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Abstrak :
Pembedahan dan pembiusan adalah penyebab stress emosional pada orangtua dan anak Salah satunya adalah kecemasan pra anestesia Kecemasan pra anestesia yang dialami orangtua dapat diturunkan kepada anaknya dan dapat menimbulkan pengaruh negatif terhadap anak berupa gangguan perilaku pascapembiusan Di Indonesia belum didapatkan data mengenai kecemasan pra anestesia Penelitian ini bertujuan untuk menentukan proporsi kecemasan pra anestesia ibu dan faktor faktor yang mempengaruhinya di klinik praoperatif RSUPN CM penelitian ini melibatkan 144 ibu dari anak usia 0 12 tahun yang akan menjalani pembiusan Semua ibu diwawancara menggunakan panduan wawancara gangguan cemas MINI ICD 10 Mini International Neuropsychiatric Interview dan kecemasan dinilai dengan VAS Visual Analog Score Sebanyak 70 48 6 ibu mengalami gangguan cemas dengan rentang skor VAS 3 8 mm Kecemasan pra anestesia ibu dipengaruhi oleh usia anak p 0 001 riwayat pembiusan pada anak sebelumnya p 0 004 dan jumlah anak dalam keluarga p 0 041 Ibu yang mempunyai anak bayi memiliki risiko 7 9 kali lipat mengalami kecemasan adjusted OR 7 982 namun karena rentang interval kepercayaan yang besar 95 CI 2 599 24 512 kemungkinan terdapat faktor lain yang mempengaruhi kecemasan pra anestesia ibu Kecemasan pra anestesia ibu mempunyai angka proporsi yang cukup tinggi Masalah ini perlu diatasi untuk mencegah dampak negatif terhadap anak pascapembiusan. ...... Surgery and anesthesia are causes for emotional stress in parents and children one of which is pre anesthesia anxiety Pre anesthesia anxiety experienced by parents can be passed on to their children and have a negative impact on a child such as post anesthesia behavior disorders In Indonesia there is no data about pre anesthesia anxiety The purpose of this study is to determine the proportion of pre anesthetic maternal anxiety and the factors that influenced it in preoperative clinic RSUPN CM This study included 144 mothers of children aged 0 12 years who will undergo anesthesia All mothers were interviewed using an interview guide anxiety disorders MINI ICD 10 Mini International Neuropsychiatric Interview and anxiety scores assessed using VAS Visual Analog Scale A total of 70 48 6 mothers had anxiety disorders with VAS score range 3 8 mm Pre anesthesia maternal anxiety is influenced by child rsquo s age p 0 001 history of previous anesthesia on child rsquo s p 0 004 and number of children p 0 041 Mothers with infants have risk 7 9 times experiencing higher anxiety adjusted OR 7 982 but because of the wide range of the confidence interval 95 CI 2 599 to 24 512 others factors may influence the pre anesthetic maternal anxiety Pre anesthetic maternal anxiety has a fairly high proportion of numbers Therefore pre anesthetic maternal anxiety needs to be addressed to prevent a negative impact on children post anesthesia

