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"Latar Belakang: Penjadwalan operasi yang baik adalah yang mengoptimalkan workflow suatu kamar operasi, mengurangi kasus pembatalan operasi, dan ketidaktepatan prediksi waktu operasi. Unit Pelayanan Bedah Terpadu RSUPN Dr. Cipto Mangunkusumo memiliki peran besar terhadap berlangsungnya operational efficiency sehingga hal-hal terkait efisiensi kerja yang termasuk didalamnya penjadwalan pasien di kamar operasi menjadi fokus perhatian utama. Penelitian ini bertujuan untuk menilai korelasi waktu persiapan, induksi, dan pemulihan anestesi berdasarkan pemilihan teknik anestesi terhadap anesthesia-controlled time (ACT). Metode: Penelitian ini merupakan penelitian observasional yang dilaksanakan di Unit Pelayanan Bedah Terpadu RSUPN Dr. Cipto Mangunkusumo sejak Maret 2019 hingga Desember 2020, dengan total 1727 sampel yang memenuhi kriteria inklusi dan tidak memiliki kriteria eksklusi. Tim anestesi kamar operasi dengan menggunakan jam digital melakukan observasi, pengambilan, dan pencatatan data waktu secara manual kedalam lembar kuesioner yang disediakan di kamar operasi atau secara daring dengan mengakses tautan yang tersedia.Hasil: Terdapat hubungan linier positif yang bermakna antara waktu persiapan anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.1, p 0.009), anestesi umum-ETT, CVC, ABP (r=0.253, p 0.028), dan anestesi umum-ETT/LMA, blok saraf perifer, CVC, ABP (r=0.489, p 0.013); waktu pemasangan monitor dengan ACT pada teknik anestesi umum-ETT (r=0.125, p 0.001), anestesi umum-ETT, CVC, ABP (r=0.502, p 0.000), anestesi umum-ETT/LMA, epidural (r=0.372, p 0.001), anestesi umum-ETT, epidural, CVC (r=0.436, p 0.006), sedasi (r=0.516, p 0.001), spinal (r=0.501, p 0.000), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.321, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.445, p 0.001); waktu induksi anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.513, p 0.000), anestesi umum-ETT, CVC, ABP (r=0.391, p 0.001), anestesi umum-LMA (r=0.312, p 0.017), anestesi umum-ETT/LMA, epidural (r=0.818, p 0.000), anestesi umum-ETT, epidural, CVC, ABP (r=0.559, p 0.000), spinal (r=0.503, p 0.000), kombinasi spinal-epidural (r=0.779, p 0.000), blok saraf perifer (r=0.729, p 0.000), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.511, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.543, p 0.000); waktu insersi CVC dengan ACT pada teknik anestesi umum-ETT/LMA, CVC (r=0.553, p 0.002), anestesi umum-ETT, CVC, ABP (r=0.434, p 0.000), anestesi umum-ETT, epidural, CVC (r=0.415, p 0.010), dan anestesi umum-ETT, epidural CVC, ABP (r=0.288, p 0.023); waktu pemulihan anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.157, p 0.000), anestesi umum-ETT/LMA, CVC (r=0.664, p 0.000), anestesi umum-ETT, CVC, ABP (r=0.374, p 0.001), anestesi umum-LMA (r=0.299, p 0.023), anestesi umum-ETT/LMA, epidural (r=0.557, p 0.000), anestesi umum-ETT, epidural, CVC (r=0.338, p 0.035), anestesi umum-ETT, epidural, CVC, ABP (r= 0.343, p 0.006), sedasi (r=0.351, p 0.033), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.424, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.589, p 0.000). Simpulan: Waktu persiapan, induksi, dan pemulihan anestesi tidak berkorelasi dengan anesthesia-controlled time berdasarkan pemilihan teknik anestesi di Unit Pelayanan Bedah Terpadu Rumah Sakit Dr Cipto Mangunkusumo.

