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"[Latar Belakang : Anestesiologis yang bertugas di IGD dapat menjalani jam kerja 24 jam. Anestesiologis yang lelah mempunyai konsekuensi menurunnya fungsi kognitif dan psikomotor. Peserta PPDS nestesiologi menjalani 32 jam kerja saat bertugas jaga IGD. Penelitian bertujuan mengetahui perubahan fungsi kognitif dan psikomotor PPDS Anestesiologi setelah menjalani 32 jam kerja.Metode : kami mengobservasi 69 peserta PPDS Anestesiologi yang menjalani 32 jam kerja, setiap peserta PPDS diperiksa fungsi kognitif dan psikmotor pada jam kerja ke-0 dan setelah 32 jam. Jumlah tidur ketika bertugas jaga dicatat. Fungsi kognitif diperiksa dengan MoCa-Ina dan psikomotor dengan grooved pegboard.Hasil : Secara statistik didapatkan penurunan bermakna fungsi kognitif (p 0,00) dan psikomotor pada tangan dominan/ non dominan (p 0,00/p 0,00) tetapi secara klinis fungsi kognitif dan psikomotornya masih dalam batas normal. Tidak terdapat pengaruh lamanya tidur dengan fungsi kognitif (p 0,121) dan psikomotor (p 0,282/p 0,317) setelah 32 jam kerja pada peserta PPDS Anestesiologi tidur minimal 5 jam dengan tidur kurang dari 5 jam.Kesimpulan : Fungsi kognitif dan Psikomotor peserta PPDS Anestesiologi dan Terapi Intensif setelah menjalani 32 jam kerja terbukti menurun, sedangkan lamanya tidur tidak terbukti mempengaruhi fungsi kognitif dan psikomotor;Background: anaesthesiologist on duty in the Emergency Room can undergo a 24-hour working hours. Anesthesiologists who are tired of having consequences with decreased cognitive and psychomotor function. Anesthesiology and Intensive Therapy resident undergo 32 work hours when he on duty in the ER. This study aims to determine changes in cognitive function and psychomotor after undergoing 32 hours of work.Method: we have done observations of the 69 participants Anesthesia resident undergo 32 work hours when he gets on duty IGD, each of PPDS in cognitive function and psikmotor examined on 0 work hours and after 32 work hours. The number of hours sleep that can be obtained when undergoing on duty was noted. Cognitive function was examined with the MOCA-Ina and psychomotor examined with the grooved pegboard.Results: Statistically significant decrease found on cognitive function (p 0.00) and decreased psychomotor function in the dominant hand (p 0.00) and the non-dominant hand (p 0.00) but clinically cognitive and psychomotor function Anesthesiology and Intensive therapy resident after 32 hours is still within the limits of normal values. There was no effect of sleep duration and cognitive function (p 0.121) and psychomotor (0.282 p / p 0.317) after 32 hours of work on the Anesthesiology redident at least 5 hours of sleep with who slept less than 5 hours.Conclusion: Cognitive and Psychomotor Function resident Anesthesiology and Intensive Therapy after undergoing 32 hours of work proved to be decreased, while the duration of sleep during working hours are not proved affect cognitive and psychomotor function, Background: anaesthesiologist on duty in the Emergency Room can undergo a 24-hour working hours. Anesthesiologists who are tired of having consequences with decreased cognitive and psychomotor function. Anesthesiology and Intensive Therapy resident undergo 32 work hours when he on duty in the ER. This study aims to determine changes in cognitive function and psychomotor after undergoing 32 hours of work.Method: we have done observations of the 69 participants Anesthesia resident undergo 32 work hours when he gets on duty IGD, each of PPDS in cognitive function and psikmotor examined on 0 work hours and after 32 work hours. The number of hours sleep that can be obtained when undergoing on duty was noted. Cognitive function was examined with the MOCA-Ina and psychomotor examined with the grooved pegboard.Results: Statistically significant decrease found on cognitive function (p 0.00) and decreased psychomotor function in the dominant hand (p 0.00) and the non-dominant hand (p 0.00) but clinically cognitive and psychomotor function Anesthesiology and Intensive therapy resident after 32 hours is still within the limits of normal values. There was no effect of sleep duration and cognitive function (p 0.121) and psychomotor (0.282 p / p 0.317) after 32 hours of work on the Anesthesiology redident at least 5 hours of sleep with who slept less than 5 hours.Conclusion: Cognitive and Psychomotor Function resident Anesthesiology and Intensive Therapy after undergoing 32 hours of work proved to be decreased, while the duration of sleep during working hours are not proved affect cognitive and psychomotor function]"

