 201+ sebagai POCT. Hasil: Sebanyak 43 subjek diikutsertakan dalam penelitian. Uji Bland-Altman Hb ABL (7 g/dL) terhadap Hb Sysmex. Interval yang dianggap akurat terhadap kadar Hb 7 g/dL adalah -1 hingga 1, diperoleh limits of agreement yang besar yaitu -2,267 hingga 2,467. Uji Bland-Altman Hb HemoCue terhadap Hb Sysmex, diperoleh limits of agreement yang kecil yaitu -0.418 hingga 0.372. Simpulan: Terdapat perbedaan bermakna dalam akurasi penghitungan hemoglobin intraoperatif antara EBL dengan Hematology Analyzer, sedangkan pengukuran dengan HemoCue® Hb 201+ sebagai perangkat POCT, mempunyai keakuratan yang baik. EBL berdasarkan rumus ABL dengan target Hb 7 g/dL tidak bisa digunakan untuk pengambilan keputusan transfusi intraoperatif karena tidak mempunyai keakuratan yang baik.

---

ABSTRACTBackground: Measurement of Estimated Blood Loss (EBL) based on the Allowable Blood Loss (ABL) formula with certain hemoglobin target is often used as a guidance to make a fast decision for intraoperative transfusion. Measurement of EBL relies on visual assessment is difficult to standardized and a new technique called Point of Care Testing (POCT) offered easier way to measure haemoglobin. This study aimed to compare the accuracy of the intraoperative hemoglobin measurement by EBL and POCT with Hematology Analyzer in the laboratory as a golden standard. Methods: This study used a Bland-Altman test on intraoperative hemoglobin measurement in patients undergoing elective surgery which was expected to experience a lot of bleeding and require blood transfusions in Center Operating Theater of Cipto Mangunkusumo Hospital from December 2014 until March 2015. Subjects were selected by consecutive sampling method. When EBL had reached ABL with a Hb level target 7 g / dL before transfusion was given, blood samples were taken for measurement of hemoglobin with Sysmex XE-2100® as Hematology Analyzer and HemoCue® Hb 201+ as POCT. Results: A total of 43 subjects were included in the study. Bland-Altman analysis of Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered as accurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to 2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealed narrow limits of agreement (-0418 to 0372). Conclusion: There was a significant difference in the accuracy of intraoperative hemoglobin measurement by EBL compared to Hematology Analyzer, while the measurement by POCT device had good accuracy. EBL based on the formula ABL with a Hb level target 7 g / dL could not be used for intraoperative transfusion decision making because it did not has good accuracy., Background: Measurement of Estimated Blood Loss (EBL) based on the formulaAllowable Blood Loss (ABL) with certain hemoglobin target, is often used as aguidance to make a quick decision for intraoperative transfusion. Measurement ofEBL relies on visual assessment cannot be standardized. As developingtechnology, Point of Care Testing (POCT) makes hemoglobin measurementeasier. This study aimed to compare the accuracy of the intraoperativehemoglobin measurement by EBL and POCT with Hematology Analyzer in thelaboratory as a golden standard.Methods: This study used a Bland-Altman test on intraoperative hemoglobinmeasurement in patients undergoing elective surgery that was expected toexperience a lot of bleeding and need transfusion in Center Operating Theater ofCipto Mangunkusumo Hospital from December 2014 until March 2015. Subjectswere selected by consecutive sampling method. When EBL had reached ABLwith a Hb level target 7 g / dL before transfusion was given, blood samples weretaken for measurement of hemoglobin with Sysmex XE-2100® as HematologyAnalyzer and HemoCue® Hb 201+ as POCT.Results: A total of 43 subjects were included in the study. Bland-Altman analysisof Hb EBL (7 g / dL) to Hb Hematology Analyzer with interval considered asaccurate for Hb 7 g / dL was -1 to 1, revealed wide limits of agreement (-2.267 to2.467). Bland-Altman analysis of Hb POCT to Hb Hematology Analyzer revealednarrow limits of agreement (-0418 to 0372).Conclusion: There was a significant difference in the accuracy of intraoperativehemoglobin measurement by EBL compared to Hematology Analyzer, while themeasurement by POCT device had good accuracy. EBL based on the formulaABL with a Hb level target 7 g/dL could not be used for intraoperative transfusion decision making because it did not has good accuracy.]"

