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Nama	:	Kadek Yogi Mahendra
NPM	:	1606927734
Judul	:	Efektivitas Klonidin Dosis 2 Mcg/Kg di Awal Induksi Dalam Menurunkan Angka Kejadian Emergence Delirium Pada Pasien Anak yang Menjalani Operasi Mata

Latar belakang. Emergence delirium (ED) adalah suatu kondisi yang umum terjadi, pada pasien anak-anak yang menjalani pembedahan, dimana anak menjadi sangat agitasi, memberontak, dan sulit untuk diredakan serta berpotensi membahayakan dirinya sendiri maupun orang lain, dengan insidensi di RSCM sebesar 39,7%. Etiologi, faktor resiko, dan patofisiologi diperkirakan multifaktorial. Berbagai upaya dan strategi telah diusahakan untuk mencegah kejadian tidak menyenangkan ini.

 

Metode. Penelitian uji klinik acak tersamar ganda pada anak usia 1-8 tahun yang menjalani operasi mata dengan anestesia umum di OK Kirana FKUI-RSCM pada bulan Januari-Maret 2020. Sebanyak 108 subjek didapatkan dengan metode konsekutif yang dirandomisasi menjadi dua kelompok. Kelompok klonidin (n = 54) mendapat klonidin 2 mcg/kgbb bolus IV lambat saat induksi anestesia, sedangkan kontrol (n = 54) mendapat NaCl 0,9%. Kejadian ED, waktu pulih, derajat nyeri, hipotensi dan bradikardia selama dan pascaoperasi dicatat. ED dinilai dengan Pediatric Anesthesia Emergence Delirium (PAED).

 

Hasil. Kejadian ED pada kelompok klonidin sebesar 29,6% sedangkan kontrol 31,5% (IK 95% 0,481-2,475; p=0,835). Waktu pulih kelompok klonidin memiliki nilai rerata 6 menit dibandingkan kelompok kontrol selama 5 menit (p=0,998). Nyeri sedang dirasakan pada 3,7% kelompok klonidin berbanding 0% pada kelompok kontrol. Hipotensi dialami pada 1 pasien di kelompok klonidin dan 1 pasien di kelompok kontrol, sedangkan bradikardia ditemukan pada 2 pasien di kelompok klonidin dan 3 pasien di kelompok kontrol

 

Simpulan. Pemberian klonidin 2 mcg/kgbb bolus IV lambat di awal induksi tidak lebih efektif dibanding plasebo dalam mencegah kejadian ED pada pasien anak yang menjalani operasi mata

Kata Kunci : emergence delirium, klonidin, kontrol, pasien anak, operasi mata, pembiusan umum

 

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Name	:	Kadek Yogi Mahendra
NPM	:	1606927734
Title	:	Effectiveness Clonidine 2 Mcg/Kg during Anesthesia Induction to Reduce Emergence Delirium Rate in Pediatric Patient Underwent Eye Surgery

Background. Emergence delirium (ED) is a common condition in pediatric patient after surgery, when they become agitated, difficult to calm and could be harmful for themself or people around with incidence 39,7% in RSCM. Etiology, risk factor, and patyhophysiology are multifactorial. Some effort and strategy have been attempted to reduce this unpleasant incident

 

Method. This was a double-blind randomized clinical trial on children aged 1-8 years old underwent eye surgery under general anesthesia in OR Kirana FKUI-RSCM on January until March 2020. One hundred eight subjects were included using consecutive sampling method and randomized into two groups. Clonidine group (n=54) was given clonidine 2 mcg/kgbw slow intravenous injection during anesthesia induction while control group (n=54) was given NaCl 0,9%. Incidence of ED, recovery time, pain scale, during and postoperative hypotension and bradycardia were observed. Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED.

 

Result. Incidence of ED in clonidine group was 29,6% while in control group was 31,5% (IK 95% 0,481-2,475; p=0,835). Recovery time in clonidine group was 6 minutes and control group was 5 minutes (p=0,998). There was 3,7% in subject group was in moderate pain and 0% in control group. Hypotension was suffered by each 1 subject in both group and bradycardia suffered in 2 patient in clonidine group compared to 3 patients in control group

 

Conclusion. Administration of clonidine 2 mg/kg as a slow intravenous injection right after induction was not effective to prevent the incidence of ED in children underwent eye surgery"