Abstrak :
Latar belakang. Waktu pulih yang cepat dan mulus telah menjadi kebutuhan yang penting bagi unit pembedahan, khususnya bagi unit yang memiliki beban jadwal operasi yang banyak. Kecepatan waktu pulih diperlukan untuk meningkatkan turn-over-rate unit tersebut. Efek sinergisme kombinasi opioid dan gas anestesi telah digunakan secara umum untuk mempertahankan kedalaman anestesia intraoperatif. Hanya saja tidak terlalu banyak data mengenai waktu pulih kombinasi opioid dan gas inhalasi, khususnya kombinasi sevofluran ? fentanil, mengingat kedua obat tersebut telah digunakan secara luas dalam praktik seharihari anestesia. Penelitian ini bertujuan untuk mengetahui perbedaan waktu pulih antara rumatan kombinasi sevofluran 1,2 vol%-fentanil 1,2 mcg/kg/jam dengan rumatan sevofluran 2 vol%. Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal terhadap pasien yang menjalani operasi elektif vitrektomi di Rumah Sakit Cipto Mangunkusumo pada bulan Mei dan Juli 2015. sebanyak 30 sampel subjek penelitian diambil dengan metode konsekutif. Waktu pulih pasca operasi dicatat dan data waktu pulih dianalisa dengan uji independent sample t-test. Hasil. Waktu pulih antara rumatan kombinasi sevofluran 1,2 vol% - fentanil 1,2 mcg/kg/jam dengan rumatan sevofluran 2 vol% memiliki perbedaan yang signifikan (p < 0,000), dimana penelitian ini menunjukkan bahwa kombinasi rumatan sevofluran 1,2 vol% - fentanil 1,2 mcg/kg/jam memiliki waktu pulih yang lebih singkat dibanding rumatan sevofluran 2 vol%. Simpulan. Waktu pulih pasca vitrektomi pada kelompok rumatan kombinasi sevofluran 1,2 vol% - fentanil 1,2 mcg/kg/jam lebih singkat dari pada waktu pulih pada kelompok rumatan sevofluran 2 vol%. ...... Background. A fast and smooth anesthesia recovery time has been a necessity in several surgical units, especially those who have high load in their operation schedules. It is important to speed up their turn over rate. Opioid - volatile anesthetic combination has been used commonly to maintain depth of anesthesia because of their synergistic effect. But there was lack of data about recovery time of opioid-inhalation combination maintenance, particularly sevoflurane-fentanyl combination, whereas sevofluran and fentanyl has been used widely in anesthesia practice. The study was designed to determine the difference of recovery time between combination of sevoflurane 1,2 vol% - fentanyl 1,2 mcg/kg/hour maintenance and sevoflurane 2 vol% maintenance. Methods. This is a single blind randomized study in patients undergo scheduled vitrectomy at Cipto Mangunkusumo hospital between May and July 2015. A total 30 subjects where included in this study by consecutive sampling. The recovery time after surgery were recorded. Data were collected by self report and analyzed by independent sample t-test. Results. There was a significant difference of recovery time between combination of sevoflurane 1,2 vol% - fentanyl 1,2 mcg/kg/hour maintenance and sevoflurane 2 vol% maintenance (p < 0,000), this study concludes that combination of sevoflurane 1,2 vol% - fentanyl 1,2 mcg/kg/hour has a faster anesthesia recovery time than sevoflurane 2 vol% maintenance. Conclusions. Post vitrectomy anesthesia recovery time was faster in combination of sevoflurane 1,2 vol% - fentanyl 1,2 mcg/kg/hour maintenance group than in sevoflurane 2 vol% maintenance group.

Abstrak :
ABSTRAK
Latar Belakang: Prediksi kedalaman rongga epidural pada pediatrik untuk menghindari komplikasi tertusuknya dura. Rumus Bosenberg 1 mm/kgbb merupakan rumus yang sering digunakan untuk menentukan jarak kulit ke rongga epidural (loss of resistance) pada pasien pediatrik pada ras Kaukasia. Terdapat perbedaan anatomi antara ras Asia dan Kaukasia, sehingga menimbulkan pertanyaan apakah rumus Bosenberg 1 mm/kgbb tepat digunakan untuk menentukan jarak kulit ke rongga epidural pada pasien pediatrik ras Melayu dan faktor apa saja yang berhubungan untuk menentukan kedalaman rongga epidural. Metode : Penelitian ini adalah uji Bland Altman dan analisis regresi dengan pengambilan data dari rekam medis pasien pediatrik ras Melayu yang menjalani tindakan anestesia epidural pada bulan Januari 2011-Juli 2015 di RSUPN Cipto Mangunkusumo. Sebanyak 67 subjek yang menjalani tindakan anestesia epidural. Data yang diolah berupa usia, berat badan, tinggi badan dan loss of resistance (LOR). Dengan menggunakan SPSS 22, dilakukan uji Bland Altman terhadap LOR aktual dan LOR yang didapat berdasarkan rumus Bosenberg. Analisis regresi linear digunakan pada variabel usia, berat badan dan tinggi badan untuk menentukan hubungan antara ketiga variabel ini terhadap LOR. Hasil : Empat belas subjek dikeluarkan dalam penelitian karena data tidak lengkap dan terdapat kriteria ekslusi pada subjek. Tersisa 53 subjek yang masuk dalam penelitian ini. Uji Bland Altman menghasilkan rentang nilai limit of agreement -4,41 sampai 3,15. Nilai ini mempunyai rentang yang cukup lebar dari nilai limit of agreement yang diharapkan (-1,25 dan 1,25). Pada analisis bivariat diperoleh korelasi sangat kuat terhadap usia (r= 0,809), berat badan (r=0,966), dan tinggi badan (r=0,906). Analisis regresi linear menghasilkan tiga persamaan dari tiap-tiap variabel dengan nilai R 2 tertinggi adalah berat badan (92,7%) diikuti tinggi badan (75,9%) dan usia (57%). Simpulan: Rumus 1 mm/kgbb tidak tepat digunakan untuk menentukan jarak kulit ke rongga epidural pada pasien pediatrik ras Melayu di RSUPN Cipto Mangunkusumo. Terdapat hubungan antara usia, berat badan, dan tinggi badan terhadap jarak kulit ke rongga epidural.