"Latar belakang: Kehilangan darah memiliki pengaruh terhadap kejadian komplikasi pasca operasi. Kehilangan darah intraoperatif berfungsi sebagai penanda keberhasilan operasi dan prognosis bagi pasien. Prosedur bedah seperti bedah ortognatik termasuk bedah mayor dengan resiko kehilangan darah intraoperatif yang banyak. Kehilangan darah setelah bedah ortognatik sangat bervariasi, dan terkadang diperlukan transfusi. Ahli bedah perlu mengevaluasi faktor yang mempengaruhi kehilangan darah intraoperatif dan menilai tingkat transfusi sehingga dapat mengurangi resiko komplikasi kehilangan darah dan menghindari penggunaan transfusi berlebihan.Tujuan: Studi ini bertujuan untuk menganalisis hubungan lama operasi, jenis bedah ortognatik dan indeks massa tubuh terhadap jumlah kehilangan darah intraoperatif pada bedah ortognatik. Metode: Studi ini menggunakan metode analitik observasional dengan desain penelitian retrospektif. Hasil: Terdapat hubungan yang signifikan antara jenis bedah ortognatik dan lama operasi dengan kehilangan darah intraoperatif pada pasien bedah ortognatik. Double jaw surgery dan Lefort I osteotomy serta faktor lama operasi menunjukkan adanya korelasi yang kuat terhadap jumlah kehilangan darah intraoperatif pada pasien bedah ortognatik. Indeks massa tubuh tidak menunjukkan hubungan yang signifikan terhadap jumlah kehilangan darah intraoperatif pada pasien bedah ortognatik. Kesimpulan: Jenis bedah ortognatik double jaw surgery dan Lefort I osteotomy serta lama operasi lebih dari 5 jam mempengaruhi jumlah kehilangan darah intraoperatif yang signifikan pada pasien bedah ortognatik.

---

Background: Blood loss has an influence on the incidence of postoperative complications. Intraoperative blood loss can be serves as a marker of successful surgery and prognosis for patients. Surgical procedures such as orthognathic surgery is one of major surgery with a high risk of intraoperative blood loss. Blood loss after orthognathic surgery varies greatly, and sometimes transfusion is needed. Surgeons need to evaluate factors that affect intraoperative blood loss and assess transfusion rates so as to reduce the risk of blood loss complications and avoid excessive transfusion use.

Objective: This study aims to analyze the relationship between duration of surgery, type of orthognathic surgery and body mass index to the amount of intraoperative blood loss in orthognathic surgery.

Method: This study uses observational analytic methods with a retrospective research design.

Results: There is a significant relationship between the type of orthognathic surgery and the length of surgery with intraoperative blood loss in orthognathic surgery patients. Double jaw surgery and Lefort I osteotomy as well as the duration of surgery showed a strong correlation with the amount of intraoperative blood loss in orthognathic surgery patients. Body mass index did not show a significant relationship to the amount of intraoperative blood loss in orthognathic surgical patients.

Conclusion: The type of orthognathic double jaw surgery and Lefort I osteotomy as well as the operating duration of more than 5 hours affect the amount of significant intraoperative blood loss in orthognathic surgery patients."