"Latar Belakang: Surgical Site Infection (SSI) adalah infeksi sekitar luka operasi dalam kurun waktu 30 hari pascabedah. SSI merupakan 23,6% dari total infeksi nosokomial pascabedah abdomen di RSCM tahun 2009-2011. Tingginya angka morbiditas dan mortalitas dikarenakan SSI menyebabkan biaya penangganan SSI, sehingga pencegahan SSI akan mengurangi biaya pengobatan. Aquadest diketahui cairan yang efektif untuk irigasi luka, mudah didapatkan, murah dan aman untuk irigasi luka. Tujuan: Mengetahui pencucian luka dengan aquadest dibanding perawatan luka Standar. Metode: Penelitian ini merupakan penelitian eksperimental terandomisasi tersamar tunggal, yang dilakukan di departemen bedah, Fakultas kedokteran Universitas Indonesia, Rumah Sakit Cipto Mangunkusumo Mei-Juni 2018. Subyek berjumlah 80 orang setelah laparatomi mediana, dibagi menjadi grup kontrol (n=40) yang menerima perawatan standar dengan tulle setiap 2 hari dan grup eksperimental (n=40) yang menerima pencucian luka dengan aquadest setiap hari, dimulai hari kedua pascabedah. Pada hari ketujuh, dilakukan kultur mikrobiologi yang diambil dari benang jahitan. Parameter yang dievaluasi adalah pertumbuhan kuman, tanda infeksi, dan biaya per subyek antara 2 grup untuk mengetahui efisiensi dan efektivitas keduanya. Hasil: Penelitian ini dilakukan pada 80 subjek yang telah memenuhi kriteria inklusi dan eksklusi untuk menentukan efektivitas pencucian luka dibandingkan dengan teknik perawatan luka standar untuk mencegah infeksi daerah operasi setelah laparotomi mediana. Hasil analisis statistik antara kedua kelompok perlakuan terhadap pertumbuhan bakteri dalam hasil kultur menunjukkan tidak ada hubungan yang signifikan (p = 0,82). Dalam penelitian ini juga diamati adanya tanda-tanda infeksi berdasarkan CDC dalam waktu satu minggu perawatan luka. Tanda-tanda infeksi yang diamati dalam penelitian ini adalah tanda infeksi superfisial. Dari hasil analisis tidak ada perbedaan yang signifikan dalam tanda-tanda infeksi pada dua kelompok perlakuan (p = 1,00). Kesimpulan : Pencucian luka dengan aquadest sama efektifnya dengan perawatan luka standar dalam mencegah infeksi daerah operasi

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Background Surgical site infections (SSIs) still a global problem in the surgical field. The report of the Center for Disease Control and Prevention (CDC) in 1999 stated that SSIs reached 38% of all hospital-acquired infections (HAIs). Although this number can be reduced by 2%-5%, according to the CDC report in 2008, it requires global efforts that are not easy and expensive that involve all stakeholders (stakeholders) to achieve that number. In preventing SSIs, wound hygiene is one of the absolute factor. The majority of medical personnel apply the concept of using antiseptics containing various types of antibiotics accompanied by temporary topical antibiotics. However, The best cleanser is water, effective, easy to obtain, and does not require additional fee. Therefore we conducted a study aimed at demonstrating that wound washing is an efficient SSIs prevention measure eventhough it is done at RSCM. If the results of this study are meaningful then postoperative wound care at RSCM will be more economical because the materials needed for wound care are inexpensive.

Method This research is a randomized experimental study. Randomization will be done in a single blind manner. The patient will not know whether he is a control or experimental group. The research team will objectively evaluate germs according to each treatment group. This research was conducted in the Medical Department of Surgery, Faculty of Medicine, University of Indonesia-RSCM for the period January-July 2018. The target population in this study were all patients undergoing postoperative wound care.

Result This study was conducted on 80 subjects who had met the inclusion and exclusion criteria to determine the effectiveness of wound washing compared to standard wound care techniques for the rate of infection in the area of surgery after median laparotomy. The results of statistical analysis between the two treatment groups on bacterial growth in culture results showed no significant relationship (p = 0.82). In this study also observed the presence of signs of infection based on CDC within a week of wound care. Signs of infection observed in this study are a sign of superficial infection. From the results of the analysis there were no significant differences in signs of infection in the two treatment groups (p = 1.00). Conclusion Washing wounds with aquadest is as effective as standard wound care in preventing infection in the surgical site."