"[Latar Belakang: Kecemasan praoperatif mempunyai pengaruh yang signifikan terhadap pembiusan dan pembedahan. Saat ini belum ada instrumen spesifik untuk mengukur kecemasan praoperasi pada populasi Indonesia. Instrumen APAIS merupakan instrumen yang telah digunakan luas di dunia untuk mengukur kecemasan praoperatif. Penerjemahan, validasi dan reliabilitas instrumen APAIS pada populasi Indonesia merupakan tujuan penelitian ini.Metode: Penerjemahan APAIS dilakukan dengan penerjemahan maju dan mundur. Sebanyak 102 pasien yang akan menjalani operasi elektif mengisi instrumen APAIS versi Indonesia satu hari sebelumnya. Validitas konstruksi dinilai dengan metode analisis faktor. Reliabilitas dinilai dengan konsistensi internal Cronbach’s Alpha.Hasil: Sebanyak 102 pasien (42 laki-laki dan 60 perempuan) menjadi subjek penelitian penelitian ini. Analisis faktor dengan rotasi oblique menghasilkan dua skala yaitu skala kecemasan dan kebutuhan informasi. Hasil reliabilitas Cronbach’s Alpha skala kecemasan dan kebutuhan informasi APAIS versi Indonesia cukup tinggi yaitu 0,825 dan 0,863. Pasien dengan kebutuhan informasi tinggi menunjukkan kecemasan praoperatif yang lebih tinggi. Skala APAIS tidak berhubungan dengan jenis kelamin, riwayat operasi, jenis operasi atau jenis anestesi.Simpulan: APAIS versi Indonesia sahih (valid) dan handal (reliable) untuk mengukur kecemasan praoperatif pada populasi Indonesia. Penelitian selanjutnya diperlukan untuk menentukan sensitivitas dan spesifisitas cut off point kecemasan pada populasi Indonesia.;Background: Preoperative anxiety has a significant effect on anesthesia and surgery. Currently there is no specific instrument for measuring preoperative anxiety in Indonesian population. APAIS have been used worldwidely to measure preoperative anxiety. Translation, validation and reliability of instrument APAIS in Indonesian population is the purpose of this study.Methods: The translation was done in forward and backward translation. Total sample 102 patient undergoing elective surgery answered the Indonesian APAIS one day before operation. Construct validity was determined by factor analysis with oblique rotation. The internal consistency was evaluated by Cronbach’s alpha.Results: A total 102 patient (42 men and 60 women) enrolled in this study. The two scales anxiety and need for information could be replicated by factor analysis. High reliability Cronbach’s alpha anxiety and need for information scale Indonesian APAIS respectively 0,825 and 0,863. Patient with high information needs showed higher preoperative anxiety. The APAIS scale are independent of sex, previous surgery, type of operation or type of anesthesia.Conclusion: Indonesian APAIS proved to be reliable and valid instrument to measure preoperative anxiety in Indonesian population. Further research is needed to determine the sensitivity and specificity of Indonesian APAIS to get cut off point anxiety of Indonesian population., Background: Preoperative anxiety has a significant effect on anesthesia and surgery. Currently there is no specific instrument for measuring preoperative anxiety in Indonesian population. APAIS have been used worldwidely to measure preoperative anxiety. Translation, validation and reliability of instrument APAIS in Indonesian population is the purpose of this study.Methods: The translation was done in forward and backward translation. Total sample 102 patient undergoing elective surgery answered the Indonesian APAIS one day before operation. Construct validity was determined by factor analysis with oblique rotation. The internal consistency was evaluated by Cronbach’s alpha.Results: A total 102 patient (42 men and 60 women) enrolled in this study. The two scales anxiety and need for information could be replicated by factor analysis. High reliability Cronbach’s alpha anxiety and need for information scale Indonesian APAIS respectively 0,825 and 0,863. Patient with high information needs showed higher preoperative anxiety. The APAIS scale are independent of sex, previous surgery, type of operation or type of anesthesia.Conclusion: Indonesian APAIS proved to be reliable and valid instrument to measure preoperative anxiety in Indonesian population. Further research is needed to determine the sensitivity and specificity of Indonesian APAIS to get cut off point anxiety of Indonesian population.]"