"[ABSTRAKLatar Belakang: Nilai hemoglobin masih dijadikan parameter dalam menentukan transfusi atau tidak walaupun tidak mengabaikan pertimbangan klinis. Namun, pada kenyataannya pemeriksaan nilai hemoglobin pascaoperasi sulit dilakukan karena keterbatasan alat dan membutuhkan waktu yang cukup lama sehingga ketika hasil pemeriksaan nilai hemoglobin didapatkan sudah tidak sesuai dengan kondisi terkini. Oleh karena itu dibutuhkan pendekatan berupa perkiraan dalam menetukan nilai hemoglobin pascaoperasi. Nilai perkiraan hemoglobin selama ini hanya terpaku dengan berapa jumlah perdarahan yang terjadi, padahal ada faktor lain yang memengaruhi, salah satunya pemberian cairan intraoperasi.Metode: Penelitian ini merupakan desain analitik retrospektif dengan pengambilan data dari status pasien yang menjalani prosedur Modified Radical Mastectomy (MRM) di RSUPN Cipto Mangunkusumo sejak 1 Januari 2012 sampai 31 Desember 2014. Dilakukan pencatatan berupa identitas, umur, jenis kelamin, berat badan, nilai hemoglobin praoperasi, jumlah perdarahan intraoperasi, jumlah cairan intraoperasi, jumlah urin output intraoperasi, dan nilai hemoglobin pascaoperasi. Dilakukan analisis bivariat untuk masing-masing variabel dan kemudian akan dilanjutkan dengan analisis multivariat regresi linier.Hasil: Dari 103 sampel penelitian didapatkan hubungan bermakna antara asupan cairan intraoperasi dengan perubahan nilai hemoglobin pascaoperasi (p=0.208, r=0.035) dan jumlah perdarahan intraoperasi dengan perubahan nilai hemoglobin pascaoperasi (p=0.297, r=0.002). Pada uji ANOVA didapatkan nilai p sebesar 0.039. Sebenarnya rumus layak untuk dibuat. Namun nilai Adjusted R square sebesar 3 % yang artinya persamaan yang diperoleh hanya mampu menjelaskan perubahan nilai hemoglobin pascaoperasi sebesar 3 %.Simpulan: Perubahan nilai hemoglobin pascaoperasi tidak dapat dapat diprediksi dari asupan cairan dan perdarahan pada Modified Radical Mastectomy (MRM) di RSUPN Cipto Mangunkusumo.

---

ABSTRACTBackground: Hemoglobin level is still a valid parameter to help decision in blood transfusion, eventhough its use is in conjunction with clinical decision. In reality, postoperative hemoglobin level is difficult to be done because of two reasons: the limitation of the tools and time consuming. At the moment the result is obtained, its result is different with current clinical condition. Therefore, we need tools to predict postoperative hemoglobin level. At present, hemoglobin prediction level is only looks at bleeding volume, eventhough there is still other factor such as intraoperative fluid intake.Methods: This study is a retrospective analytic design using data from medical record of the patients undergo the Modified Radical Mastectomy (MRM) procedure at Cipto Mangunkusumo hospital since January 1, 2012 to December 31, 2014. We record the identity, age, sex, weight, preoperative hemoglobin level, the volume of intraoperative blood loss, the volume of intraoperative fluids, the volume of intraoperative urine output, and postoperative hemoglobin level. Each variable will be analyzed using bivariate analysis, and then continued with multivariate linear regression analysis.Results: Data from 103 samples showed a significant relationship between intraoperative fluid intake with the value of the postoperative hemoglobin (p = 0.208, r = 0.035), and the number of intraoperative blood loss with the value of the postoperative hemoglobin (p = 0.297, r = 0.002). ANOVA shows p value of 0.039. Eventhough the formula could be made, the Adjusted R square value of 3%, means the equation only could explain 3%changes in postoperative hemoglobin level.Conclusions: Postoperative hemoglobin value changes can not predicted with fluid intake and blood loss in Modified Radical Mastectomy (MRM) at Cipto mangunkusumo hospital., Background: Hemoglobin level is still a valid parameter to help decision in blood transfusion, eventhough its use is in conjunction with clinical decision. In reality, postoperative hemoglobin level is difficult to be done because of two reasons: the limitation of the tools and time consuming. At the moment the result is obtained, its result is different with current clinical condition. Therefore, we need tools to predict postoperative hemoglobin level. At present, hemoglobin prediction level is only looks at bleeding volume, eventhough there is still other factor such as intraoperative fluid intake.Methods: This study is a retrospective analytic design using data from medical record of the patients undergo the Modified Radical Mastectomy (MRM) procedure at Cipto Mangunkusumo hospital since January 1, 2012 to December 31, 2014. We record the identity, age, sex, weight, preoperative hemoglobin level, the volume of intraoperative blood loss, the volume of intraoperative fluids, the volume of intraoperative urine output, and postoperative hemoglobin level. Each variable will be analyzed using bivariate analysis, and then continued with multivariate linear regression analysis.Results: Data from 103 samples showed a significant relationship between intraoperative fluid intake with the value of the postoperative hemoglobin (p = 0.208, r = 0.035), and the number of intraoperative blood loss with the value of the postoperative hemoglobin (p = 0.297, r = 0.002). ANOVA shows p value of 0.039. Eventhough the formula could be made, the Adjusted R square value of 3%, means the equation only could explain 3%changes in postoperative hemoglobin level.Conclusions: Postoperative hemoglobin value changes can not predicted with fluid intake and blood loss in Modified Radical Mastectomy (MRM) at Cipto mangunkusumo hospital.]"