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ackground: An ideal operating schedule is the one that optimizes the workflow of an operating room, reduces case cancellation and inaccurate prediction of total procedural time. Central Surgical Unit of Dr. Cipto Mangunkusumo Hospital has a major role of ensuring the continuity of operational efficiency so that matters related to work efficiency, including patient scheduling in the operating room, are the main focus of attention. This study aims to assess the correlation of time of preparation, anesthesia induction and recovery time with anesthesia-controlled time (ACT) based on the choice of anesthesia technique. Methodes: This observational research was done in Central Surgical Unit of Dr. Cipto Mangunkusumo Hospital from March 2019 to December 2020, with a total of 1727 samples that fulfilled inclusion criteria, without exclusion criteria. By means of using a digital clock, anesthesia team performs observations, retrieval, and recording of time data manually into a questionnaire sheet provided in the operating room or an online document by accessing the link provided.Results: There is a significant positive linear correlation between anesthesia preparation time and ACT on general anesthesia-ETT (r=0.1, p 0.009), general anesthesia-ETT, CVC, ABP (r=0.253, p 0.028), and general anesthesia-ETT/LMA, peripheral nerve block, CVC, ABP technique (r=0.489, p 0.013); basic monitoring placement time and ACT on general anesthesia-ETT (r=0.125, p 0.001), general anesthesia-ETT, CVC, ABP (r=0.502, p 0.000), general anesthesia-ETT/LMA, epidural (r=0.372, p 0.001), general anesthesia-ETT, epidural, CVC (r=0.436, p 0.006), sedation (r=0.516, p 0.001), spinal (r=0.501, p 0.000), pediatric general anesthesia-ETT/LMA, CVC, ABP (r=0.321, p 0.000), and pediatric general anesthesia-ETT/LMA, caudal technique (r=0.445, p 0.001); anesthesia induction time and ACT on general anesthesia-ETT (r=0.513, p 0.000), general anesthesia-ETT, CVC, ABP (r=0.391, p 0.001), general anesthesia-LMA (r=0.312, p 0.017), general anesthesia-ETT/LMA, epidural (r=0.818, p 0.000), general anesthesia-ETT, epidural, CVC, ABP (r=0.559, p 0.000), spinal (r=0.503, p 0.000), combined spinal-epidural (r=0.779, p 0.000), peripheral nerve block (r=0.729, p 0.000), pediatric general anesthesia-ETT/LMA, CVC, ABP (r=0.511, p 0.000), and pediatric general anesthesia -ETT/LMA, caudal technique (r=0.543, p 0.000); CVC insertion time and ACT on general anesthesia-ETT/LMA, CVC (r=0.553, p 0.002), general anesthesia-ETT, CVC, ABP (r=0.434, p 0.000), general anesthesia-ETT, epidural, CVC (r=0.415, p 0.010), and general anesthesia-ETT, epidural CVC, ABP technique (r=0.288, p 0.023); anesthesia recovery time and ACT on general anesthesia-ETT (r=0.157, p 0.000), general anesthesia-ETT/LMA, CVC (r=0.664, p 0.000), general anesthesia-ETT, CVC, ABP (r=0.374, p 0.001), general anesthesia-LMA (r=0.299, p 0.023), general anesthesia-ETT/LMA, epidural (r=0.557, p 0.000), general anesthesia-ETT, epidural, CVC (r=0.338, p 0.035), general anesthesia-ETT, epidural, CVC, ABP (r= 0.343, p 0.006), sedation (r=0.351, p 0.033), pediatric general anesthesia-ETT/L anesthesia-ETT/LMA, caudal technique(r=0.589, p 0.000). Conclusions: Time of anesthesia preparation, induction, and recovery do not correlate with ACT based on the anesthesia technique used to fascilitate surgery in Central Surgical Unit of Dr Cipto Mangunkusumo Hospital."

"Latar Belakang: Tindakan pembedahan dengan invasi minimal seperti laparoskopi abdomen seringkali menjadi modalitas terpilih dengan perkembangan teknologi. Selama pembedahan, digunakan teknik anestesi umum pada pasien. Teknik anestesi yang ideal adalah teknik yang dapat menjaga kestabilan kardiovaskular dan respirasi, mengurangi kejadial mual muntah pascabedah, serta dapat mengurangi derajat nyeri pascabedah. Namun, prosedur laparoskopi menyebabkan perubahan fisiologis akibat kondisi pneumoperitoneum yang disebabkan oleh insuflasi gas karbon dioksida selama pembedahan, yang merupakan sebuah tantangan tambahan dalam pemberian anestesi yang ideal. Maka, penelitian ini bertujuan untuk membandingkan efektivitas penggunaan kombinasi anestesi umum dan spinal dengan anestesi umum saja dalam pembedahan laparoskopi abdomen.Metode: Penelitian ini merupakan uji klinik acak terkendali tanpa penyamaran pada pasien laparoskopi abdomen di Rumah Sakit Cipto Mangunkusumo. Pemberian anestesi umum menggunakan lidokain, fentanyl, propofol, dan rocuronium. Pemberian anestesi spinal menggunakan bupivakain 10 mg. Luaran yang dinilai berupa kebutuhan opioid intraoperatif, kestabilan MAP, nyeri pascabedah, dan kejadian post-operative nausea and vomiting (PONV).Hasil: Kombinasi anestesi umum dan spinal menyebabkan penurunan kebutuhan opioid fentanyl intraoperatif (p<0.001), kestabilan MAP yang lebih baik (p<0.009), dan penurunan nyeri pascabedah secara signifikan dibandingkan kelompok anestesi umum. Tidak terdapat perbedaan signifikan dari tingkat kejadian PONV. Simpulan: Kelompok anestesi umum dan spinal menunjukan penurunan kebutuhan opioid intraoperatif dan MAP yang lebih stabil pada tindakan laparaskopi dibandingkan dengan kelompok anestesi umum.