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ABSTRACT
Background : Skin-epidural distance prediction on pediatric patient undergoing procedure is necessary to prevent complication. Bosenberg prediction formula of 1 mm/kg of body weight is widely used in Caucasian pediatric patient. However, there is anatomical variation between Caucasian and Asian which created question on the accuracy of Bosenberg prediction formula if used on Malayan pediatric population and factors related to skin-epidural distance in these population. Methods : This study use cross-sectional design in which the data from medical record was used to collect information about age, weight, height and skin-epidural distance from pediatric (loss of resistance) patient undergoing epidural procedure. SPSS 22 was used to perform statistical calculation on this set of data. Accuracy of Bosenberg formula was analysed using Bland-Altman test in which the skinepidural distance measured using loss of resistance (LOR) compared with prediction from Bosenberg formula. Linear regression analysis was used to identify predictor variable for skin-epidural distance. Result : 67 subject was recruited for the study in which 14 was not included in analysis because the exclusion criteria. Bland-altman test reveal limit of agreement between -4,41 and 3.15 which is significantly larger than the expected limit of agreement (-1,25 to 1.25). There is strong corelation between age, weight and height to skin-epidural distance. The regression model derived from weight variable have the strongest power to predict skin-epidural distance (R value for weight, height and age based model is 92.7%, 75.9% and 57% respectively. Conclusion : The Bosenberg prediction formula of 1 mm/kg of body weight is not accurate to predict skin-epidural distance in Malayan pediatric population. There is relationship between age, height, and weight to skin-epidural distance in Malayan pediatric patient.

Abstrak :
Latar Belakang: Post Aneshesia Shivering (PAS) adalah gerakan involunter satu otot rangka atau lebih yang biasanya terjadi pada masa awal pemulihan pascaanestesia. Kekerapannya mencapai 60% pada pasien yang mendapatkan anestesia umum. PAS dapat menyebabkan hipoksia arterial, meningkatnya curah jantung, risiko terjadinya infark miokard, dan mengganggu interpretasi alat-alat pemantauan tanda vital. Tatalaksana kejadian PAS diantaranya dengan menggunakan metode farmakologi diantaranya dengan pemberian ondansetron dan meperidin. Penelitian ini bertujuan membandingkan keefektifan pencegahan PAS dengan pemberian ondansetron 4 mg dengan meperidin 0.35 mg/kgBB intravena. Metode:Uji klinis, acak, tersamar ganda pada 92 pasien yang menjalani operasi elektif sederhana di kamar operasi RSCM Kirana. Pasien dibagi dalam dua kelompok yaitu kelompok ondansetron dan kelompok meperidin. Pasien mendapatkan ondansetron atau meperidin sesaat sebelum anestesia, lalu seluruh pasien mendapatkan anestesia yang distandarisasi (premedikasi dengan midazolam 0.05 mg/kgBB dan fentanyl 2 mcg/kgBB, induksi dengan propofol 12.5 mg/kgbb, intubasi atau insersi LMA difasilitasi rokuronium 0.6 mg/kgBB, pemeliharaan dengan sevofluran 2 vol% dengan compressed air:O2 = 2:1). Kekerapan dan derajat menggigil dicatat tiap lima menit selama tiga puluh menit pascaanestesia. Efek samping pascapemberian juga dicatat. Hasil: Tidak terdapat perbedaan bermakna secara statistik (p>0.05) dalam kekerapan PAS pada kedua kelompok. Kekerapan kelompok ondansetron sebesar 15.2%, sedangkan kekerapan kelompok meperidin sebesar 6.5%. Kesimpulan: Ondansetron 4 mg intravena sama efektifnya dengan meperidin 0.35 mg/kgBB dalam mencegah kejadian PAS.

