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"Latar Belakang: Hipotensi dengan, segala efek buruknya adalah komplikasi yang paling sering ditemukan pada tindakan anestesia spinal sebagai teknik yang paling popular pada anestesia bedah sesar. Pemberian ringer laktat adalah salah satu usaha pencegahan dengan waktu pemberian sebagai salah satu faktor yang dapat mempengaruhi manlaat.Tujuan: Mengetahui efek hipotensi dan efek samping hipotensi akibat anestesia spinal setelah pemberian ringer iaktat saat dilakukan anestesia spinal dan 20 menit sebelum dilakukan anestesia spinalMetode: Penelitian ini dilakukan dengan desain eksperimental acak tersamar tunggal mengikutsertakan 155 subjek yang menjalani bedah sesar. 5 subjek dikeluarkan dari penelitian, dan subjek dibagi dalam dua kelompok yang sama besar (75 orang) secara acak sederhana. Kelompok perlakuan mendapat ringer laktat saat dilakukan anestesia spinal dan kelompok kontrol mendapat ringer laktat 20 menit sebelum dilakukan anestesia spinal sebanyak 20 inl/KgBB maksimal 1000 ml.Hasil: Terdapat perbedaan yang bermakna antara angka kejadian hipotensi pada kedua kelompok dengan perbedaan sebesar 17% (interval kepercayaan 95% 1,4;32,6, dengan risk ratio 0,67 dan Number Needed to Treat (NNT) 6 orang. Terdapat perbedaan yang bermakna antara angka kejadian efek samping hipotensi pada kedua kelompok. Didapatkan penurunan angka kejadian efek samping hipotensi sebesar 24% (interval kepercayaan 95% 11,2;36,8), dengan risk ratio 0,31, dan NNT 4 orang. Terdapat hubungan yang bermakna antara hipotensi dan efek samping hipotensi. Didapatkan perbedaan angka kejadian efek samping hipotensi yang timbul sebesar 52,3 % (interval kepercayaan 95% 40,15;64,45) pada pasien yang mengalami hipotensi. Tidak terdapat hubungan yang bermakna antara jumlah pernakaian efedrin dengan efek samping hipotensi, dengan korelasi yang sangat lemah.Kesimpulan: Pemberian ringer laktat saat dilakukannya anestesia spinal lebih baik dalani menurunkan angka kejadian hipotensi dan angka kejadian efek samping hipotensi akibat anestesia spinal dibandingkan dengan pemberian ringer laktat 20 menit sebelum anestesia spinal."

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

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

"[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.

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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: Posisi pasien selama tindakan anestesia spinal menentukan keberhasilan penempatan jarum spinal. Traditional sitting position (TSP) merupakan posisi standar untuk anestesia spinal, namun angka keberhasilannya masih cukup rendah. Crossed leg sitting position (CLSP) merupakan salah satu posisi alternatif dalam anestesia spinal yang memiliki kelebihan berupa derajat fleksi lumbal yang lebih besar. Penelitian ini bertujuan untuk membandingkan CLSP dan TSP terhadap keberhasilan penempatan jarum spinal pada pasien bedah urologi. Metode: Penelitian ini adalah uji klinik acak tidak tersamar terhadap pasien yang menjalani anestesia spinal untuk prosedur urologi pada bulan Maret-April 2015 di RSUPN dr. Cipto Mangunkusumo. Setelah mendapatkan persetujuan izin etik dari Komite Etik Penelitian Kesehatan FKUI-RSCM, sebanyak 138 subjek dialokasikan ke dalam dua kelompok posisi penusukan jarum spinal yaitu kelompok CLSP dan TSP. Proporsi keberhasilan penempatan jarum spinal di rongga subarakhnoid, kemudahan perabaan landmark, dan jumlah needle-bone contact pada kedua kelompok kemudian dinilai.Hasil: Enam subjek masuk kriteria pengeluaran berupa kegagalan penempatan jarum spinal setelah lebih dari sembilan kali percobaan. Tersisa 132 subjek, 67 subjek pada kelompok CLSP dan 65 subjek pada kelompok TSP, yang berhasil menyelesaikan penelitian. Keberhasilan penempatan jarum spinal secara one shot pada kelompok CLSP dan TSP tidak berbeda bermakna (64.2% vs 53.8%, p=0.227). Kemudahan perabaan landmark pada kelompok CLSP berbeda bermakna dengan TSP (94% vs 75%, p=0.003). Jumlah needle-bone contact pada kedua kelompok tidak berbeda bermakna (p=0.337). Simpulan: Keberhasilan penempatan jarum spinal pada kelompok CLSP tidak berbeda bermakna dibandingkan dengan keberhasilan penempatan jarum spinal pada kelompok TSP pada pasien bedah urologi.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients., Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.]"