"Latar belakang: Perdarahan merupakan faktor resiko dalam suatu tindakan operasi yang dapat mengakibatkan kematian. Perdarahan yang menyebabkan massive hemorrhage ini sering terjadi pada pasien yang mengalami operasi pengangkatan tumor Ameloblastoma. Untuk mengatasi komplikasi perdarahan intraoperasi diperlukan transfusi darah. Karena resiko transfusi darah cukup tinggi maka seorang ahli bedah harus dapat mempertimbangkan kebutuhan transfusi darah secara tepat untuk menghindari komplikasi tersebut. Tujuan: Untuk menganalisa hubungan lama operasi, luas defek, dan tipe histopatologi terhadap kehilangan darah intraoperasi dan kebutuhan transfusi darah pada bedah reseksi rahang kasus Ameloblastoma. Metode: Studi ini menggunakan metode analitik observasional dengan desain penelitian retrospektif. Hasil: Terdapat hubungan yang signifikan antara lama operasi nilai p = 0.0480(<0.05) dan luas defek reseksi 0.001 (p <0.05) terhadap jumlah kehilangan darah. Kesimpulan: Terdapat perbedaan bermakna antara luas defek dengan jumlah kehilangan darah intraoperasi. Khususnya pada klasifikasi L, C, H, LC, LCL, HC.

---

Background: Bleeding is a risk factor in an operation that can result in death. Bleeding that causes massive hemorrhage often occurs in patients who undergo surgical removal of Ameloblastoma tumors. Blood transfusion is needed to overcome the complications of intraoperative bleeding. Because the risk of blood transfusion is quite high, a surgeon must be able to properly consider the need for blood transfusion to avoid these complications.

Objective: To analyze the relationship between duration of surgery, extent of defect, and histopathological type of intraoperative blood loss and the need for blood transfusion in jaw resection surgeries in Ameloblastoma cases. Method: This study uses observational analytic methods with a retrospective research design. Results: There is a significant relationship between the length of surgery p = 0.0480(<0.05 and the extent of the resection defect 0.001 (p <0.05) to the amount of blood loss.

Conclusion: There is a significant difference between the extent of the defect and the amount of intraoperative blood loss. Especially in the classification of L, C, H, LC, LCL, HC."