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Background: Minimally invasive surgical procedures such as laparoscopic abdominal surgery have often become the preferred modality with technological advancements. During surgery, general anesthesia techniques are employed in patients. The ideal anesthesia technique is one that can maintain cardiovascular and respiratory stability, reduce postoperative nausea and vomiting, and alleviate postoperative pain. However, laparoscopic procedures induce physiological changes due to pneumoperitoneum conditions caused by the insufflation of carbon dioxide gas during surgery, posing an additional challenge in achieving ideal anesthesia. Therefore, this study aims to compare the effectiveness of using a combination of general and spinal anesthesia with general anesthesia alone in laparoscopic abdominal surgery.

Methods: This research is a controlled randomized clinical trial without masking on patients undergoing laparoscopic abdominal surgery at Cipto Mangunkusumo Hospital. General anesthesia is administered using lidocaine, fentanyl, propofol, and rocuronium, while spinal anesthesia is administered using bupivacaine. The assessed outcomes include intraoperative opioid requirements, MAP stability, postoperative pain, and the incidence of postoperative nausea and vomiting (PONV).

Results: The combination of general and spinal anesthesia resulted in a significant reduction in intraoperative fentanyl opioid requirements (p<0.001), better MAP stability (p<0.009), and a significant decrease in postoperative pain compared to the general anesthesia group. There was no significant difference in the incidence of PONV .

Conclusion: The combination of general and spinal anesthesia group showed decreased intraoperative opioid requirements and more stable in mean arterial pressure (MAP) during laparoscopic procedures compared to general anesthesia group."

"Latar Belakang. Bedah jantung terbuka mengakibatkan nyeri dan respons stres pascabedah yang dapat memberikan dampak buruk bagi pasien. Blok transversus thoracis plane merupakan blok interfascial dalam di area parasternal untuk mengatasi nyeri sternotomi. Penelitian ini bertujuan untuk membandingkan efektivitas penambahan blok transversus thoracis muscle plane bilateral dalam mengurangi nyeri dan respons stres pascabedah jantung terbuka terhadap kontrol. Metode. Penelitian ini adalah uji klinis terkontrol acak tersamar ganda. Tiga puluh empat subjek yang memenuhi syarat yang menjalani operasi jantung elektif antara September 2020 dan Agustus 2001 secara acak dimasukkan ke kelompok blok TTP atau kontrol. Penelitian membandingkan beda rerata konsumsi morfin 24 jam pascabedah, waktu pertama dosis morfin pascabedah, waktu ekstubasi, konsentrasi plasma IL-6 dan kortisol pada 24 jam dan 48 jam pascabedah. Penelitian juga ingin mengetahui konsumsi fentanil intraoperatif, waktu pertama opioid rescue intraoperatif, komplikasi, efek samping opioid, dan lama rawat inap. Hasil. Konsumsi morfin 24 jam pertama pascabedah lebih tinggi secara bermakna (p<0,001) pada kelompok kontrol dibandingkan kelompok blok TTP. Waktu pertama pemberian morfin pascabedah lebih lama secara bermakna (p<0,001) pada kelompok blok TTP dibandingkan kelompok kontrol. Waktu ekstubasi tidak berbeda bermakna antara kelompok blok TTP dan kelompok kontrol. Konsentrasi plasma IL-6 dan kortisol tidak berbeda bermakna antara kelompok blok TTP dan kelompok kontrol pada 24 jam dan 48 jam pascabedah. Kesimpulan. Penambahan blok transversus thoracis muscle plane bilateral tidak terbukti lebih efektif dalam mengurangi nyeri dan respons stres pascabedah jantung terbuka dibandingkan dengan kontrol.

