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Latar Belakang: Perdarahan masif merupakan komplikasi paling banyak pada kasus spektrum plasenta akreta. Penyebab perdarahan terutama tergantung dari derajat keparahan spektrum plasenta akreta yang dapat diprediksi dari USG dan secara klinis dibuktikan pada saat operasi. Meskipun banyak faktor yang memengaruhi jumlah perdarahan saat operasi, namun memprediksi jumlah perdarahan melalui jumlah aliran darah yang masuk ke uterus adalah suatu patut diperhatikan. Oleh karena itu, penelitian ini bertujuan untuk memahami hubungan volume flow arteri uterina dan iliaka interna terhadap perdarahan, temuan intraoperasi dan histopatologi pada kasus SPA.

Tujuan: Mengetahui hubungan volume flow dan diameter arteri uterina dan iliaka  interna dengan perdarahan dan temuan intraoperasi serta histopatologi pada pasien spektrum plasenta akreta.

Metode: Sebuah studi cross-sectional dilakukan pada 31 wanita, yang secara klinis didiagnosis dengan SPA. Pengukuran volume flow dan diameter arteri uterina dan iliaka interna dilakukan dengan USG Doppler sebelum operasi dilakukan. Temuan intraoperasi dan hasil histopatologi dikategorikan sesuai kriteria klinis dan histopatologi FIGO. Jumlah perdarahan intraoperasi diukur dan dicatat. Data kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 25.

Hasil: Dari 31 subjek penelitian didapatkan jumlah perdarahan intraoperasi sebanyak 1500 (1000-3000) mL. Sebagian besar tindakan yang dilakukan bersifat elektif (n=18^; 58,1%) dengan seksio sesarea diikuti oleh histerektomi sebanyak 19 kasus (61,3%). Temuan klinis intraoperasi yang paling sering ditemukan adalah kriteria klinis FIGO 1 sebanyak 15 kasus (48,4%). Hasil histopatologi terbanyak adalah kriteria histopatologi FIGO 2 sebanyak 19 kasus (61,3%).

Rerata volume flow Arteri Iliaka Interna (p=0,002) berkorelasi dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,525, sedangkan rerata volume flow Arteri Uterina tidak berkorelasi dengan jumlah perdarahan intraoperasi. Rerata diameter arteri uterina (p=0,034) berkorelasi positif dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,383. Hal ini menunjukkan semakin besar volume flow arteri Iliaka Interna, semakin besar jumlah perdarahan intraoperasi. Ditemukan bahwa rerata diameter arteri iliaka interna memiliki perbedaan secara statistik dengan temuan klinis intraoperatif (p=0,044). Tidak ditemukan hubungan antara rerata volume flow dan diameter arteri uterina dan arteri iliaka interna dengan hasil histopatologi.

Kesimpulan. Pengukuran volume flow arteri iliaka interna dan diameter arteri uterina dapat memberikan gambaran perkiraan jumlah perdarahan saat operasi kasus spektrum plasenta akreta.

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Background: Massive bleeding is the most common complication in cases of the placenta accreta spectrum (PAS). The cause of bleeding largely depends on the severity of the PAS, which can be predicted through ultrasound (USG) and clinically confirmed during surgery. Although many factors influence the amount of bleeding during surgery, predicting the amount of bleeding through the measurement of blood flow into the uterus is noteworthy. Therefore, this study aims to understand the relationship between the volume flow of the uterine and internal iliac arteries and bleeding, intraoperative findings, and histopathology in PAS cases.

Objective: To determine the Relationship between Volume Flow and Diameter of Uterine and Internal Iliac Arteries with Intraoperative Bleeding and Findings, as well as Histopathology in Patients with Placenta Accreta Spectrum.

Methods: A cross-sectional study was conducted on 31 women clinically diagnosed with PAS. Measurement of volume flow and diameter of the uterine and internal iliac arteries was performed using Doppler ultrasound before surgery. Intraoperative findings and histopathological results were categorized according to clinical and FIGO histopathological criteria. The amount of intraoperative bleeding was measured and recorded. The data were then analyzed using Statistical Package for Social Sciences (SPSS) version 25.