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Background: Post Anesthesia Shivering (PAS) is the involuntary movements of one or more skeletal muscles that usually occur in the early time of postanesthesia recovery. The incidence reached 60% in patients receiving general anesthesia. PAS can cause arterial hypoxia, cardiac output increased, the risk of myocardial infarction, and interfere with interpretation tools vital sign monitoring. Management of the incidence of PAS such as by using pharmacological methods such as by administration of ondansetron and meperidine. This study aimed to compare the effectiveness of prevention PAS by administering ondansetron 4 mg with meperidine 0.35 mg / kg intravenously. Methods: Clinical trials, randomized, double-blind on 92 patients undergoing elective surgery in the RSCM-Kirana operating room. Patients were divided into two groups: group ondansetron and meperidine. Patients received ondansetron or meperidine shortly before anesthesia and all patients receive standardized anesthesia (premedication with midazolam 0.05 mg / kg and fentanyl 2 mcg / kg, induced with propofol 1-2.5 mg / kg, intubation or LMA insertion is facilitated with rocuronium or 0.6 mg / kg, maintenance with sevoflurane 2 vol% to compressed air: O2 = 2: 1). The frequency and degree of shivering recorded every five minutes for thirty minutes post-anesthesia. The side effects were also recorded. Result: There was no statistically significant difference (p> 0.05) in the frequency of PAS in both groups. Ondansetron group frequency of 15.2%, while the frequency of meperidine group was 6.5%. Conclusion: Ondansetron 4 mg intravenously as effective as meperidine 0.35 mg/kgBW in preventing the incidence of PAS.

Abstrak :
LATAR BELAKANG : Manajemen cidera dan penyakit pada tangan membutuhkan intervensi bedah dan non-bedah yang baik dan teliti untuk mencapai restorasi anatomi dan fungsional yang optimal. Saat ini penggunaan tourniquet kimia dengan epinephrin mulai mengantikan touniquet udara untuk operasi tangan sadar penuh menggunakan infiltrasi lokal ke tempat pembedahan sebagai metode dari pembiusan lokal. Berbagai jenis spuit dan jarum dapat digunakan untuk infiltrasi bius lokal. Untuk mengeluarkan larutan dari spuit ke jaringan membutuhkan gaya yang spesisfik. Ada 2 jenis gaya yg digunakan untuk mengeluarkan larutan dari spuit: (1) untuk gerakan awal dari piston (PBF: plunger-stopper break loose force), (2) gaya untuk mempertahankan laju piston (DGF: dynamic gliding force). Kedua gaya tersebut dipengaruhi oleh diameter spuit dan jarum, dan juga viskositas larutan. Tujuan dari studi ini untuk memberikan kombinasi yang terbaik antara spuit dan jarum suntik yang membutuhkan tenaga yang minimal untuk mengeluarkan larutan dari spuit. METODE : Untuk menjelaskan aspek fisik dan mekanik mengenai gaya yang dibutuhkan untuk infiltrasi bius lokal pada kombinasi spuit dan jarum, kami mengunakan spuit 1cc, 3cc, 5cc, 10cc dan 20cc serta jarum suntik asli dari kemasan, jarum 27-Gauge, jarum spinal 27-Gauge, dan jarum 30-Gauge. Setiap kombinasi spuit dan jarum dilakukan sebanyak 3 kali. Kami telah melakukan total 60 tes pada kombinasi spuit dan jarum. Tes dilakukan dengan menggunakan mesin Instron 5940 dengan kecepatan 100mm/menit. HASIL : Nilai PBF terdendah didapatkan pada kombinasi spuit 1cc dengan jarum 27-Gauge; nilai PBF tertinggi didapatkan pada kombinasi spuit 10cc dengan jarum 30-Gauge. Nilai DGF terendah didapatkan pada kombinbasi spuit 1cc dengan jarum pada kemasannya; nilai DGF tertinggi didapatkan pada kombinasi spuit 20cc dengan jarum 27-Gauge needle. Kombinasi spuit 20cc dengan jarum 27-Gauge membutukan gaya sebesar 25,33 N untuk PBF dan 113,367 N buat DGF. Gaya ini 33x lebih tinggi untuk PBF dan 324x lebih tinggi untuk DGF pada spuit 1cc. Ketika kita menggunakan spuit 3cc dengan jarum27-Gauge, makan akan membutuhkan gaya 5,8x lebih inggi pada PBF dan 24,8x lebih tinggi pada DGF. Pada spuit 5ccdenga kombinasi jarum 27-Gauge, perlu gaya 2,4 kali lebih tinggi pada PBF dan 5,8 kali lebih tinggi pada DGF. Untuk jarum suntik 10cc, maka akan membutuhkan gaya 5,8 lebih tinggi di PBF dan 2,6 lebih tinggi pada DGF. SIMPULAN : Kombinasi terbaik dari spuit dan jarum suntik untuk memasukan larutan bius lokal adalah yang membutuhkan PBF dan DGF yang rendah yang terdapat pada spuit 1cc dan jarum yang berada pada kemasannya. Hal lain yang harus dipertimbangkan adalah kekuatan individual tangan dokter bedah untuk memenuhi beban fisiologis dan ergonomis bersama dengan gaya yang rendah untuk menjalankan operasi. ...... BACKGROUNDS : Management of hand injury or disease needs meticulous surgical intervention as well as tender loving non-surgical intervention to reach optimal goals which are anatomical restoration and good functional outcome. The application of chemical tourniquet using epinephrine has begun to replace the use of pneumatic tourniquet. Wide-awake hand surgery uses local infiltration to the surgical site as the method of anesthesia. Different types of syringe can be used to administer the tumescent solution. Injection of the tumescent solution in the syringe requires a specific force to eject the solution into the tissue. There are two types of power used in syringe: (1) for initial movement of the syringe?s piston which is known as plunger-stopper break loose force (PBF) and (2) the power to maintain the sustaining or the forward motion of the piston which is known as dynamic gliding force (DGF). Both of these forces are affected by the diameter of the needle and syringe, and also the viscosity of the tumescent solution as well. The purpose of this studyis to data for describing the best combination of syringe and needle which requires the least force. METHODS : To elaborate the physical and mechanical aspect regarding the power and force in the combination of needle and syringe used for local anesthesia injection, we use 1cc, 3cc, 5cc, 10cc and 20cc syringe with original needle from packaging, 27-Gauge needle, 27-Gauge spinal needle, and 30-Gauge needle. We have performed 60 test of syringe and needle combination. Each combination was tested in triplet data using Instron 5940 Series testing systems, in 100mm/minute velocity. RESULT : The lowest PBF value was performed by the combination of 1cc syringe and 27-Gauge Needle; and the highest PBF value was achieved by the combination of 10cc syringe and 30-Gauge Needle.The lowest DGF value was measured in the combination of 1cc syringe and original needle. And the highest DGF value was performed by the combination of 20cc syringe and 27-Gauge needle. The 20cc syringe needs 25.33 Newton for PBF and 113.367 Newton for DGF. These forces are 33 times higher for PBF and 324 times higher for DGF, if we use the 1 cc syringe. When we choose 3cc syringe and 27-Gauge needle, it will need 5,8 times higher in PBF and 24,8 times higher in DGF. Another option of syringe is 5cc syringe, that will need 2,4 times higher in PBF and 5.8 times higher in DGF. For 10cc syringe, it will need 5.8 higher in PBF and 2.6 higher in DGF. CONCLUSIONS : The best combination of syringe and needle that required the least force (PBF and DGF) for hand and digit surgery are 1 cc syringe and original needle. Another thing to be considered is the individual power of the Surgeon?s hand to meet the physiologic and ergonomic burden along with the initial and maintenance force needed through the operations.