"[Latar Belakang: Pelayanan Acute Pain Service (APS) di RSUPN CiptoMangunkusumo berkembang pesat sejak tahun 2003 yang melayani sekitar 44 pasien, meningkat menjadi 590 pasien pada tahun 2006, dan meningkat lagi tahun 2010 menjadi 1185 pasien. Perkembangan pesat pelayanan APS harus diikuti dengan peningkatan mutu pelayanan yang dapat diukur dengan menilai tingkat kepuasan pasien pelayanan APS. Tingkat kepuasan APS dipengaruhi beberapa faktor antara lain: ketersediaan informasi saat pra-anestesia, tata laksana efeksamping, cara pemberian anestesia dan interaksi antara professional kesehatan dan pasien. Pemberian informasi pra-anestesia dapat menggunakan leaflet. RSUPN Cipto Mangunkusumo memiliki leaflet APS dengan tujuan meningkatkan pemahaman pasien APS. Pemahaman ini dapat memengaruhi kepuasan pasien APS. Penelitian ini bertujuan untuk mengetahui pengaruh penambahan leaflet saat pemberian informasi pra-anestesia pada pasien pascabedah elektif yangmendapatkan pelayanan APS di RSUPN Cipto Mangunkusumo.Metode: Penelitian ini merupakan uji klinis acak pada pasien pascabedah elektif berusia 18-65 tahun yang mendapatkan pelayanan APS di RSUPN Cipto Mangunkusumo pada Agustus-September 2014. Subjek dibagi menjadi kelompok kontrol yang diberikan informasi pra-anestesia saja dan kelompok intervensi yang diberikan informasi pra-anestesia ditambahkan leaflet APS secara randomisasi. Pemberian leaflet pada kelompok intervensi dilakukan satu hari saat kunjunganpra-anestesia pasien. Tiap-tiap kelompok dinilai dengan menggunakan sepuluh pertanyaan kuesioner yang dikembangkan sendiri oleh peneliti. Tingkat kepuasan dinilai setelah 24 jam pascabedah di ruang rawat.Hasil: Sebanyak 52 subjek diikutsertakan dalam penelitian, 26 subjek dikelompok kontrol dan 26 subjek di kelompok intervensi leaflet. Tidak didapatkan perbedaan bermakna pada distribusi kedua kelompok penelitian. Didapatkan skor kepuasan pada kedua kelompok yang tidak bermakna secara signifikan, terhadapsepuluh pertanyaan kuesioner kepuasan APS (p >0,05, uji Fisher). Padakelompok kontrol didapatkan proporsi kepuasan sebesar 77 – 96,2 % dan kelompok leaflet sebesar 88,4 – 96,1 % merasa puas terhadap pelayanan APS. Simpulan: Penambahan leaflet pada saat pemberian informasi pra-anestesia tidakmemengaruhi tingkat kepuasan pasien pascabedah elektif terhadap pelayanan APS di RSUPN Cipto Mangunkusumo., Background : Acute Pain Service (APS) in Cipto Mangunkusumo growing rapidly since 2003, which serves about 44 patients, increased to 590 patients in 2006, and 1185 patients in 2010. The rapid development of APS service should be followed in quality controlled of service. It could be measured by assessing patient satisfaction level. APS satisfaction level is influenced by several factors.including: the availability of information during preanesthetic, administration of side effects, technique of anesthesia and the interaction between health professionals and patients. Provision of preanesthetic information with leaflet could be added to the patient. Cipto Mangunkusumo hospital provides APS leaflets for improving understanding in APS patients. This understanding may influence patient satisfaction to APS. The Aim of this study is to determine theeffect of providing information leaflets during preanesthetic in postoperative elective surgery patients who received APS care at Cipto Mangunkusumo hospital.Methods : This study is a randomized clinical trial in patients 18-65 years old with postoperative elective surgery patients in Cipto Mangunkusumo hospital who received APS service in August- September 2014. The subjects were randomly divided into two groups: subjects in control group were given a preanesthetic information only and subjects in intervention group were provided with information preanesthetic and APS