Results: From 31 study subjects, the amount of intraoperative bleeding was found to be 1500 (1000-3000) mL. Most procedures were elective (n=18; 58.1%), with cesarean section followed by hysterectomy in 19 cases (61.3%). The most common intraoperative clinical finding was FIGO clinical criteria 1 in 15 cases (48.4%). The majority of histopathological results were FIGO histopathological criteria 2 in 19 cases (61.3%). The mean volume flow of the Internal Iliac Artery (p=0.002) correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.525, while the mean volume flow of the Uterine Artery did not correlate with the amount of intraoperative bleeding. The mean diameter of the uterine artery (p=0.034) positively correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.383. This indicates that the larger the volume flow of the Internal Iliac Artery, the greater the amount of intraoperative bleeding. It was found that the mean diameter of the internal iliac artery differed statistically with intraoperative clinical findings (p=0.044). No relationship was found between the mean volume flow and diameter of the uterine and internal iliac arteries with histopathological results.

Conclusion: Measurement of the volume flow of the internal iliac artery and the diameter of the uterine artery can provide an estimate of the amount of bleeding during surgery in cases of the placenta accreta spectrum."

"ABSTRAK Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakanpenyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utamapenggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peaksistolik velocity arteri brakialis dan volume flow draining vein intraoperatif denganmenggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yangdigunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukankorelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flowdraining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/mindihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukantindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angkakegagalan maturasi AVF. ABSTRACT Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure."

"Pendahuluan: Pembedahan pada anak berbeda dengan orang dewasa, khususnya pada pembedahan tumor malignant muskuloskeletal anak. Kompleksitas kondisi preoperatif, termasuk status nutrisi, kemoterapi neoadjuvant, kondisi klinis umum yang buruk serta jenis pembedahan dapat mempengaruhi kondisi pascaoperatif, dan luaran baik klinis dan onkologi. Penelitian ini bertujuan untuk mengevaluasi kondisi preoperatif, intraoperatif yang mempengaruhi pascaoperatif, luaran fungsional dan onkologi.Metode: Penelitian ini secara retrospektif meninjau delapan puluh tiga subjek pasien tumor muskuloskeletal ganas pediatrik yang menjalani operasi baik sebagai salavage atau prosedur amputasi dari 2017-2021. Data perioperatif, hasil fungsional dan onkologis pada tindak lanjut 1 tahun dikumpulkan.     Hasil: Dari 83 subjek penelitian, osteosarkoma adalah tumor yang paling banyak ditemukan (90,4%), Ewing sarkoma (3,6%), rhabdomyosarcoma (3,6%), Ewing sarkoma ekstraskeletal (1,2%), dan limfoma ganas (1,2%). Tingkat kelangsungan hidup 1 tahun adalah 72,3%, dan 37,3%. Usia, jenis tumor, tormbosit praoperatif, albumin, dan ASA dihubungkan dengan durasi operasi (p<0,01). Faktor-faktor yang terkait dengan jumlah kehilangan darah adalah usia, jenis operasi, dan kadar albumin (p<0,01). Usia dan kehilangan darah memiliki hubungan dengan hasil fungsional (p<0,01).Kesimpulan: Faktor praoperatif yang mempengaruhi hasil adalah usia. Pada kelompok subjek yang memiliki komplikasi pasca operasi relatif memiliki tingkat metastasis yang lebih tinggi. Kehilangan darah intraoperatif adalah salah satu faktor prognostik untuk komplikasi pasca operasi yang dikaitkan dengan jenis tumor, usia, dan tingkat albumin. 

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Introduction: Surgical procedure in children is different from adults, especially in pediatric malignant musculoskeletal surgery. The complexity of preoperative condition, including nutritonal status, neoadjuvant chemoteraphy, anemic, poor general condition and type of surgery that may affect the postoperative and outcome. This study aims to evaluate preoperative, intraoperative parameters that affect the postoperative, functional and oncologic outcome.