"Latar belakang. Komplikasi paru pascaoperasi merupakan salah satu penyebab penting morbiditas dan mortalitas pascaoperasi yang berkaitan dengan anestesia dan pembedahan. Pengaturan ventilasi mekanis berpengaruh terhadap munculnya komplikasi paru pascaoperasi. Penelitian ini bertujuan meneliti pengaruh volume tidal 6 mL/kg dan 10 mL/kg dengan menggunakan PEEP 6 cmH2O terhadap penanda fungsi paru yaitu PaO2/FiO2.Metode. Penelitian ini bersifat uji klinis acak senter tunggal terhadap pasien yang menjalani operasi abdominal mayor elektif di Rumah Sakit Cipto Mangunkusumo pada bulan November 2014 sampai April 2015. Sebanyak 52 subyek diambil dengan metode consecutive sampling. Subyek diacak dalam 2 kelompok yaitu kelompok yang medapat volume tidal 6 mL/kg dengan PEEP 6 cmH2O dan volume tidal 10 mL/kg dengan PEEP 6 cmH2O. Keluaran primer adalah pemeriksaan fungsi paru menggunakan rasio PaO2/FiO2. Keluaran sekunder adalah komplikasi paru (pneumonia, atelektasis, ARDS, gagal napas), komplikasi ekstraparu (SIRS, sepsis, sepsis berat), dan mortalitas dalam 28 hari pascaoperatif.Hasil. Kedua grup memiliki karakteristik dasar dan intraoperatif yang sama. Tidak ditemukan perbedaan yang bermakna rasio PaO2/FiO2 antara kelompok VT-6 mL/kg dengan VT-10 mL/kg, baik pada awal operasi (p=0,14), akhir operasi (p=0,44), hari pertama pascaoperasi (p=0,23), dan hari kedua pascaoperasi (p=0,39). Tidak ada perbedaan bermakna keluaran sekunder berupa kompikasi paru sampai hari ke-7 pascaoperasi, ekstraparu sampai hari ke-7 pascaoperasi, dan mortalitas dalam 28 hari pascaoperasi antara kedua kelompok.Simpulan. Volume tidal-6 sampai volume tidal-10 dengan PEEP6 cmH2O aman untuk dipakai pada pasien yang menjalani operasi abdominal mayor.

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Background. Postoperative pulmonary complications are one of the important causes of postoperative morbidity and mortality associated with anesthesia and surgery. Mechanical ventilation settings influence the emergence of postoperative pulmonary complications. The aim of this study is to investigate the influence of tidal volume 6 mL/kgBW and 10 mL/kgBW with PEEP 6cmH2O to pulmonary function which is measured by the ratio of PaO2 / FiO2.Methods. This study is a single center randomized clinical trial on patients undergoing elective major abdominal surgery at Cipto Mangunkusumo Hospital in November 2014 to April 2015. A total of 52 subjects were taken with consecutive sampling method. The subjects were randomized into two groups: the group receiving tidal volume 6 mL/kgBW with PEEP 6 cmH2O and the group receiving tidal volume of 10 mL/kgBW with PEEP 6 cmH2O. The primary output is the assessment of pulmonary function using the ratio of PaO2/FiO2. Secondary outputs are pulmonary complications (pneumonia, atelectasis, ARDS, respiratory failure), extrapulmonary complications (SIRS, sepsis, severe sepsis), and mortality within 28 days postoperative.Results. The two intervention groups had similar characteristics at baseline. There are no significant PaO2 / FiO2 ratio differences between the VT - 6 mL/kgBB with VT - 10 mL/kgBB, at the start of the operation (p=0,14), the end of surgery (p=0.44), the first postoperative day (p=0,23), and the second postoperative day (p=0,39) . There is no significant difference in the secondary outcomes in form of pulmonary complications until postoperative day 7, extrapulmonary complications until postoperative day 7, and in 28-days postoperative mortality between the two groups.Conclusions : Tidal volume of 6 to 10 mL/kg with PEEP 6 cmH2O are safe for use in patients undergoing major abdominal surgery."