"A patient undergoing surgery faces great physiologic and psycologic stress, so nutritional demands are greatly increased during this period and deficiencies can easily develop. If this deficiencies are allowed to develop and are not met in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met complications are less likely developing. Nutritional resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutrition, burns and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders and use of supplements can hasten wound healing and shorten recovery times. "

"Global Status Report on Road Safety 2019 yang dibuat oleh World HealthOrganization (WHO), sebanyak 1,24 juta korban meninggal tiap tahunnya diseluruh dunia akibat kecelakaan lalu lintas. Sedangkan di Indonesia rata-rata 3orang meninggal setiap jam akibat kecelakaan lalu lintas pada tahun 2019.Kecelakaan lalu lintas menyebabkan trauma sehingga produktivitas seseorangdapat menurun selain itu dapat menyebabkan kecacatan sementara hinggapermanen. Fraktur atau sering dikenal dengan patah tulang adalah hilangnyakontinuitas tulang, retak atau patahnya tulang yang semulanya utuh. Dampak yangditimbulkan oleh trauma pada fraktur diantranya terbatasnya aktivitas, karena rasanyeri akibat tregeseknya saraf motorik dan sensorik pada luka fraktur. Salah satutatalaksana dari fraktur adalah tindakan operasi dengan metode Open ReductionExternal Fixation (OREF). Nyeri post operasi pemasangan OREF sangatdirasakan oleh pasien. Nyeri adalah sesuatu hal yang bersifat subjektif. Rasa nyerimenghambat pasien untuk memulai menggerakkan ekstermitas yang cedera.Range Of Motion adalah tindakan keperawatan. ROM dapat menurunkanintensitas nyeri karena memperlancar sirkulasi darah, dan memelihara mobilitaspersendian, mengurangi ketegangan, serta meningkatkan relaksasi (Brunner &Suddarth, 2018).

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Global Status Report on Road Safety 2019 which was made by World Health

Organization (WHO), as many as 1,24 million people die every yearof

worldwide duee to traffic accidents. While in Indonesia an average of 3 people

die every hour due to traffic accident in 2019 pada tahun 2019. The traffic

accident cause the trauma, so that the productivity's someone can decrease. In

addition it can cause temporary to permanent disability. Fractures or often

known as fractures are the loss of continuity of bone, cracks or fractures of

bones that were originally intact. The impact caused by trauma to fractures

includes limited activity, because of the pain caused by the friction of the motor

and sensory nerves in the fracture wound. One of the treatments for fractures is

surgery using the Open Reduction External Fixation (OREF) method. The

patient feels the postoperative pain of OREF installation. Pain is something that

is subjective. Pain prevents the patient start moving the injured extremity.

Range Of Motion is a nursing action. ROM can reduce pain intensity because it

facilitates blood circulation, and maintains joint mobility, reduces tension, and

increases relaxation (Brunner & Suddarth, 2018).

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"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."

"ABSTRAKLatar Belakang. Meskipun kemajuan dalam desain dan bentuk fiksasi pada implant total knee replacement (TKR) meningkatkan kesintasan dan fungsi TKR secara dramatis, jumlah perdarahan prosedur ini hingga kini masih merupakan masalah penting yang belum dapat teratasi dengan baik.Metode. Penelitian ini adalah randomized controlled trial. Terdapat 28 pasien yang menjalani TKR periode Agustus 2014 hingga Februari 2016 di Rumah Sakit Cipto Mangunkusumo, 22 diantaranya memenuhi kriteria inklusi dan dibagi menjadi tiga kelompok. Kelompok kontrol, kelompok asam tranexamat intraartikular intraoperatif dan kelompok asam traneksamat intravena preoperatif. Perdarahan intraoperatif, kadar hemoglobin (Hb) preoperasi hingga hari kelima pasca operasi, total produksi drain, jumlah transfusi total dan hari pencabutan drain dicatat dan dibandingkan.Hasil. Jumlah transfusi pada kelompok intraartikular (200 +/- SB 100 ml) dan intravena (238 ± SB 53 ml ) secara signifikan berbeda dengan kelompok kontrol (1016 ± SB 308.2 ml) (p = 0.001). Total produksi drain pada kelompok intraartikuler (328 ml ± SB 193 ml) maupun intravena (391 ml ± SB 185 ml) berbeda bermakna dengan kelompok kontrol (652 ± SB 150 ml) (p = 0.003). Tidak terdapat perbedaan yang bermakna antara jumlah transfusi antara grup intravena dengan grup intraartikuler. Tidak terdapat perbedaan yang bermakna antara kadar Hb baik preoperasi maupun pascaoperasi, jumlah perdarahan intraoperatif, maupun hari drain dicabut pada setiap kelompok.Simpulan. Pemberian asam traneksamat menghasilkan total transfusi dan total produksi drain yang secara signifikan berbeda dibandingkan dengan kontrol, namun tidak terdapat perbedaan yang bermakna antara jumlah transfusi antara grup intravena dengan grup intraartikuler. Pemberian asam traneksamat baik intravena maupun intraartikuler dapat mengurangi jumlah transfusi dan total produksi drain secara efektif pada pasien yang menjalani prosedur TKR