Methods: The study retrospectively reviewed eighty-three subjects of pediatric malignant musculoskeletal tumor patients who underwent surgery either as salavage or ablation procedures from 2017-2021. Perinoperative data, functional and oncological outcomes on a 1-year follow-up were collected.           

Results: Of  the 83 study subjects, osteosarcoma was the most common tumor (90.4%), Ewing sarcoma (3.6%), rhabdomyosarcoma (3.6%), extraskeletal Ewing sarcoma (1.2%), and malignant lymphoma (1.2%). The 1-year survival rate was 72.3%, and 37.3%. Usia, tumor type, preoperative tormbocytes, albumin, and ASA were associated with surgical duration (p<0.01). Factors associated with the amount of blood loss are age, type of surgery, and albumin levels (p<0.01). Age and  blood loss have a relationship with functional outcomes (p<0.01).

Conclusion: The preoperative factor influencing outcomes is age. In the group of subjects who had postoperative complications relatively had a higher rate of metastases. Intraoperative blood loss is one of the prognostic factors for postoperative complications associated with tumor type, age, and albumin levels. "

"Mortalitas 30 hari pascaoperasi CABG di RSCM mencapai 13,96%. Angka ini jauh lebih besar dari mortalitas di Amerika Serikat 2% dan Pakistan 3,4%. Perbedaan yang besar ini menimbulkan pertanyaan adakah prediktor mortalitas lain selain yang terdapat pada EuroSCORE dan STS yang dapat menjadi prediktor mortalitas 30 hari pascaoperasi CABG di Indonesia. Penelitian ini berusaha mengetahui peran determinan praoperasi seperti yang terdapat pada EuroSCORE dan STS, determinan intraoperasi, dan pascaoperasi terhadap mortalitas 30 hari pascaoperasi CABG. Penelitian ini merupakan penelitian retrospektif menggunakan data sekunder rekam medis pasien berusia > 18 tahun yang menjalani operasi CABG di Pusat Jantung Terpadu, Rumah Sakit Dr. Cipto Mangunkusumo tahun 2012-2015. Analisis dilakukan secara multivariat regresi Cox untuk mendapat model akhir hubungan antara deteminan pra-, intra-, pasca-, dan perioperasi dengan mortalitas pascaoperasi CABG. Penelitian ini menunjukkan bahwa Terdapat hubungan antara disfungsi neurologi, disfungsi ginjal, disfungsi ventrikel kiri, lama klem aorta, durasi operasi, trombositopenia pasca operasi dan pemasangan IABP pasca operasi dengan HR (IK 95%) berturut-turut: 5,63 (2,18-14,49); 3,49 (1,30-9,42); 3,07 (1,30-7,23); 4,00 (1,62-9,88); 3,03 (1,08-8,49); 3,37 (1,40-8,14) dan 9,56 (4,03- 22,67). Di samping prediktor praoperasi yang sudah standar, lama klem aorta, durasi operasi, trombositopenia pascaoperasi dan pemasangan IABP pascaoperasi merupakan determinan yang perlu dipertimbangkan dalam memprediksi mortalitas 30 hari pascaoperasi CABG.

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Thirty-day mortality after CABG surgery in dr. Cipto Mangunkusumo Hospital is 13.96%, higher than in the US (2%) and Pakistan (3.4%). This huge difference suggests that there are other predictors beside those included in EuroSCORE dan STS. This research aimed to determine the role of preoperative, intraoperative, postoperative, and perioperative determinants of CABG surgery in 30-day mortality after the procedure. This was a retrospective study using secondary data from medical record of patients who underwent CABG in Comprehensive Heart Care Centre, dr. Cipto Mangunkusumo General Hospital in 2012-2015. Data were analysed using regresi Cox multivariate. This research showed that age, neurological dysfunction, renal dysfunction, left ventricle dysfunction, aortic clamp time, surgery duration, low platelet after surgery, and IABP support after surgery were associated with 30-day mortality after CABG with HR (95% CI) : 5,63 (2,18-14,49); 3,49 (1,30-9,42); 3,07 (1,30-7,23); 4,00 (1,62-9,88); 3,03 (1,08- 8,49); 3,37 (1,40-8,14) and 9,56 (4,03-22,67). In conclusion, besides scoring model determinants, low platelet count and administration of IABP after surgery should be considered as predictors of 30-day mortality after CABG."

