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"Latar Belakang: Bedah abdomen merupakan salah satu tindakan yang memiliki persentase mortalitas dan morbiditas yang tinggi. Pemberian cairan sebagai kompensasi hipotensi dan kehilangan darah yang menyebabkan gangguan hemodinamik pada pasien bedah mayor abdomen menjadi faktor resiko utama dalam terjadinya morbiditas dan mortalitas. Hipotensi dan gangguan hemodinamik dapat dipertahankan dengan pemberian vasopressor. Norepinefrin merupakan vasopressor lini pertama yang diberikan untuk mempertahankan hemodinamik. Metode: Penelitian ini merupakan penelitian eksperimental dengan sistem random sampling, 196 subjek dipilih berdasarkan kriteria inklusi dan dilakukan randomisasi untuk dikategorikan menjadi dua kelompok yaitu kelompok terapi standar dan kelompok norepinefrin. Hasil: Hasil penelitian dengan Chi-square menunjukkan bahwa durasi hipotensi dan laktat serta profil hemodinamik (index contractility, mixed vein, stroke volume variation) tidak memiliki perbedaan yang bermakna antara kelompok norepinefrin dan kelompok terapi standar (OR 1.00;95% CI = 0.062 - 16.217; OR 1.18;95% CI = 0.670-2.095; OR 1.09;95% CI = 0.611 – 1.952; OR 0.94;95% CI = 0.472- 1.872; OR 1.54;95% CI = 0.863-2.746). Kesimpulan: Pada penelitian ini didapatkan bahwa dengan pemberian norepinefrin dini pada awal fase hipotensi memiliki efek yang sama baiknya dengan terapi cairan, sehingga dapat menjadi alternatif dalam mempertahankan hemodinamik perioperatif.

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Introduction: Major abdominal surgery is one of the actions that have a percentage of high mortality and morbidity. Giving fluid as compensation for hypotension and loss of blood causes disturbance in hemodynamics in patients with major abdominal surgery factor risk main in happening morbidity and mortality. Hypotension and disorders in hemodynamics could be maintained with the administration of vasopressors. Norepinephrine is a first-line vasopressor for maintaining hemodynamics. Method: In this experimental study with systematic random sampling, 196 subjects were chosen based on criteria inclusion and randomization for categorized into two groups that is group therapy standard and group norepinephrine. Result: This experiment analyzed with Chi-square shows that duration hypotension and lactate as well as profile hemodynamics (index contractility, mixed vein, stroke volume variation) do have meaningful differences _ Among group norepinephrine and group therapy standard OR 1.00;95% CI = 0.062 - 16.217; OR 1.18;95% CI = 0.670-2.095; OR 1.09;95% CI = 0.611 – 1.952; OR 0.94;95% CI = 0.472- 1.872; OR 1.54;95% CI = 0.863-2.746). Conclusion: This experiment obtained that given norepinephrine at the beginning phase of hypotension has the same effect as fluid therapy, so that could be an alternative in maintaining hemodynamics perioperativ"

"ABSTRAKNyeri pasca bedah abdomen adalah gabungan dari beberapa pengalaman sensori, emosional, dan mental yang tidak menyenangkan akibat trauma bedah. Walaupun nyeri telah dikelola dengan baik, kira-kira 86% pasien mengalami nyeri sedang ke hebat pasca bedah meskipun analgesik ditingkatkan. Penelitian ini bertujuan mendeskripsikan karakteristik responden (exploratory study) dan selanjutnya menjelaskan faktor-faktor yang mempengaruhi intensitas nyeri pasca bedah abdomen (explanatory study). Desain penelitian ini adalah deskriptif analitik dengan pendekatan cross sectional pada 67 orang responden pasca bedah abdomen. Pada penelitian ini digunakan instrumen State Anxiety Inventory (S-AI) Form Y untuk menilai keadaan cemas pasien pasca bedah abdomen, sikap dan keyakinan terhadap nyeri, dan skala nyeri untuk menilai intensitas nyeri pasca bedah menggunakan kombinasi Visual Analog Scale (VAS) dan Numeric Rating Scale (NRS). Hasil penelitian ini menunjukan bahwa faktor-faktor yang mempengaruhi secara signifikan terhadap intensitas nyeri pasca bedah abdomen adalah jenis kelamin (p value = 0,005), letak insisi (p value = 0,0005), dan tingkat kecemasan (p value = 0,0005). Faktor yang paling mempengaruhi intensitas nyeri pasca bedah abdomen adalah tingkat kecemasan (standardized coefficient β 0,501). Hasil penelitian ini bermanfaat bagi praktisi keperawatan sebagai acuan asuhan keperawatan dalam melakukan pengelolaan nyeri pasca bedah abdomen untuk mempertimbangkan faktor tingkat kecemasan, jenis kelamin, dan letak insisi. Rekomendasi hasil penelitian ini perlu adanya penelitian lebih lanjut dengan jumlah sampel yang lebih besar dan faktor-faktor lain yang dapat mempengaruhi nyeri.

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ABSTRACT

Abdominal postoperative pain is a combined of several unpleasant sensory, emotional, and mental experience precipitated by the surgical trauma. Pain experience are influenced by many factors and it is difficult to understand and about 86% of patients experience moderate to severe pain following surgery in the hospital. The purpose of this study was to identify the characteristic of respondent (exploratory study) and to explain influencing factors of abdominal postoperative pain intensity (explanatory study). The design was an analytic description using a cross sectional for 67 respondents abdominal postoperative. In the study using State Anxiety Inventory (S-AI) Form Y instrument was used to measure the abdominal postoperative state anxiety, attitudes and beliefs about pain, and pain scale using a combined Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) was used to measure postoperative pain intensity. The finding showed that gender (p value = 0,005), incision site (p value = 0,0005), and anxiety levels (p value = 0,0005) were significantly influencing factors of abdominal postoperative pain intensity. The most influencing factor of abdominal postoperative pain intensity was anxiety levels (standardized coefficient β 0,501). This study information for nursing practitioner as reference in nursing care planning should be considered anxiety levels, gender, and incision site to management of patients with postoperative pain relief. It is recommended to conduct further research using more samples and other factors that also may alter pain reaction."