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ABSTRACTIntroduction. This is a randomized controlled trial study. From 28 patients who underwent TKR from August 2014 to Februari 2016 at Cipto Mangunkusumo Hospital, 22 patients met the inclusion criteria and were divided into three groups. The control group,tranexamic acid intraarticular-intraoperative group, and intravenous tranexamic acid preoperative group. Intraoperative bleeding, hemoglobin (Hb) level on pre-operative to fifth day post surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared.Method. This is a randomized controlled trial study. From 28 patients who underwent TKR from August 2014 to Februari 2016 at Cipto Mangunkusumo Hospital, 22 patients met the inclusion criteria and were divided into three groups. The control group,tranexamic acid intraarticular-intraoperative group, and intravenous tranexamic acid preoperative group. Intraoperative bleeding, hemoglobin (Hb) level on pre-operative to fifth day post surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared.Result. The amount of blood transfusions needed both in the intra-articular group (200 +/- SD 100ml) and in the intra-venous group (238 ± SD 53 ml) was significantly different compared with those in the control group (1016 ± SD 308.2 ml) (p = 0.001), but there is no significant difference between the amount of blood transfusion needed in the intra-articular group and the amount needed in the intra-venous group. The total drain production in the intra-articular group (328 ml ± SD 193 ml) and intra-venous group (391 ml ± SD 185 ml) was significantly different compared to those in the control group (652 ± SD 150 ml) (p = 0.003). There is no significant difference between the levels of both preoperative and postoperative hemoglobin, the amount of intraoperative bleeding, as well as the duration of drain usage on each group.Consclusion. Tranexamic acid used both intra-articularly and intra-venously significantly reduce the amount of blood transfusion needed dan total drain production compared to control, but there is no significant difference between the intra-articular group and intra-venous group."

"Latar belakang: Nyeri tenggorok pascaoperasi merupakan salah satu komplikasi yang terjadi setelah intubasi endotrakeal. Pencegahannya dapat menggunakan magnesium sulfat. Magnesium sulfat dapat menghambat pelepasan tromboksan A2, substansi P, dan glutamat, serta antagonis reseptor NMDA. Penelitian ini untuk membandingkan teknik pemberian magnesium sulfat melalui inhalasi dan kumur untuk mencegah kejadian nyeri tenggorok pascaoperasi.Metode: Penelitian ini merupakan uji klinik acak tersamar ganda terhadap pasien dewasa yang menjalani pembiusan umum dengan intubasi endotrakeal di RSCM pada bulan Oktober sampai November 2018. Sebanyak 108 pasien dialokasikan menjadi kelompok inhalasi (inhalasi magnesium sulfat 225 mg) dan kelompok kumur (kumur magnesium sulfat 20 mg/kg). Kejadian nyeri tenggorok dinilai hingga 6 jam pascaoperasi. Analisis data menggunakan uji bivariat dengan Chi-Square.Hasil: Kejadian nyeri tenggorok pascaoperasi pada kelompok inhalasi magnesium sulfat sebesar 14 (25,9%) dan kelompok kumur magnesium sulfat sebesar 5 (9,3%) dengan perbedaan bermakna (p 0,023). Tidak ada efek samping berupa iritasi, mual, hipotensi, depresi nafas, dan desaturasi. Hipermagnesium terjadi pada 1 (1,8%) pada kelompok kumur magnesium sulfat, namun secara klinis tidak terjadi intoksikasi magnesium.Simpulan: Inhalasi dan kumur magnesium sulfat dapat mencegah kejadian nyeri tenggorok pascaoperasi. Inhalasi magnesium sulfat tidak lebih baik dari kumur magnesium sulfat dalam mencegah kejadian nyeri tenggorok pascaoperasi.

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Background: Postoperative sore throat (POST) is one of the most common complications after endotracheal intubation. Magnesium sulphate can be used to prevent POST. Magnesium sulphate inhibits release of thromboxan A2, substance P, and glutamate, and also as NMDA receptor antagonist. This study is to compare between nebulized and gargle magnesium sulphate to prevent POST.