"Pendahuluan: Pertambahan usia pada kelompok geriatri dikaitkan dengan perubahan beberapa fungsi fisiologis, termasuk termoregulasi. Hal ini menyebabkan pasien geriatri berisiko tinggi untuk terjadinya hipotermia perioperatif yang berpengaruh pada morbiditas dan mortalitas pembedahan. Pencegahan hipotermia perioperatif dengan pemanasan aktif digunakan untuk mempertahankan normotermia pada pasien usia geriatri.Metode: Penelitian ini merupakan uji klinis acak tidak tersamar yang melibatkan 42 subjek pasien geriatri yang menjalani anestesi umum untuk prosedur bedah minor. Subjek dibagi menjadi dua kelompok yakni kelompok perlakuan yang mendapatkan prewarming dengan FAW selama 15 menit dengan suhu target 37 – <37,5 °C dan kelompok kontrol yang mendapatkan selimut selama 15 menit. Data suhu, tekanan darah, dan laju nadi dicatat per 15 menit sampai 1 jam pascaanestesia. Hasil: Pada kedua kelompok terjadi penurunan suhu dalam 1 jam pascaanestesia umum. Kelompok prewarming dengan FAW memiliki suhu yang lebih tinggi dibandingkan dengan kelompok selimut 1 jam pascaanestesia dengan nilai suhu median 36.3 (36.1-36.6) °C dibandingkan 35.0 (34.5-35.4) °C, (p<0.001). Perubahan suhu prewarming pada kelompok FAW dibandingkan dengan suhu baseline pada 0 menit, 15 menit, 30 menit, 45 menit, dan 60 menit yakni sebesar 0.94 (0.7-1.2) °C, p<0,001; 0.94 (0.7-1.2) °C, p<0,001; 1.03 ± 0.11 °C, p<0,001; 1.04 (0.8-1.3) °C, p<0,001; dan 1.13 ± 0.1 °C, p<0,001. Perubahan suhu kelompok selimut dibandingkan dengan suhu baseline pada 0 menit, 15 menit, 30 menit, 45 menit, dan 60 menit yakni sebesar 1.22 ± 0.18 °C, p<0,001; 1.32 ± 0.17 °C, p<0,001; 1.42 ± 0.19 °C, p<0,001; 1.47 ± 0.21 °C, p<0,001, dan 1.56 ± 0.22 °C, p<0,001.Kesimpulan: Prewarming dengan FAW selama 15 menit dapat mencegah hipotermia pasca 1 jam anestesia umum pada pasien geriatri.

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Introduction: Aging in geriatric patients is associated with physiological changes, including impaired thermoregulation. This may increase the risk of perioperative hypothermia, which impacts surgical morbidity and mortality. Active warming methods potentially help maintain normothermia in this susceptible population. Methods: This randomized, open-label clinical trial involved 42 geriatric patients undergoing general anesthesia for minor surgery. Participants were divided into a prewarming group receiving forced-air warming (FAW) at 37–<37.5°C for 15 minutes, and a control group using blankets for similar duration. Temperature, blood pressure, and heart rate were monitored every 15 minutes up to one hour post- induction.

Results: The temperature were declined in two groups during 1 hour of general anesthesia. The temperature was higher in the FAW group compared to the blanket group one hour post general anesthesia with median temperature 36.3 (36.1-36.6) °C vs. 35.0 (34.5-35.4) °C, (p<0.001). Baseline temperature perioperative decline in FAW compared with 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes post general anesthesia were 0.94 (0.7-1.2) °C, p<0,001; 0.94 (0.7-1.2) °C, p<0,001; 1.03 ± 0.11°C, p<0,001; 1.04 (0.8-1.3) °C, p<0,001; dan 1.13 ± 0.1°C, p<0,001. Baseline temperature perioperative decline in blanket compared with 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes post general anesthesia were 1.22 ± 0.18 °C, p<0,001; 1.32 ± 0.17 °C, p<0,001; 1.42 ± 0.19 °C, p<0,001; 1.47 ± 0.21 °C, p<0,001, dan 1.56 ± 0.22 °C, p<0,001.