"Latar Belakang: Endoscopic Retrograde Cholangiopancreatography (ERCP) adalah tindakan endoskopi yang kompleks yang memerlukan sedasi. Sedasi dalam tindakan ini penting untuk imobilisasi pasien sehingga prosedur lebih mudah dilakukan. Propofol cukup ideal sebagai obat sedasi,obat ini disukai karena awitan yang cepat dan waktu pulih yang singkat. Hampir sebanyak 80% propofol berikatan dengan albumin. Kondisi hipoalbuminemia sendiri banyak ditemui pada pasien yang menjalani ERCP. Kondisi hipoalbuminemia dapat memengaruhi kadar propofol dan fentanil bebas dalam plasma. Perbedaan awitan dan waktu pulih pada pasien hipoalbuminemia yang menjalani ERCP dengan sedasi propofol-fentanil belum pernah diteliti.Metode: Penelitian ini adalah uji klinik Cross sectional, dilakukan secara tersamar. Pengumpulan subjek dilakukan secara consecutive sampling, masing-masing pasien diberikan sedasi dengan propofol kontinyu dosis 4ug/L, kemudian dilakukan pencatatan waktu hilangnya refleks bulu mata dan kembalinya kesadaran yang ditandai dengan kemampuan pasien mengikuti perintah menggenggam. Awitan dan waktu pulih kelompok pasien hipoalbuminemia dibandingkan dengan kelompok pasien kadar albumin normalHasil: Sebanyak 48 subjek diawal penelitian, 48 orang masuk kepada kriteria penerimaan. 48 subjek penelitian yang menjalani ERCP dengan sedasi kemudian dianalisis. Tidak terdapat perbedaan onset maupun waktu pulih antara kelompok hipoalbuminemia dan kadar albumin normal.Kesimpulan: Perbandingan awitan kelompok hipoalbuminemia dan kadar albumin normal tidak menunjukkan perbedaan, begitu juga dengan waktu pulih kelompok hipoalbuminemia dan kadar albumin normal.

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Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex procedure that requires appropiate sedation. Propofol is considered as an ideal sedative with rapid onset and short recovery time. Almost 80% of propofol binds to albumin. Hypoalbuminemia, is a condition commonly found in patients undergoing ERCP, can affect the levels of free propofol and fentanyl in plasma. Differences in onset and recovery time in hypoalbuminemic patients undergoing ERCP with propofol-fentanyl sedation have not been studied.

Methods Similar number of hypoalbuminemic parients and patients with normal albumin level who underwent ERCP were collected consecutively. Each patient was given a dose of sedation with continuous propofol 4uG / L, then loss of eyelash reflex time and return of consciousness characterized by the ability of patients to follow the gripping command were recorded. The onset and recovery time of hypoalbuminemic patients were compared to patients with normal albumin levels.

Results A total of 48 subjects met the inclusion criteria. The median (range) onset of propofol in hypoalbuminemia group was 2 minutes (1 to 5 minutes), whereas normal albumin group was 3 minutes (1 to 4 minutes). The median (range) recovery time of propofol-fentanyl in hypoalbuminemia group was 10.5 minutes (6 to 17 minutes), while the normal albumin group was 11 minutes (8 to 20 minutes). The differences of onset and recovery time between two groups were not statistically significant (p=0,196 and p=0,422, respectively).

Conclusion: There were no differences in onset and time to recover of propofol and propofol-fentanyl in ERCP procedure between hypoalbuminemia group and normal albumin group."

"[ABSTRAK Latar belakang. Penyuntikan berulang pada prosedur anestesia spinal berkaitan dengan tingginya angka komplikasi dan ketidaknyamanan pasien. Sistem prediksi praoperatif yang akurat terhadap kemungkinan kesulitan penempatan jarum spinal dapat membantu mengurangi insiden penyuntikan berulang sehingga mengurangi risiko komplikasi terhadap pasien. Penelitian ini bertujuan untuk mengetahui ketepatan prediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi. Metode. Penelitian ini bersifat observasional analitik terhadap pasien bedah urologi yang menjalani anestesia spinal di Rumah Sakit Cipto Mangunkusumo pada bulan April sampai Mei 2015. Sebanyak 109 subyek diambil dengan metode consecutive sampling. Data pasien (usia, jenis kelamin, indeks massa tubuh, status fisik, gambaran radiologis vertebrae lumbal, dan kualitas penanda anatomis tulang belakang), jumlah penusukan kulit dan redireksi jarum spinal, serta angka kesulitan penempatan jarum spinal dicatat. Kesulitan penempatan jarum spinal ditentukan berdasarkan jumlah penusukan kulit dan redireksi jarum spinal. Variabel yang signifikan ditentukan melalui uji Pearson?s Chi-square dan uji Fisher, kemudian analisis multivariat dengan metode regresi logistik digunakan untuk melihat hubungan antara kesulitan penempatan jarum spinal dengan variabel-variabel yang signifikan. Hasil. Faktor usia memiliki hubungan yang bermakna hanya pada analisis bivariat (p=0,028). Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal memiliki nilai prediksi terhadap kesulitan penempatan jarum spinal (p=0,000 dan p=0,006). Hasil uji kalibrasi menunjukkan kualitas prediksi yang baik. Dari uji diskriminasi didapatkan AUC sebesar 0,84 (IK 95% 0,751-0,929). Simpulan. Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal mampu memprediksi kesulitan penempatan jarum spinal dengan tepat pada pasien bedah urologi. ABSTRACT Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ;Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. , Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson’s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ]"