"Latar Belakang: Spektrum Plasenta Akreta (SPA) merupakan salah satu komplikasi obstetri dengan tingkat morbiditas yang tinggi. 3D Power Doppler telah banyak digunakan untuk meningkatkan diagnosis SPA, seperti menggunakan Plasenta Akreta Indeks, tetapi hanya mengukur secara kualitatif. Oleh karena itu, penelitian ini bertujuan untuk memahami hubungan kuantitatif indeks vaskularisasi plasenta terhadap temuan makroskopik, grading histopatologi, dan perdarahan intraoperatif pada kasus SPA.Tujuan: Mengetahui hubungan indeks vaskular (vascular index / VI), indeks aliran (flow index / FI), dan indeks aliran vaskular (vascular flow Index / VFI) dengan diagnosis klinis, jumlah perdarahan dan temuan histopatologi SPA di Rumah Sakit Cipto Mangunkusumo.Metode: Sebuah studi cross-sectional dilakukan pada 34 wanita, yang secara klinis didiagnosis dengan SPA. Power Doppler 3D yang dikombinasikan dengan perangkat lunak VOCAL II digunakan untuk mengukur tingkat indeks vaskularisasi (VI), indeks aliran (FI), dan indeks aliran vaskularisasi (VFI). Gambaran gross anatomy dan hasil histopatologi yang dikategorikan sebagai akreta, inkreta, dan perkreta. Tingkat kehilangan darah intra-operatif diukur dan diklasifikasikan sebagai perdarahan masif diatas 1500 ml. Data kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 25.Hasil: Median (min-max) untuk semua indeks vaskularisasi sebagai berikut: VI = 44,2 (23,7-74,9), FI = 35,4 (24,9-57), dan VFI = 15,3 (8,5-41,7). Nilai FI ditemukan signifikan dalam membandingkan tahap makroskopis (p =0,015) dan memiliki korelasi positif sedang dalam kaitannya dengan perdarahan (r =0,449). hasil analisa AUC of ROC VI, FI, dan VFI nilai batas terbukti sangat terkait dengan kehilangan darah 1500cc yaitu dengan hasil FI dengan nilai AUC of ROC 0.784, nilai cut off ≥38.9, OR: 10.00 (IK95% [1.58-63.09], p =0.014),VI dengan nilai AUC of ROC 0.712, nilai cut off ≥60.4, OR: 7.00 (IK95% [1.23-39.56], p =0.031), danVFI dengan nilai AUC of ROC 0.779, nilai cut off ≥23.2, OR: 9.16 (IK95% [1.53-54.59], p =0.015).Kesimpulan. Indeks Vaskularisasi Plasenta (FI) yang diukur dengan Power Doppler 3 dimensi dapat menjadi pemeriksaan tambahan Diagnostik SPA yang berpotensi dapat memprediksi kedalaman invasi SPA secara intra-pembedahan, jumlah perdarahan dan kemungkinan akan didapatkannya perdarahan masif pada pembedahan SPAKata Kunci. Plasenta akreta, 3D Power Doppler, indeks vaskular, indeks aliran, indeks aliran vaskular, perdarahan intraoperasi, histologi akreta

---

Background: Placenta Accreta Spectrum (PAS) is an obstetrical complication with a high level of morbidity. The 3D Power Doppler method has been widely used to improve the PAS diagnosis, such as using Placenta Accreta Index, but it only measures qualitative features. Therefore, this study aims to understand the relationship of quantitative placental vascular indices towards macroscopic findings, histopathological grading, and intra-operative blood loss in cases of PAS disorder.

Objectives: Knowing the relationship between vascular index (VI), flow index (FI), and vascular flow index (VFI) with clinical diagnosis, amount of bleeding and histopathological findings of SPA at Cipto Mangunkusumo Hospital.

Methods: A cross-sectional study was conducted in 34 women, who were clinically diagnosed with PAS. The 3D Power Doppler in combination with VOCAL II software was used to measure the level of vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Gross anatomical appearance and histopathology results were categorized as accreta, increta, and percreta. Intra-operative blood loss level was measured and classified as massive hemorrhage if it was≥1500 ml. Data were then analyzed using Statistical Package for Social Sciences (SPSS) version 25.

Results: The median (min-max) for all vascularity indexes as follows: VI = 44.2 (23.7-74.9), FI = 35.4 (24.9-57), and VFI = 15.3 (8.5-41.7). FI value was found to be significant in comparing gross pathological stages (p=0.015) and had a moderate positive correlation in relation to blood loss (r= 0.449). the results of the AUC of ROC VI, FI, and VFI analysis above the cut-off values were shown to be strongly associated with blood loss ≥1500cc the results obtained:

FI with AUC of ROC value of 0.784, cut off value 38.9, OR: 10.00 (IK95% [1.58-63.09], p = 0.014),

VI with AUC of ROC value of 0.712, cut off value 60.4, OR: 7.00 (IK95% [1.23-39.56], p = 0.031), and

VFI with AUC of ROC value of 0.779, cut off value 23.2, OR: 9.16 (CI95% [1.53-54.59], p = 0.015).

Conclusion: Flow index (FI) value from 3D Power Doppler ultrasound may become a potential diagnostic marker to predict the depth of PAS invasion prior to surgery, along with the level of blood loss intra-operatively.