Conclusion: Fifteen minutes of prewarming with FAW effectively prevents hypothermia one hour after general anesthesia in geriatric patients."

"Latar Belakang: Laparoskopi merupakan prosedur yang menguntungkan pada operasi transplantasi ginjal . Namun teknik ini dapat menyebabkan perubahan pada sistem pernafasan. Pengaturan volume tidal merupakan salah satu strategi proteksi untuk mencegah komplikasi paru pascaoperatif. Penelitian ini berusaha membandingkan efek volume tidal 6 mL/kgbb dan 10 mL/kgbb terhadap distribusi ventilasi pada pasien donor transplantasi ginjal yang menjalani nefrektomi per laparoskopi menggunakan EIT. Metoda: Uji klinis ini dilakukan di Instalasi Bedah Pusat RSUPN Cipto Mangunkusumo dan ruang operasi RSCM Kencana Jakarta terhadap 30 pasien donor transplantasi ginjal yang menjalani laparoskopi nefrektomi. Subjek dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik intraoperatif dengan volume tidal 6 mL/kgbb dan 10 mL/kgbb. Hipotesis penelitian adalah distribusi ventilasi volume tidal 6 mL/kg lebih baik dibandingkan 10 mL/kg. Parameter yang dinilai adalah ?TIV, ?EELI global dan regional dan ?CR diambil dari monitor EIT PulmoVista 500. Hasil: Nilai ∆TIV paru dependen dan nondependen antara kedua kelompok berbeda bermakna secara statistik pada posisi supine pascadesuflasi (p =0,008), dimana volume tidal 6 mL/kgbb menunjukkan distribusi ventilasi tidak homogen. Nilai ∆EELI global dan regional volume tidal 10 mL/kg lebih tinggi dan bermakna secara statistik pada posisi lateral dekubitus sebelum insuflasi (p <0,005). Tidak ditemukan perbedaan bermakna nilai ∆CR (paru dependen dan nondependen).Simpulan. Pemberian volume tidal 6 mL/kgbb tidak memberikan gambaran distribusi ventilasi yang lebih baik dibandingkan dengan volume tidal 10 mL/kgbb pada pasien donor ginjal yang menjalani operasi laparoskopi nefrektomi berdasarkan parameter EIT.

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Background: Laparoscopy is a procedure that is profitable on a kidney transplant operation. However, this technique may cause changes in the respiratory system. Tidal volume setting is one of protection strategies for preventing pulmonary complications postoperative. This study attempted to compare the effects of tidal volume 6 mL kgbw and 10 mL kgbb kgbw against distribution of ventilation in kidney transplant donor patients who underwent laparoscopic nephrectomy using EIT.

Method: This randomized clinical trial conducted in the Surgical Center Installation RSUPN Cipto Mangunkusumo and operating room RSCM Kencana Jakarta against 30 kidney transplant donor patients who underwent laparoscopic nephrectomy. Subjects were randomized into two intervention groups mechanical ventilation with intraoperative tidal volume 6 mL kgbw and 10 mL kgbw. The hypothesis is distribution of ventilation tidal volume 6 mL kgbw is better than 10 mL kgbw. Parameter TIV, EELI global and regional and CR were taken from a monitor EIT PulmoVista 500.

Result: The value of TIV between dependent and nondependent parts of lung statistically significant difference on postdesuflation supine position p 0,008 , where the tidal volume of6 mL kgbw indicates distribution of ventilation is not homogenous. The value of EELI global and regional tidal volume 10 mL kg is higher and meaningful statistically on lateral decubitus before insuflation p 0,005 . There is no meaningful difference in CR value the dependent and nondependent parts of lung.

Conclusion: Tidal volume 6 mL kgbw does not give a better distribution of ventilation compared with 10 mL kgbw in kidney donor patient undergoing laparoscopic nephrectomy based on the parameters of the EIT.Keywords Distribution of ventilation, EIT, kidney donor, laparoscopic nephrectomy, intraoperative volume tidal."