"Latar Belakang: Pasien pascabedah abdomen mayor seringkali berhubungan dengan terjadinya general increase permeability sindrom akibat kelebihan cairan selama selama durante operasi dan pada saat perawatan pascabedah. Tujuan dari penelitian ini adalah ingin membuktikan apakah keseimbangan cairan kumulatif, tekanan vena sentral dan rasio albumin-kreatinin urin dapat digunakan sebagai prediktor kebocoran kapiler. Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang menjalani tindakan bedah abdomen mayor. Dilakukan pemeriksaan keseimbangan cairan kumulatif, tekanan vena sentral, rasio albumin-kreatinin urin dan indeks kebocoran kapiler, pada saat sebelum induksi anestesi, 48 jam dan 72 jam pasca bedah. Hasil: Pada penelitian ini didapatkan nilai titik potong dari indeks kebocoran kapiler 155 (AUC 0,013, sensitifitas 100% dan spesifisitas 74,50%. Analisis dengan Generalized Estimating Equations didapatkan tekanan vena sentral menujukan hubungan tidak bermakna dengan indeks kebocoran kapiler (OR 1,62 ; CI 95% = 0,92 – 2,83), sedangkan keseimbangan cairan kumulatif dan rasio albumin kreatinin urin menunjukkan hubungan yang bermakna dengan indeks kebocoran kapiler (OR = 2,561 ; CI 95% = 1,352-4,850 dan OR = 2,017 ; CI 95% = 1,086-3,749). Faktor skor SOFA terkategori sepsis juga mempunyai hubungan dengan indeks kebocoran kapiler (OR = 2,764 ; CI 95% = 1,244-6,140). Kesimpulan: Kelebihan cairan kumulatif, rasio albumin kreatinin urin dan skor SOFA terbukti dapat digunakan untuk memprediksi kebocoran kapiler.

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Background: Patients after major abdominal surgery are often associated with the occurrence of general increase in permeability syndrome due to excess fluid during surgery and during postoperative care. The purpose of this study was to prove whether cumulative fluid balance, central venous pressure and urine albumin-creatinine ratio of urine can be used as predictors of capillary leakage. Method: This study is a prospective cohort study with research subjects as adult patients undergoing major abdominal surgery. Cumulative fluid balance, central venous pressure, urine albumin-creatinine ratio and capillary leak index were examined, before anesthesia induction, 48 hours and 72 hours postoperatively. Result: In this study, a cut-off point from the capillary leak index ≥155 (AUC 0.013, sensitivity 100% and specificity 74.50%) was obtained. Generalized Estimating Equations analysis showed that the central venous pressure showed no significant relationship with the capillary leak index (OR 1.62; 95% CI = 0.92 - 2.83), while cumulative fluid balance and urine albumin : creatinin ratio showed a significant association with capillary leak index (OR = 2.561; 95% CI = 1.352-4.850 and OR = 2.017; 95% CI = 1,086-3,749) Sepsis categorized SOFA score factors also have a relationship with capillary leak index (OR = 2.764; 95% CI = 1,244-6,140). Conclusion: Cumulative fluid overload, urine creatinine albumin ratio and SOFA score have been shown to predict capillary leakage."

"Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya.

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This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score."

"Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine."

"[ABSTRAK Tujuan dari penelitian ini adalah untuk menilai dampak dari preopratif incentive spirometry terhadap komplikasi paru dan uji fungsi paru di antara pasien dengan operasi abdomen mayor Pasien yang menjalani operasi mayor abdomen tanpa riwayat penyakit paru secara acak dibagi menjadi dua kelompok: kelompok latihan dan kelompok kontrol. Kelompok Latihan diberi 15 menit latihan empat kali sehari selama 2 hari sebelum operasi. Kelompok kontrol tidak menerima latihan. Pengukuran fungsi paru baseline dan pasca operasi diambil pada kedua kelompok. Fungsi paru pasca operasi diukur dari hari pertama sampai hari ketujuh. Semua pasien dinilai untuk komplikasi paru pasca operasi oleh ahli pulmonologi.Kami merekrut 23 pasien dalam setiap kelompok. Insiden komplikasi paru adalah 56,5% pada kelompok kontrol dan tidak ada komplikasi yang ditemukan di antara pasien pada kelompok latihan. Ada penurunan yang signifikan dari komplikasi paru pada kelompok exrcise (p <0,001). Ada penurunan signifikan dari atelektasis (p <0,01), pneumonia (p 0,025), Hipokemia (p 0,005). Incentive spirometry memiliki efek perlindungan dengan resiko relative (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) untuk komplikasi pada kelompok kontrol adalah 3,3 (OR 3,30 CI 95% 1,97-5,54) pada komplikasi paru. Dalam hal fungsi paru, kami menemukan peningkatan yang signifikan pada Vital Capacity (dari 2336,96 + 722,56 mL ke 2541,30 + 718,78 mL dengan p <0,01) dan Force Vital Capacity (dari 2287,39 + 706 , 11 untuk 2469,57 + 676,10 dengan p <0,01) setelah latihan. Sebagai kesimpulan, preoperatif incentive spirometry dapat menurunkan insiden komplikasi paru.ABSTRACT The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending

pulmonologist.

We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.

As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. , The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending

pulmonologist.

We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.

As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. ]"