Method: A randomized double-blinded clinical trial study involving adult patients who underwent general anesthesia with endotracheal intubation at RSCM during October to November 2018. A total of 108 patients allocated to nebulized group (nebulized magnesium sulphate 225 mg) and gargle group (gargle magnesium sulphate 20 mg/kg). POST measured until 6 hours postoperative. Data were analyzed using bivariate analysis test with Chi-Square.

Results: Incidence of POST in nebulized group was 14 (25,9%) and gargle group was 5 (9,3%) with significant difference (p 0,023). No adverse events such as irritation, nausea, hypotension, respiratory depression, and desaturation. Hypermagnesium at 1 (1,8%) at gargle group, but clinically there was no magnesium intoxication.

Conclusion: Nebulized and gargle magnesium sulphate prevent POST. Nebulized magnesium sulphate was not better than gargle magnesium sulphate to prevent POST.

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"Karya ilmiah akhir ini bertujuan untuk memberikan gambaran asuhan keperawatan pada anak dengan malforasi anorektal pre dan postoperasi PSARP, dengan bermain terapeutik menggunakan boneka jari untuk mengurangi nyeri. Tindakan dan perawatan PSARP menimbulkan nyeri pada anak. Salah satu teknik nonfarmakologis untuk meminimalkan nyeri tersebut dengan menggunkan bermain terapeutik. Hasil dari penerapan intervensi bermain terapeutik yang telah dilakukan pada anak malforasi anorektal selama 5 hari untuk mengurangi nyeri terbukti efektif menurunakn skala nyeri klien dari skala 8 menjadi 2 dengan menggunakan

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This final scientific work aims to provide an overview of nursing care for children with pre and postoperative anorectal malfunction of PSARP, by playing therapeutically using finger puppets to reduce pain. Medical treatment and PSARP treatment cause pain in children. One nonph acological technique to minimize the pain is by using therapeutic play. The results of the application of therapeutic play interventions that have been carried out on children anorectal malforation for 5 days to reduce pain proved effective in reducing the client's pain scale from scale 8 to 2 using FLACC postoperative pain scale."

"Coronary Arteri Bypass Graft masih menjadi tindakan bedah jantung terbanyak yang dilakukan diseluruh dunia, Komplikasi yang terjadi paska prosedur CABG dapat dikategorikan menjadi dua yaitu mayor dan minor. Salah satu komplikasi mayor adalah infeksi daerah operasi. Factor preoperasi yang mungkin dapat memicu infeksi daerah operasi mulai dari usia, status gizi, DM, kebiasaan merokok, durasi operasi dan penggunaan benang penutup operasi menjadi factor pre operasi yang harus diperhatikan. Tujuan penelitian ini untuk mengetahui faktor- faktor yang mempengaruhi kejadian infeksi daerah operasi pada pasien operasi coronary artery bypass graft di RS Jantung Jakarta. Penelitian ini menggunakan analitik observasional. Desain yang digunakan adalah case-control study. Populasi dalam penelitian ini adalah pasien CABG di kamar bedah RS.Jantung Jakarta periode 2019-2021. Sampel yang dipeorleh yaitu 64 sampel, 32 kasus infeksi, 32 non infeksi. Hasil penelitian menunjukkan ada hubungan antara usia, DM, riwayat merokok, status gizi, lama operasi dengan kejadian infeksi daerah operasi pada pasien pascaoperasi CABG di RS Jantung Jakarta. Dan tidak ada hubungan antara peggunaan benang penutup luka operasi dengan kejadian. Bagi pelayanan keperawatan diharapkan dilakukan skrining yang lebih yang lebih lengkap untuk pasien-pasien yang akan dilakukan operasi CABG.

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Coronary artery bypass grafting is still the most common heart surgery performed worldwide. The complications occurring after the CABG procedure can be categorized into two types, namely major and minor complications. One of the major complications is infection at the surgical site. Age, nutritional status, diabetes mellitus, smoking habits, surgery duration, and the use of surgical sutures are all pre-operative risk factors that can lead to infection in the operating room. Those are preoperative risk factors that must be considered. The purpose of this study is to determine the factors that influence the incidence of surgical site infection in coronary artery bypass graft surgery patients at the Jakarta Heart Hospital. This study employs observational analytic techniques. The design research study is a case-control study. The population in this study were CABG patients in the operating room of the Jakarta Heart Hospital for the 2019–2021 period. 64 samples were collected, 32 of which were infected and 32 of which were not. The results showed that there is a relationship between age, diabetes mellitus, smoking history, nutritional status, the duration of surgery, and the incidence of surgical site infection in post-operative CABG patients at the Jakarta Heart Hospital. As a result, there is no link between the use of threads to cover surgical wounds and incidents. For nursing services, it is hoped that more comprehensive screening will be carried out for patients who will undergo CABG surgery."