"Pendahuluan. Penelitian ini merupakan penelitian lanjutan untuk melakukan pengkajian nilai batasan bloodflow rate BFR intraoperatif menggunakan ultrasonografi Doppler dalam memprediksi maturitas fistula brakiosefalika dengan sampel yang lebih besar dan lebih spesifik untuk mendapatkan nilai dengan tingkat error dan bias lebih rendah, sehingga nantinya dapat dijadikan referensi di divisi Bedah Vaskular RSCM. Metode. Dilakukan studi potong lintang analitik di Divisi Vaskular Departemen Ilmu Bedah FKUI-RSCM, Jakarta yang melibatkan semua penderita gagal ginjal stadium 4-5 akibat nefropati diabetik yang akan dihemodialisis dengan akses vaskular fistula brakiosefalika. Hasil. Terdapat 71 subjek dengan rerata BFR 249,15 86,86 mL/menit, rerata diameter arteri 3,3 mm 2,0-7,4 mm dan rerata diameter vena 3 mm 2,1-5,6 mm. Analisis statistik menunjukkan bahwa hanya BFR yang berhubungan bermakna dengan maturitas AVF p80.

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Introduction. This research is a follow-up study to determine the value limits of bloodflow rate BFR intraoperative using Doppler ultrasound to predict maturity of brachiocephalic fistula with a larger sample and to obtain lower level of error and bias, so it can be used as a reference in the Vascular Surgery division, Cipto Mangunkusumo Hospital.

Methods. Cross-sectional design with analytic fashion conducted at Division of Vascular Surgery Department of the Faculty of medicine - Cipto Mangunkusumo Hospital, Jakarta with all patients with stage IV-V CKD, due to diabetic nephropathy who planned to get vascular access for hemodialysis brachiocephalic fistula.

Result. Total subject are 71 with mean bloodflow rate is 249.15 86.86 mL / min, mean arterial diameter is 3.3 mm 2.0 to 7.4 mm and the mean diameter of the vein is 3 mm 2.1 to 5.6 mm . Only BFR associated significantly with maturity AVF p

BFR intraoperatif, maturitas AV fistula, brakiosefalika, sensitivitas, spesifisitas"

"Latar Belakang: Hipotermia pasca bedah merupakan kejadian yang umum terjadi pada pasien pascabedah, khususnya geriatri yaitu sebesar 70%. Hipotermia memiliki dampak serius, antara lain gangguan koagulasi dan perdarahan, gangguan metabolisme obat, infeksi, iskemia miokardial, aritmia, hospitalisasi lama, dan peningkatan morbiditas serta mortalitas pascabedah. Di Indonesia, khususnya di RSUPN dr. Cipto Mangunkusumo memiliki karakteristik distribusi status fisik preoperasi, jumlah pemberian cairan, dan indeks massa tubuh yang berbeda dari negara lain.Tujuan: Studi ini dilakukan untuk menganalisa hubungan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh terhadap hipotermia pascabedah pada pasien geriatri.Metode: Penelitian menggunakan metode potong-lintang dengan uji observasional terhadap 108 subjek penelitian dari rekam medis sejak November 2018-Januari 2019. Subjek penelitian adalah pasien geriatri yang telah menjalani pembedahan dalam anestesi umum dengan/tanpa anestesi regional dan dirawat di RSUPN dr. Cipto Mangunkusumo. Kriteria eksklusi yaitu pasien tidak memiliki catatan rekam medis lengkap, meninggal pada saat operasi atau saat tiba di rumah sakit, dan sudah mengalami hipotermia sebelum pembedahan.Hasil: Pada penelitian ini didapatkan proporsi hipotermia pascabedah pada pasien geriatri adalah 67,6%. Hasil penelitian antara hipotermia pascabedah dengan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh pada pasien geriatri yaitu nilai p = 0,997, p = 0,310, p = 0,413.Kesimpulan: Hipotermia pascabedah pada pasien geriatri tidak memiliki hubungan yang bermakna dengan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh pada pasien geriatri.