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Background. Open-heart surgery is a major surgery that causes postoperative pain and surgical stress response, contributing further to postoperative complications and morbidity. Transversus thoracis muscle plane block is a deep interfascial block in the parasternal area to treat sternotomy pain. This study aimed to compare the effectiveness of bilateral transversus thoracis muscle plane blocks in reducing pain and stress response after open-heart surgery versus control. Methods. This is a prospective, double-blind, randomized control trial. Thirty-four eligible subjects who underwent elective cardiac surgery between September 2020 and August 2001 were randomly assigned to the TTPB or control group. The primary outcomes were the different means of 24-hour postoperative morphine consumption, time of first postoperative morphine dose, extubation, postoperative plasma levels of IL-6 and cortisol at 24 hours and 48 hours after surgery. The secondary outcomes were intraoperative fentanil consumption, time of first intraoperative opioid rescue, complication, opioid side effects, and length of stay. Results. The 24-hour postoperative morphine consumption was significantly higher (p<0.001) in the control group than in the TTPB group. The time of first postoperative morphine dose was significantly longer (p<0.001) in the TTPB group than in the control group. Extubation time was not statistically different between the TTP block group and the control group. Plasma levels of IL-6 and cortisol were not statistically different between the TTP block group and the control group at 24 hours and 48 hours after surgery. Conclusion. The bilateral transversus thoracis muscle plane blocks were not shown to be more effective in reducing pain and stress response after open-heart surgery compared to controls."

"Latar Belakang : Tingkat kepuasan pasien merupakan salah satu indikator kualitas pelayanan anestesia, baik rawat inap maupun rawat jalan. Bedah rawat jalan menawarkan banyak kelebihan dibandingkan rawat inap, sehingga berkembang sangat pesat di Indonesia khususnya di RSUPN Cipto Mangunkusumo Jakarta dan sebagian besar jenis anestesia pada bedah rawat jalan adalah anestesia umum. Perkembangan ini harus diimbangi dengan peningkatan kualitas pelayanan anestesia. Oleh karena itu perlu dilakukan penilaian terhadap tingkat kepuasan pasien dan faktor-faktor yang memengaruhinya. Tingkat kepuasan pasien dapat memberikan feedback untuk meningkatkan kualitas pelayanan anestesia pada instalasi bedah rawat jalan. Tujuan : Mengetahui tingkat kepuasan pasien yang menjalani anestesia umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo dan faktor yang memengaruhinya. Metode : Penelitian ini adalah penelitian potong lintang. Dilakukan penilaian tingkat kepuasan pada 76 pasien dengan menggunakan kuesioner yang telah divalidasi. Kriteria penerimaan adalah usia 18-65 tahun yang menjalani pembiusan umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo Jakarta, dapat berbahasa Indonesia, membaca dan menulis, bersedia berpartisipasi dan menandatangani surat persetujuan penelitian, pulang dihari yang sama setelah pembedahan atau dirawat kurang dari 24 jam. Hasil kuesioner akan diolah menggunakan perangkat lunak SPSS dengan uji univariat dan bivariat. Hasil : Uji univariat menunjukkan tingkat kepuasan pasien terhadap anestesia umum rata-rata diatas 70 %. Sedangkan dari uji bivariat, faktor yang berpengaruh terhadap tingkat kepuasan pasien adalah usia, jenis kelamin dan pekerjaan. Kesimpulan : Pasien merasa puas terhadap pelayanan anestesia umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo Jakarta. Karakteristik pasien yang memengaruhi tingkat kepuasan pasien adalah usia, jenis kelamin dan pekerjaan.

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Background : Patient satisfaction has been one of quality indicators in anesthesia services whether it is inpatient or outpatient. Ambulatory surgery offers more advantages compares to inpatient services, thus it developed nicely in Indonesia especially in RSUPN Cipto Mangunkusumo Jakarta where most patients undergone general anesthesia. This development is yet to be offset by improvement in anesthesia quality services. Thus, it is needed to assess patient satisfaction and factors. Patient satisfaction can give feedback to improve quality of anesthesia services in ambulatory surgery.

Purpose : The purpose of this study was to know patient satisfaction toward general anesthesia and influencing factors in ambulatory surgery RSUPN Cipto Mangunkusumo Jakarta.

Methods : This is a cross sectional study. Patient satisfaction was assessed in 76 patients using validated questionnaire. The inclusion criteria were age 18-65 undergoing general anesthesia in Ambulatory Surgery, Bahasa speaking, able to read and write, and agreed to participate in this study by signing research consent and discharged on the same day or hospitalized less than 24 hours after surgery. Result was processed using SPSS with univariate and bivariate test.

Results: Univariate test showed patient satisfaction toward general anesthesia was above 70%. While Bivariate test indicated factors influencing patient satisfaction were age, gender and occupation.

Conclusion : Patients were satisfied with general anesthesia services in Ambulatory Surgery RSUPN Cipto Mangunkusumo Jakarta. Patient characteristics influencing patient satisfaction were age, gender and occupation."