"Latar Belakang: Laparotomi merupakan pembedahan mayor yang dapat menyebabkan penurunan massa otot rangka dan kapasitas fungsional, seperti kekuatan genggam tangan (KGT). Berbagai studi membuktikan penurunan KGT pascaoperasi menimbulkan komplikasi pascaoperasi, serta KGT berkorelasi erat dengan appendicular skeletal muscle index (ASMI). Pengaruh ASMI praoperasi terhadap KGT pascaoperasi belum banyak dilakukan penelitian, sehingga penelitian ini bertujuan menilai korelasi ASMI praoperasi dengan KGT pascaoperasi.Metode: Studi observasional prospektif dilakukan pada subjek berusia 18 – 65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangunkusumo, yang dirawat untuk laparotomi elektif pada Maret sampai Juni 2023. Pengukuran ASMI praoperasi menggunakan bioimpedance analysis (BIA) multifrequency seca® mBCA 525 dengan cutoff laki-laki > 7,0kg/mg2 dan perempuan >5,7 kg/m2. Pengukuran KGT pada tangan kanan dan kiri pascaoperasi pada hari ke-6 pascaoperasi (POD-6) dengan dinamometer tangan spring-type CAMRY® dengan cutoff laki-laki >28 kg/m2 dan perempuan >18 kg/m2. Analisis bivariat dan multivariat digunakan untuk menilai hubungan variabel bebas dan terikat, serta mengidentifikasi faktor perancu yang berhubungan dengan KGT pascaoperasi.Hasil: Pada 85 subjek penelitian, sebanyak 98,82% subjek memiliki ASMI praoperasi rendah, 72,94% subjek memiliki KGT pascaoperasi tangan kanan menurun, dan 80% subjek memiliki KGT pascaoperasi tangan kiri menurun dari cutoff. Didapatkan hasil signifikan pada korelasi ASMI praoperasi dengan KGT pascaoperasi tangan kanan (r=0,444, p<0,001) dan kiri (r=0,423, p<0,001). Analisis lanjutan dengan regresi linier untuk faktor perancu didapatkan indeks massa tubuh (IMT) adalah faktor paling signifikan meningkatkan KGT tangan kanan dan kiri pascaoperasi.Kesimpulan: Terdapat hubungan yang bermakna secara statistik pada korelasi ASMI praoperasi dengan KGT pascaoperasi laparotomi elektif.

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Background: Laparotomy is a major surgery that can lead to a decrease in skeletal muscle mass and functional capacity, such as handgrip strength (HGS). Various studies have shown that HGS is decreasing after surgery can result in postoperative complications, and HGS is closely correlated with the appendicular skeletal muscle index (ASMI). Research on the preoperative influence of ASMI on postoperative HGS is limited, so this study aims to assess the correlation between preoperative ASMI and postoperative HGS.

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Methods: A prospective observational study was conducted on subjects aged 18-65 years at the tertiary education hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Preoperative ASMI measurements were taken using multifrequency bioimpedance analysis (BIA) with seca® mBCA 525, with a cutoff for males > 7.0 kg/m2 and females > 5.7 kg/m2. Postoperative HGS measurements for the right and left hands on postoperative day 6 (POD-6) were conducted using a spring-type hand dynamometer CAMRY® with a cutoff for males > 28 kg/m2 and females > 18 kg/m2. Bivariate and multivariate analyses were employed to assess the association between independent and dependent variables, as well as to identify confounding factors associated with postoperative HGS.

Results: In 85 research subjects, 98.82% had low preoperative ASMI, 72.94% experienced a decrease in postoperative right HGS, and 80% had a decrease in postoperative left HGS from the cutoff. Significant results were obtained in the correlation between preoperative ASMI and postoperative right HGS (r=0.444, p<0.001) and left HGS (r=0.423, p<0.001). Further analysis with linear regression for confounding factors revealed that body mass index (BMI) was the most significant factor in increasing postoperative HGS for both right and left hands.

Conclusion: There is a statistically significant in the correlation between preoperative ASMI and postoperative HGS in elective laparotomy."