Keywords: Placenta accreta spectrum (PAS), Ultrasound markers, Vascularization, Macroscopic, Histopathology, Blood loss, 3D Power Doppler Biopsy, Vascular Index, Flow Index, Vascular Flow Index"

"Latar Belakang : Pasien yang menjalani operasi koreksi skoliosis pascaoperasi di RSCMmendapatkan lama ventilasi mekanik pascaoperasi yang beragam. Pemakaian ventilasimekanik pascaoperasi koreksi skoliosis memengaruhi biaya perawatan dan waktu kontakpasien dengan keluarga. Identifikasi faktor-faktor yang dapat memengaruhi lama ventilasimekanik diharapkan dapat memprediksi lama ventilasi mekanik pascaoperasi sehinggalebih efektif dalam penggunaan ventilasi mekanik. Penelitian ini dilakukan dengan harapanmengetahui faktor risiko lama ventilasi mekanik pascaoperasi koreksi skoliosis pendekatanposterior di RSCM.Tujuan : Mengetahui faktor-faktor risiko yang dapat memengaruhi lama penggunaanventilasi mekanik pascaoperasi koreksi skoliosis pendekatan posterior.Metode : Penelitian ini adalah penelitian kohort retrospektif menggunakan data dari rekammedis. Lima puluh dua pasien yang menjalani operasi koreksi skoliosis pendekatanposterior antara januari 2011 hingga Juni 2016 dianalisis secara retrospektif. Dicatat lamapemakaian ventilasi mekanik pascaoperasi koreksi skoliosis pendekatan posterior. Faktorpreoperasi dan intraoperasi yang dianalisis merupakan data yang biasa dicatat dalam rekammedis antara lain nilai kapasitas vital paksa preoperasi, hipertensi pulmonal, jumlahperdarahan, jumlah cairan intraoperasi, transfusi darah dan lokasi segmen vertebra. Dataakan diolah menggunakan perangkat lunak SPSS dengan uji korelasi dan analisismultivariat regresi linier.Hasil : Mayoritas sampel adalah wanita 86,5 . Analisis korelasi didapatkan jumlahperdarahan r=0,431."

"ABSTRAKSalah satu komplikasi tersering PCNL adalah perdarahan. Penelitian ini bertujuan mengidentifikasi faktor prediktor jumlah total perdarahan PCNL, dan mengevaluasi pola transfusi darah. PCNL dilakukan acak oleh dua konsultan endourologi dan dianalisa prospektif. Pasien dewasa dengan batu ginjal pielum > 20 mm, kaliks inferior >10 mm, atau staghorn dijadikan sampel. Pasien dengan koagulopati, pengobatan antikoagulan, atau dilakukan konversi operasi terbuka dieksklusi. Pemeriksaan darah lengkap dilakukan pada awal dan 12, 24, 36, 72 jam paska-operasi. Faktor-faktor seperti stone burden, jenis kelamin, luas permukaan tubuh, perubahan kadar hematokrit dan jumlah transfusi darah dianalisa regresi untuk mendapatkan prediktor total blood loss (TBL). Didapatkan rerata TBL 560,92±428,43 ml dari total 85 pasien. Stone burden merupakan faktor paling berpengaruh terhadap TBL (p=0.037). Kebutuhan transfusi darah diprediksi dengan menghitung TBL (ml) = -153,379 + 0,229 stone burden (mm2) + 0,203 baseline serum hematokrit (%). Sebanyak 87,1% pasien tidak menerima transfusi peri-operatif, 3,5% menerima transfusi intra-operatif, 7,1% menerima transfusi post-operatif, 2,3% menerima transfusi intra dan post-operatif; sehingga menghasilkan cross-matched transfusion ratio 7,72. Rerata tranfusi darah peri-operatif 356,00±145,88 ml. Stone burden menjadi faktor prediktif paling berpengaruh terhadap jumlah perdarahan. Jumlah darah yang ditransfusikan dan dilakukan cross-matched ditemukan tinggi. Formula yang kami usulkan dapat mengurangi kejadian transfusi yang tidak dibutuhkan.