"ABSTRAKLatar Belakang: Quality of Recovery-40 (QoR-40) adalah salah satu instrumen yang telah digunakan luas di dunia untuk menilai kualitas pemulihan pascaanestesia umum. Saat ini belum ada instrumen spesifik yang menilai kualitas pemulihan pascaanestesia di Indonesia.Metode: Hasil terjemahan akan diujikan pada minimal 102 pasien yang menjalani anestesia umum satu hari praoperasi dan satu hari pascaoperasi. Uji kesahihan isi menggunakan koefisien Aiken v, uji kesahihan konstruksi (analisis faktor dan uji korelasi pearson), Konsitensi Internal ( Chronbach α), ketanggapan (responsiveness) dengan Standart respon mean (SRM) .Hasil: Uji kesahihan isi formula Aiken V didapatkan bahwa QoR-40 versi Indonesia sahih dengan nilai ≥ 0,5. Uji kesahihan konstruksi dengan analisis faktor menunjukan semua faktor memiliki korelasi yang tinggi (korelasi ≥ 0,5). Uji korelasi Pearson didapatkan 3 item pertanyaan dari dimensi dukungan tehadap pasien yang tidak sahih, (Mendapat dukungan dari dokter Rumah Sakit, ρ= 0,252), (Mampu memahami arahan dan nasehat ρ= 1,98), (Merasa bingung ρ= 0,202). Standart Respon Mean (SRM) pada Uji ketanggapan adalah 1,06. Terdapat hubungan negatif antara skor QoR-40 versi Indonesia dengan lama masa rawatanSimpulan: QoR - 40 versi Indonesia menunjukkan kesahihan dan keandalan yang memuaskan. Dimensi dukungan terhadap pasien dengan koefisien kesahihan terendah dan tiga pertanyaan yang tidak memiliki kesahihan konstruksi. Ada hubungan negatif antara skor QoR - 40 versi Indonesia dengan panjang pengobatan . Penelitian ini menghasilkan instrumen QoR - 40 versi Indonesia yang memiliki ketanggapan atau sensitif untuk menilai perubahan klinis pascanestesia umum.

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ABSTRACTBackground: Quality of Recovery-40 (Qor-40) is one of the instruments that have been used widely in the world to assess the quality of recovery after general anesthesia. Currently there is no specific instrument that assesses the quality of recovery after general anesthesia in Indonesia.Methods: The translation will be tested on at least 102 patients undergoing general anesthesia preoperative one day and one day postoperative. Test the validity of the content using the coefficient Aiken V, Construction validity (factor analysis and Pearson correlation), Internal consistency (Chronbach α), responsiveness with Standard response mean (SRM).Results: Test the content validity of Aiken V formula found that Qor-40 Indonesian version valid with a value of ≥ 0.5. Test construction validity by factor analysis showed all the factors have a high correlation (correlation ≥ 0.5). Pearson correlation test item obtained 3 question in patient support dimension not valid, ( Getting support from Hospital doctors, ρ = 0.252), (Able to understand the direction and advice of ρ = 1.98), (Feeling confused ρ = 0.202). SRM on test responsiveness 1,06. There is a negative correlation between the scores Qor-40 version Indonesia with long term careConclusion: QoR-40 Indonesian version showed satisfactory validity and reliability. Dimensions support to patients with the lowest validity coefficient and three questions that do not have construction validity. There is a negative relationship between the score Qor-40 version of Indonesia with the length of treatment. This research resulted in the instrument Qor-40 Indonesia version (responsivness) or sensitive to assess clinical changes after general anesthesia."

"[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.]"