Abstrak :
This practical reference is a comprehensive guide to the anesthetic and perioperative management of patients before and during all procedures performed by general and subspecialist surgeons requiring anesthetic management. The book explains each procedure from both the surgeon and anesthesiologist perspectives, presents details on anesthetic technique, and guides the anesthesiologist and surgeon through the decisions that must be made before, during, and after surgery. Emphasis is on factors that impact the anesthesiologist, including patient positioning, duration of surgery, and complications.

Abstrak :
This is a major revision, updating, and expansion of the leading single-source volume on pediatric sedation outside of the operating room. Edited and written by an international roster of outstanding experts, it is the only book aimed at the broad range of specialists who deliver pediatric sedation in the non-OR setting. The second edition features a significant expansion of contributions from international leaders and individual new chapters on pre-sedation assessment, sedatives’ short- and long-term effects on neurocognition; non-pharmacologic districtions, Michael Jackson’s death and medical ethics, the role of simulation in safety and training; and palliative sedation in terminally ill children. The specialty-specific chapters continue to be geared toward all sedation providers, regardless of where they practice and patient safety is again emphasized. Fundamental chapters provide in-depth reviews of topics which include, among others, physiology and pharmacology.

Abstrak :
Get trusted anesthesiology guidance in a compact, high-yield source with Stoelting's Handbook of Pharmacology and Physiology in Anesthetic Practice. Updated from the Fifth Edition of Stoelting's Pharmacology and Physiology in Anesthetic Practice, this handbook provides succinct, current, and accurate information on the pharmacology and physiology that are relevant to anesthesiology, equipping you to deliver safe and effective perioperative patient management. Key features: apply the latest knowledge with coverage of all new drugs, as well as new findings on the actions and interactions of established drugs; focus on the information you need thanks to a quick-reference tabular format; easily turn to the parent textbook for more in-depth information thanks to an organization that mirrors Stoelting's Pharmacology and Physiology in Anesthetic Practice. Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to: complete content with enhanced navigation; a powerful search that pulls results from content in the book, your notes, and even the web; cross-linked pages, references, and more for easy navigation; highlighting tool for easier reference of key content throughout the text; ability to take and share notes with friends and colleagues; and, quick reference tabbing to save your favorite content for future use.