---

ABSTRACTThe most common complication of PCNL is bleeding. We aimed to identify predictive factors of PCNL blood loss and evaluate transfusion practice. A prospective study was randomly performed by two consultants of endo-urology. Adults with kidney stones in pelvic >20mm, inferior calyx >10mm or staghorn were included; those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. Full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, hematocrit level shifting and amount of blood transfused were analyzed statistically using regression to identify predictive factors of total blood loss (TBL). Mean TBL was 560.92±428.43 ml from 85 patients enrolled. Our results revealed that TBL (ml): -153.379 + 0.229xstone burden (mm2) + 0.203xbaseline serum hematocrit (%); considerably predicted the need for blood transfusion. Amount of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% post-operative, 2.3% both intra and post-operative, giving a cross-matched transfusion ratio 7.72. Mean peri-operative blood transfused was 356.00±145.88 ml. Stone burden was the most influential PCNL blood loss predictive factor. Amount of blood transfused and cross-matched was relatively high. An appropriate blood order using our equation would reduce any unnecessary transfusions.;;;;"

"Latar Belakang: Laparoskopi nefrektomi merupakan teknik pembedahan pilihan untuk pasien donor ginjal di RSCM karena memiliki beberapa keunggulan dibandingkan laparotomi. Pembedahan akan mengaktivasi respon stress yang mempengaruhi perubahan hemodinamik intraoperatif. Kombinasi anestesi regional epidural dengan anestesi umum dapat mengurangi respon stress intraoperatif. Teknik yang digunakan adalah epidural. Blok Quadratus Lumborum (QL) merupakan blok interfasia efektif sebagai analgesia pasca bedah abdomen. Penelitian ini bertujuan untuk menilai respon stress hemodinamik intraoperatif antara blok QL dan epidural pada pasien laparoskopi nefrektomi. Parameter yang dinilai adalah tekanan arteri rata-rata (MAP), laju nadi, indeks kardiak (CI), dan gula darah. Kebutuhan fentanyl intraoperatif juga turut dinilai. Metode: Penelitian ini adalah uji klinis acak tidak tersamar terhadap pasien donor ginjal yang menjalani laparoskopi nefrektomi di RSCM selama bulan Juni hingga September 2018. Dilakukan randomisasi sebanyak 36 subjek menjadi 2 kelompok. Setelah induksi, kelompok epidural diberikan epidural kontinyu bupivacain 0.25% sebanyak 6 ml/jam dan pada kelompok QL diberikan 20 ml bupivacain 0.25% secara bilateral. Variabel MAP, laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif dicatat. Analisis data dilakukan melalui uji bivariat t-test tidak berpasangan, Mann-Whitney serta uji multivariat general linear model. Hasil: Perubahan MAP pada kelompok QL lebih baik secara signifikan dibandingkan dengan epidural. Tidak terdapat perbedaan yang bermakna pada variabel laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif. Kesimpulan: Blok QL tidak lebih baik dari epidural dalam menurunkan respon stress intraoperatif pada laparoskopi nefrektomi. Akan tetapi perubahan MAP pada blok QL lebih stabil.

---

Background: Laparoscopic nephrectomy is a surgical technique preferred for renal donor in RSCM because of its advantages over laparotomy. Surgery activated stress responses thus affected intraoperative hemodynamics. Regional epidural anesthesia often combined with general anesthesia to reduce stress responses. Quadratus Lumborum (QL) block is an interfacial block and effective as abdominal surgery analgesia. This study was aimed to assess intraoperative hemodynamic stress response between QL and epidural block in laparoscopic nephrectomy patients. Mean arterial pressure (MAP), pulse rate, cardiac index (CI), and blood sugar was collected. Intraoperative fentanyl consumption also noted.

Methods: This was a randomized clinical trial of renal donor patients who underwent laparoscopic nephrectomy at RSCM during June to September 2018. A total of 36 subjects were randomized into 2 groups. After induction of general anesthesia, the epidural group received continuous epidural infusion of 0.25% 6 ml / hour of bupivacaine and QL group received 20 ml of 0.25% bupivacaine. MAP variables, pulse rate, CI, blood sugar and intraoperative fentanyl consumption were recorded in both groups. Data was analyzed with bivariate paired t-test, Mann-Whitney and multivariate general linear model test.