"Latar belakang : Penelitian ini membandingkan efek ropivakain hiperbarik 15 mg + morfin 0,15 mg dengan ropivakain hiperbarik 12 mg + morfin 0,15 mg untuk bedah sesar dengan analgesia spinal.Metode : Dilakukan secara acak tersamar Banda. Hipotesis yang dibuat adalah Ropivakain hiperbarik 12 mg dengan morfin 0,15 mg intratekal, mempunyai mula kerja hambatan sensorik dan motorik yang sama dengan ropivakain hiperbarik 15 mg ditambah morfin 0,15 mg intratekal, namun dengan masa kerja hambatan sensorik dan motorik lebih singkat, dan dapat digunakan untuk anestesia spinal pada bedah sesar. Sebanyak 66 wanita hamil yang akan menjalani beddah sesar, ASA I -- II diberikan ropivakain hiperbarik 15 mg + morfin 0,15 mg (n=33) atau ropivakain hiperbarik 12 mg + morfin 0,15 mg (n-33) dengan teknik blok subaraknoid. Perubahan blok sensorik diukur dengan tes pinprick, dan perubahan hambatan motorik diukur dengan modifikasi skala bomage, VAS diukur 3 kali.Basil : Tidak ada perbedaan bermakna pada data demografi kedua kelompok. Kelompok ropivakain 15 mg mempunyai penyebaran hambatan sensorik maksimal lebih tinggi (median [min-max]) : Th 4 (th 1 - 6) vs Th 5 (Th 2 -- 6), tidak ada perbedaan bermakna pada mula kerja hambatan sensorik (median [min-max]) : 3,2 mnt (2 - 5 mnt) vs 3,0 (1- 5 mnt), tidak ada perbedaan bermakna pada mula keija hambatan motorik (median [min-max]) : 3,3 mnt (1-10 mnt) vs 3 mnt (1-7 mnt), masa kerja hambatan sensorik lebih lama pada kelompok ropivakain 15 mg (median [min-max]) : 60 mnt (45 -120mnt) vs 52 mnt (30 - 103 mnt), masa kerja hambatan motorik lebih lama pada kelompok ropivakain 15 mg (median[min-max]) : 60 mnt (35-118 mnt) vs 57 mnt (32 -102 mnt), dan basil yang sama pada pengukuran VAS sebanyak 3 kali.Simpulan : Ropivakain hiperbarik 15 mg + morfin 0,15 mg dan ropivakain hiperbarik 12 mg + mofin 0,15 mg dapat digunakan untuk analgesia spinal untuk operasi bedah sesar.

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Background This study was designed to evaluate the effects of intrathecal hyperbaric ropivacaine 15 mg plus morln 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg in women undergoing cesarean section.Methods : This was a prospective, randomized, doubleblinded study. We hypothesized that hyperbaric ropivacaine 12 mg plus morphin 0,15 mg has the same onset of sensory and motoric block, with longer duration of sensory and motoric block with hyperbaric ropivacaine 15 mg plus morphine 0,15 mg. Sixtysix parturients, physical status ASA I - II were given either hyperbaric ropivacaine 15 mg plus morphine 0,15 mg (n=33) or hyperbaric ropivacaine 12 mg plus morphine 0,15 mg (n=33), for cesarean section with spinal analgesia. Changing of sensory block was assessed by pinprick test and motoric block was assessed by bromage score (modification). Visual analogue score was measured three times.Results : There were no significant differences in demographic variable between groups. Higher cephalic spread (median [range]) maximum block height to pinprick hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg : Th 4 (th 1 - 6) vs Th 5 (Th 2 - 6), no significant difference of sensory block onset (median [range]) : 3,2 min (2 - 5 minutes) vs 3,0 (1 - 5 min), no significant difference of motoric block onset (median [range]) : 3,3 min (1-10 min) vs 3 min ( 1-7 min), longer sensoric block duration hyperbaric ropivacaine 15 mg compare to hyperbaric ropivacaine 12 mg (median [range]) : 60 min (45 -120min) vs 52 min (30 -- 103 min), longer motoric block duration in hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg (median[range]) : 60 min (35-118 min) vs 57 min (32 - 102 min), and no significant difference in visual analogue score in three times measurements.Conclusion : Hyperbaric ropivacaine 15 mg plus morphine 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg are sufficient for spinal analgesia in patients undergoing cesarean section."