leaflets as addition. Provision of leaflets in theintervention group performed one day before preanesthetic visit. Each group was assessed using the ten questions questionnaire developed by the researcher. The level of satisfaction was assessed after 24 hours postoperative in the ward.Results : A total of 52 subjects were included in the study, 26 subjects in the control group and 26 subjects in the intervention leaflets group. There were no significant differences in the data distribution of both study groups. Satisfaction scores in the two groups were not statistically significant, to the ten questions questionnaire APS satisfaction ( p > 0.05, Fisher's exact test ). In the control groupobtained proportion of satisfaction from 77 - 96.2 % and leaflets group from 88.4 - 96.1 % were satisfied with the APS service.Conclusion : Additional information leaflet during preanesthetic did not influence patient satisfaction level in postoperative elective surgery against APS service in Cipto Mangunkusumo hospital.]"

"[Latar Belakang: Anestesia spinal pada wanita hamil sangat dipengaruhi oleh posisi pasien. Pendant position merupakan posisi yang baru diperkenalkan pada laporan kasus. Penelitian ini bertujuan untuk membandingkan keberhasilan penempatan jarum spinal pada usaha pertama antara pendant position dengan traditional sitting position untuk pasien yang menjalani pembedahan Sesar.Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subjek dilakukan randomisasi untuk menentukan perlakuan pendant position atau traditional sitting position. Keberhasilan penempatan jarum spinal dinilai dari jumlah usaha, jumlah kontak tulang dan lama waktu penempatan jarum spinal.Hasil: Sebanyak 308 subjek penelitian, tidak ada yang termasuk kriteriapenolakan dan pengeluaran. Keberhasilan penempatan jarum spinal pada usaha pertama untuk pendant position lebih baik (142 subjek (92%) vs 121 subjek (78%), p 0,001), total jumlah kontak tulang lebih sedikit (185 vs 421, p<0,001) dan median lama waktu yang dibutuhkan untuk penempatan jarum spinal lebih cepat ( 9 (4-350) vs 12 (5-486) detik, p<0,001) jika dibandingkan dengan traditional sitting position.Simpulan: Pendant position lebih baik dalam hal keberhasilan penempatan jarum spinal pada usaha pertama untuk pasien yang menjalani pembedahan Sesar jika dibandingkan traditional sitting position., Background: Spinal anesthesia in pregnant women is strongly influenced by the position of the patient. Pendant position is a new position introduced in the case report. This study aimed to compare the successful placement of spinal needle on the first attempt between pendant position and traditional sitting position for patients who underwent sectio Caesarean.Methods: The study was a randomized controlled trial (RCT), conducted openly (not blind). Subject randomization to determine treatment pendant position or traditional sitting position. The successful placement of spinal needle judged from the number of first attempt, the amount of bone contact and the duration of the placement of spinal needle. Results: A total of 308 subjects, none of which include criteria for exclusion and drop out. The successful placement of spinal needle on the first attempt of pendant position is better (142 subjects (92%) vs. 121 subjects (78%), p 0.001), the total amount of bone contact is less (185 vs. 421, p <0.001) and the median length of time required for placement of spinal needle is faster (9 (4-350) vs. 12 (5-486) seconds, p <0.001) when compared to the traditional sitting position.Conclusion: Pendant position is better in terms of the successful placement of spinal needle on the first attempt for a patient who underwent sectio Caesarean compared to traditional sitting position.]"

"[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. ]"