Results: MAP changes in QL group is significantly better than epidural group. There was no difference in heart rate, CI, blood glucose and fentanyl consumption intraoperative between two groups.

Conclusion : QL block compared to epidural did not have better result in reducing intraoperative stress response. However, MAP changes in QL group have better stability than epidural group."

"Latar belakang: Perdarahan pada operasi OPCAB dapat terjadi didasari oleh mekanisme aktivasi jalur fibrinolisis akibat trauma bedah. Asam traneksamat yang diberikan secara topikal bekerja sebagai antifibrinolitik secara lokal dengan efek samping sistemik minimal. Penelitian ini bertujuan untuk mengetahui keunggulan penggunaan asam traneksamat topikal dibandingkan plasebo pada pasien yang menjalani operasi OPCAB pada perdarahan pascaoperasi.Metode: Randomisasi 44 sampel menjadi kelompok asam traneksamat topikal (n = 22) dan kelompok plasebo (n = 22). Pengukuran volume perdarahan dilakukan empat kesempatan, pada perdarahan inisial, enam jam, 24 jam dan 48 jam pascaoperasi. Transfusi komponen darah (PRBC, TC, FFP, kriopresipitat) dicatat selama masa perawatan. Variabel dengan sebaran normal menggunakan statistik independent t-test, sedangkan data dengan sebaran tidak normal menggunakan statistik nonparametrik uji Mann-Whitney.Hasil: Perdarahan inisial (72,50 (15-210) vs. 62,5 (10-180), p = 0,878), perdarahan enam jam (145 (55-640) vs. 220 (90-810), p = 0,006), perdarahan 24 jam (327,5 (120-770) vs. 437,5 (250-1620), p = 0,045), perdarahan 48 jam (462,5 (175-1680) vs. 572,5 (311-2060), p = 0,177), tidak ada perbedaan bermakna pada kebutuhan transfusi komponen darah pada kedua kelompok. Efek samping lebih rendah pada kelompok asam traneksamat.Simpulan: Pemberian asam traneksamat topikal secara klinis lebih unggul dibandingkan plasebo dalam menurunkan volume perdarahan pada 6 jam dan 24 jam pascaoperasi namun tidak lebih unggul dalam menurunkan kebutuhan transfusi darah pada pasien yang menjalani operasi jantung dengan teknik OPCAB.

---

Background: Bleeding during OPCAB surgery can occur based on the activation mechanism of the fibrinolysis pathway due to surgical trauma. Topically administered tranexamic acid acts as a local antifibrinolytic with minimal systemic side effects. This study aims to determine the advantages of using topical tranexamic acid compared to placebo in patients undergoing OPCAB surgery for postoperative bleeding.

Method: A total of 44 samples were randomized into topical tranexamic acid group (n =22) and placebo group (n = 22). Bleeding volume measurements were carried out four times, at the initial bleeding, six hours, 24 hours, and 48 hours postoperatively. Transfusions of blood components (PRBC, TC, FFP, cryoprecipitate) were recorded throughout the treatment period. Variables with normal distribution were carried out with independent t-test statistical analysis, whereas data with abnormal distribution were analyzed using nonparametric statistics Mann-Whitney test.

Result: Initial bleeding (72.50 (15-210) vs. 62.5 (10-180), p = 0.878), six-hour bleeding (145 (55-640) vs. 220 (90-810), p = 0.006), 24-hour bleeding (327.5 (120-770) vs. 437.5 (250-1620), p = 0.045), 48-hour bleeding (462.5 (175-1680) vs. 572.5 (311) -2060), p = 0.177), there was no significant difference in the need for blood component transfusions in the two groups. The side effects were lower in the tranexamic acid group.

Conclusion: Topical tranexamic acid administration is clinically superior to placebo in reducing bleeding volume at 6 hours and 24 hours postoperatively but not superior in reducing the need for blood transfusions in patients undergoing cardiac surgery using the OPCAB technique.

"