"Tujuan : Mengetahui besarnya kegunaan dan keberhasilan pemasangan LMP yang menggunakan pelincir jeli lidokain 2% dibandingkan dengan yang dibasahi salin 0,9% pada anestesi umum inhalasi dengan N20 : 02 = 70% : 30%. Disain : Uji klinik tersamar ganda. Pasien : 56 pasien yang menjalankan operasi berencana dengan anestesi umum inhalasi dan tidak ada indikasi kontra penggunaan LMP di InstaIasi Bedah Pusat RSCM pada bulan Oktober sampai dengan Desember tahun 2005, usia 18-60 tahun, ASA 1/1I, berat badan sesuai ukuran LMP no 3 atau 4. Pasien dibagi menjadi 2 kelompok, masing masing 26 pasien, kelompok 1 dilakukan pemasangan LMP dengan pelincir salin 0,9% dan kelompok II dilakukan pemasangan LMP dengan pelincir ieli lidokain 2%. Apabila LMP terinsersi dilakukan OGT. Selama pemasangan LMP tersebut dilakukan pengamatan dan pengukuran tekanan sungkup LMP setiap 30 menit sarnpai operasi selesai. Analisa statistik dilakukan dengan uji t untuk data numerik, uji x kuadrat untuk data nominal dan koreksi yaitu bila nilai ekspektasi kurang dari 5 dengan tingkat signifikan p<0,05. Hasil : Angka keberhasilan pemasangan LMP dengan menggunakan pelincir lidokain sama dengan menggunakan pelincir salin (92,3 %><84,6 %) p>0,05. Sehingga pada uji statistik perbedaan tersebut tidak signifikan (p>0,05). Komplikasi "sore throat" yang timbal selama pemasangan LMP dengan pelincir lidokain dan salin pada 5 menit pasca ekstubasi di ruang pulih adalah sama yaitu "sore throat" ringan 3,8 % pada pelincir salin dan 7,7 % "sore throat" sedang pada pelincir lidokain, namun dari uji statistik perbedaan ini tidak signifikan (p>0,05). Begitu juga "sore throat" yang terjadi 24 jam pasca bedah pada pemasangan LMP dengan salin terdapat 3,8 % "sore throat" sedang dan pada lidokain 7,7 % "sore throat" ringan secara uji statistik perbedaan ini tidak signifikan (p>0,05).Kesimpulan : Secara uji statistik keberhasilan pemasangan sungkup LMP pada kelompok salin dan lidokain tidak berbeda secara signifikan. Begitu pula dengan kekerapan "sore throat" dan derajat "sore throat" antara kelompok salin dan lidokain tidak berbeda secara signifikan.

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OBJECTIVE : To compare the successfully of attempt LMP with correlation between lubricant lidocain 2 % or saline 0,9 % and incidence of post operative sore throat after general anesthesia inhalation with N20/02/Enflurance facilitated by LMP with lubricant lidocain 2 % or saline 0,9%.

STUDY DESIGN : Double blind randomized clinical trial. PATIENT : 56 patient, 18 to 60 years old, underwent elective surgery in IBP RSUPN -- CM, ASA I 1 II malampatie score 1, area of surgery not in the head and neck, in supine position with OGT placement. Patients were allocated into two groups. 26 patients in group I with saline lubricant, and 26 patients in group II with lidocaine lubricant. After the operation patients was recorded about successfully attempt of LMP and complaint of sore throat in the recovery room, and 24 hours after anesthesia. Statistics analysis with T-test for continues data, x2 test and Fischer's exact test for categorical data. Spearman correlations test with significant value P <0,05 and confidence interval 95%.

RESULTS : The incidence of successfully attempt LMP with lidocaine equivalent with saline (92,3% >< 84,6%) P >0,05, The incidence of mild sore throat at the recovery room 3,8% with saline and 7,7% moderate sore throat with lidocaine (P >0,05). The incidence of sore throat at 24 hours after surgery were 3,8% moderate sore throat with saline and 7,7% mild sore throat with lidocaine (P > 0,05).

CONCLUSION : The successfully attempt of LMP in the saline group not signifikan compare to lidocain group. Morbidity of sore throat not significant between saline group compare to lidocaine group and intensity of sore throat between saline group not significant compare to lidocaine group."

"Latar Belakang: Insidens postdural puncture headache menggunakan jarum spinal ukuran kecil belum pernah diteliti di RSUPNCM. Saat ini di tempat kami jarum spinal yang tersedia yaitu jarum spinal Quincke ukuran 25G, 26G, dan 27G. Metode: Penelitian observasional ini dilakukan secara prospektif untuk mencari insidens postdural puncture headache sampai 72 jam pasca-anestesia spinal. Faktor-faktor risiko yang berhubungan dengan pasien dan prosedur dihubungkan dengan PDPH dan dilakukan analisis regresi linear terhadap faktor-faktor tersebut. Hasil: Insidens postdural puncture headache pasca-anestesia spinal sebesar 6,6%. Kelompok usia <50 tahun memiliki kemungkinan 3 kali PDPH dibanding kelompok umur lebih tua. Jarum spinal 25G/26G Quincke memiliki kemungkinan 2 kali risiko MPDPH dibandingkan jarum 27G. Kesimpulan: Insidens postdural puncture headache setelah anesthesia spinal di RSUPNCM tidak berbeda dengan hasil laporan di tempat lain.

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Background : Incidence of postdural puncture headache using small spinal needles was not yet investigated in RSUPNCM. In our centre we use Quincke spinal needle sizes 25G, 26G, and 27G.

Methods : The incidence of postdural puncture headache was prospectively investigated until 72 hours after spinal anesthesia in 440 patients at RSUPNCM. Patient and procedure related factors were recorded and submitted to multiple logistic regression analysis to determine the relationship of these factors to postdural puncture headcahe.