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Background: Postoperative hypothermia is commonly found in postoperative patients, especially in geriatrics, which is 70%. Hypothermia also has serious effects, including coagulation and bleeding disorders, drug metabolism disorders, infections, myocardial ischemia, arrhythmias, prolonged hospitalization, and increased postoperative morbidity and mortality. In Indonesia, especially in Centre Cipto Mangunkusumo Hospital subjects characteristics, the distribution of preoperative physical status, amount of fluid administration, and body mass index are different from other countries.

Objective: This study was conducted to analyze the association between preoperative physical status, the amount of intraoperative crystalloid fluid administration, and body mass index for postoperative hypothermia in geriatric patients.

Methods: This was a cross-sectional observational study which included 108 research subjects and obtained from the medical records since November 2018-January 2019. Subjects were geriatric patients who under going surgery with general anesthesia with/without regional anesthesia in Centre dr. Cipto Mangunkusumo Hospital. Exclusion criteria were patient who did not have a complete medical record, died during surgery or when arrived at the hospital, and had history of hypothermia before surgery.

Results: In this study, the incidence of postoperative hypothermia among geriatric patients was 67.6%. The results of the study between postoperative hypothermia with preoperative physical status, the amount of intraoperative crystalloid fluid administration, and body mass index in geriatric patients were p = 0.997, p = 0.310, p = 0.413.

Conclusion: Postoperative hypothermia in geriatric patients did not have significant association with preoperative physical status, amount of intraoperative crystalloid fluid administration, and body mass index in geriatric patients."

"Ners Spesialis peminatan kardiovaskular didapatkan setelah melalui program praktik residensi keperawatan. Praktek residensi keperawatan terdiri dari 2 program yaitu praktek residen umum dan praktek residensi peminatan yaitu kardiovaskular. Kegiatan praktek residensi peminatan termasuk peran perawat sebagai pemberi asuhan keperawatan, peneliti, dan inovator. Peran pemberi asuhan keperawatan yaitu melakukan asuhan keperawatan pada 1 kasus utama dan 30 kasus resume pasien gangguan sistem kardiovaskular menggunakan model konservasi Levine. Peran peneliti adalah melakukan penerapan EBN yaitu akupresur terhadap kecemasan pasien preoperasi jantung. Hasil penerapan EBN; akupresur sebagai intervensi nonfarmakologi, nonivasif, mudah, sederhana dan aman dapat menurunkan kecemasan preoperasi jantung. Terakhir, peran inovator yaitu penggunaan skala Munro untuk mencegah kejadian perioperative related pressure injury pada pasien bedah jantung. Instrumen skala Munro sebagai pengkajian risiko pressure injury spesifik pada perioperatif, dilakukan 3 tahapan (preoperatif, intraoperatif, dan postoperatif), valid dan reliabel. Instrumen dapat digunakan sebagai bagian dari satuan intervensi pencegahan perioperative related pressure injury bersama dengan pengkajian kulit.

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Nurse Specialist in cardiovascular is obtained after going through a nursing residency practice program. Nursing residensy practice consists of 2 programs, namely general residency practice and specialization residency practice, namely cardiovascular. Specialization residency practice activities include the roel of nurses as nursing care providers, researchers and innovators. The role of nursing care provder is to manage nursing care in 1 main case and 30 resume cases of pastients with cardiovascular system disorders using Levine conservation model. The role of researcher is to implement EBN, namely acupressure on the anxiety of preoperative cardiac patients.

Results of the EBN application; acupressure as a non-pharmacological intervention, non-invasive, simple, easy and safe can reduce anxiety of preoperative cardiac. Finally, the rola of an innovator is the use of Munro scale to prevent perioperative related pressure injury in cardiac surgery patients. Instrument of Munro scale as an assessment of the risk of specific in perioperative pressure injury, carried out 3 stages (preoperative, intraoperative, dan postoperative), valid and reliable. Instrument can be used as bundle of an intervention for the prevention of perioperative related pressure injury along with skin assessment."