Results: The incidence of postdural puncture headache after spinal anesthesia were 6,6%. The age <50 years old is identified increase three times for PDPH compare to older. Larger needles Quincke (25G/26G) is identified increase twice for PDPH compare to 27G.

Conclusion : The incidence of postdural puncture headache after spinal anesthesia at RSUPNCM is comparable to those reported elsewhere."

"Berbagai studi dan penelitian telah dilakukan di berbagai negara untuk mengetahui pengetahuan pasien terhadap anestesia namun tidak ada instrumen kuesioner yang baku untuk menilai pengetahuan pasien tentang anestesia, dan hal ini belum pernah dilakukan di Indonesia khususnya di RSUPN Cipto Mangunkusumo. Kuesioner pengetahuan yang valid dan reliabel diharapkan menjadi standar untuk menilai pengetahuan masyarakat terhadap anestesia, dan dapat menjadi dasar bagi penelitian selanjutnya.Metode: Kuesioner pengetahuan anestesia sebelumnya telah melalui tahapan pretest oleh ahli dan uji pilot, hasil kuesioner uji pilot disempurnakan sehingga dianggap layak diujicobakan. Penelitian dilakukan pada bulan Januri 2014 sampai dengan Maret 2014 terhadap subyek secara consecutive sampling yang akan menjalani pembiusan dan diperiksa di klinik preoperatif RSUPN Cipto Mangunkusumo Jakarta. Teknik uji validitas menggunakan validitas konstruk dengan koefisien korelasi minimal 0,3 dapat dianggap valid dan uji reliabilitas menggunakan teknik konsistensi internal dengan nilai cronbach α minimal 0,4 dianggap reliabel.Hasil: Penelitian ini diikuti oleh 95 subyek dengan 1 subyek dikeluarkan dari penelitian karena tidak mengisi kuesioner secara lengkap. Kuesioner pengetahuan terdiri dari 20 pertanyaan, 8 pertanyaan diantaranya dinilai tidak valid dan reliabel yang dapat disebabkan oleh pertanyaan dan jawaban kuesioner yang tidak dapat dimengerti oleh subyek, pembahasan terlalu dalam dan penggunaan istilah medis yang tidak familiar. Beberapa jawaban pertanyaan memiliki kesamaan yang dapat membingungkan subyek, serta terdapat inkonsistensi jawaban yang diberikan oleh subyek. Tingkat penghasilan dan pendidikan subyek yang rendah serta pengalaman dan informasi yang kurang, sangat mempengaruhi pengetahuan subyek terhadap anestesia, tercermin dari rendahnya rerata tingkat pengetahuan subyek sebesar + 31,6%.Kesimpulan: Kuesioner penilaian pengetahuan tentang anestesia pada pasien di klinik preoperatif RSUPN Cipto Mangunkusumo tidak dapat dijadikan sebagai suatu standar instrumen yang baku oleh karena dinilai tidak valid dan reliabel.

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Various studies and researches have been conducted abroad to determine the patient?s anesthesia knowledge, although no standard questionnaires exist. Research on anesthesia?s knowledge questionnaires have never been done specifically in Cipto Mangunkusumo hospital. A valid and reliable questionnaire is aimed to be a standard instrument assessing the community?s knowledge on anesthesia, and as a foundation for future researches.Methods: The anesthesia knowledge questionnaires has been evaluated through a pre-test phase done by experts and pilot test, the results was then revised until it is acceptable and can be tested. Researches was conducted on January 2014 until March 2014 on subjects by consecutive sampling who are going to undergo anesthesia and evaluated at the preoperative clinic Cipto Mangunkusumo Hospital Jakarta. Validity test techniques using construct validity with the minimal correlation coefficient 0.3 is valid. Reliability tests using internal consistency techniques with minimal cronbach alpha value 0.4 is reliable.Results: Research was participated by 95 subjects with 1 subject excluded from the research because of not filling in the questionnaire completely. The knowledge questionnaire included 20 questions, whereas 8 questions was marked to be invalid and unreliable that may be caused by questions and answers were not fully understood by the subjects, the contents was too spesific, usage of medical terms that aren?t familiar. Some of the given answers have similarities that may confuse the subject, and also inconsistency from the subject?s answers. Low level of salary and education with lacking of experience and information from the subjects, has significant influence on the subjects knowledge on anesthesia which is reflected by the low average level of the subject`s knowledge which is + 31.6%.Conclusions: Anesthesia knowledge questionnaires on patients at preoperative clinic Cipto Mangunkusumo hospital is invalid and unreliable therefore fail to be a standard instrument."