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"Latar Belakang: Kardiomiopati uremikum adalah kelainan jantung yang didasari oleh kelainan pada ginjal dan merupakan penyebab kematian tertinggi pada pasien penyakit ginjal kronik (PGK). Overload cairan dan stres oksidatif berperan dalam patogenesis penyakit ini. Kuersetin adalah antioksidan yang bersifat kardioprotektif, namun belum ada data tentang efeknya pada kardiomiopati uremikum. Penelitian ini bertujuan untuk mengetahui efek kuersetin pada kardiomiopati uremikum menggunakan model nefrektomi 5/6 pada tikus. Metode: Uremia diinduksi pada 3 kelompok tikus jantan Sprague-Dawley dengan nefrektomi 5/6, satu kelompok kontrol tanpa nefrektomi 5/6, masing-masing 6 ekor/kelompok dan diamati selama 8 minggu. Kelompok SNX tidak diberi pengobatan. Kelompok SNX+Q mendapat quersetin per oral dengan dosis 100 mg/kgBB/hari dan kelompok SNX+Cap mendapat kaptopril 10 mg/kgBB/hari. Hewan uji dikorbankan untuk diukur kadar malondialdehid (MDA) plasma dan jantung, aktivitas glutation peroksidase (GPX) jantung, NT-proBNP plasma, dan fibrosis jantung. Data dianalisis dengan uji ANOVA. Hasil: Nefrektomi 5/6 menimbulkan sedikit fibrosis jantung, tidak mempengaruhi NT-proBNP, tidak mempengaruhi MDA jantung dan plasma dan meningkatkan secara bermakna aktivitas GPX jantung (p<0.05) sedangkan pemberian kuersetin dan kaptopril tidak mempengaruhi fibrosis jantung, tidak mempengaruhi NT-proBNP (p>0.05), tidak mempengaruhi MDA jantung dan plasma (p>0.05) dan tidak mempengaruhi aktivitas GPX jantung pada tikus uremia yang diinduksi dengan nefrektomi 5/6 (p>0.05). Kesimpulan: Kuersetin tidak mempengaruhi fibrosis jantung dan fungsi jantung tikus uremia pasca nefrektomi 5/6. Peningkatan secara bermakna aktivitas GPX jantung pada semua kelompok pasca nefrektomi 5/6 (p<0.05) dibandingkan kelompok kontrol normal menunjukkan bahwa jantung tikus uremia masih berada pada fase kompensasi, yaitu mekanisme adaptasi jantung dan fungsi jantung belum terganggu meskipun terjadi sedikit fibrosis jantung.

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Background: Uremic cardiomyopathy is a heart disease because of abnormalities in the kidneys that is the leading cause of death in patients with chronic kidney disease (CKD). Fluid overload and oxidative stress play an important role in its pathogenesis. Quercetin, as an antioxidant, has cardioprotective effect. To the best of our knowledge, its effect on uremic cardiomyopathy has not been investigated yet. This study aims to determine the effect of quercetin on uremic cardiomyopathy using 5/6 nephrectomy model in rats.

Methods: Uraemia was induced surgically in male Sprague-Dawley rats via 5/6 nephrectomy (SNX). Quercetin was administered per orally at a dose of 100 mg/kgBW/day for 8 weeks prior to sacrifice. Meanwhile captopril was administered per orally at a dose of 10 mg/kgBW/day. Oxidative stress was assessed using tiobarbituric acid reactive substances reaction then glutathione peroxidase (GPX) activity was determined to study on antioxidant mechanism. Myocardial fibrosis was analyzed using Massons? Trichrome staining and NTproBNP was measured as a marker of cardiac function. Data was analyzed using ANOVA.

Results: Nephrectomy 5/6 had no effects on plasma NT - proBNP, cardiac and plasma MDA, but induced mild myocardial fibrosis and increased cardiac GPX activity significantly (p<0.05). However, administration of quercetin and captopril had no effects on plasma NT - proBNP, cardiac and plasma MDA, myocardial fibrosis and GPX activity in uremic rats? heart induced by 5/6 nephrectomy.

Conclusion: Uremic rats? heart induced by 5/6 nephrectomy demonstrated mild myocardial fibrosis but preserved in vivo cardiac function. Increased GPX activity in uremic rats? heart compared to normal control (p<0.05) suggests induction of antioxidant defense mechanisms that might not be exhausted yet highlighting a compensatory phase which was unchanged following chronic either quercetin or captopril administration."

"Latar Belakang: Penyakit ginjal kronik (PGK) merupakan penyakit progresif dan ireversibel yang mempunyai berbagai komplikasi serius serta belum ada terapi yang dapat memperbaiki kerusakan ginjal yang telah terjadi. Beberapa studi menunjukkan stres oksidatif berperan dalam patogenesis penyakit ini. Stres oksidatif terjadi akibat ketidakseimbangan produksi ROS dan pertahanan antioksidan. Nrf2 merupakan faktor transkripsi yang terlibat dalam mekanisme pertahanan sel dalam mengatasi stres oksidatif. Penelitian ini bertujuan untuk mengetahui aktivitas kuersetin sebagai aktivator Nrf2 dalam menghambat progresivitas penyakit ginjal yang diinduksi nefrektomi 5/6. Metode: Tikus Sprague-Dawley jantan dikelompokkan secara acak dalam kelompok kontrol normal (C), kontrol nefrektomi 5/6 (Nx), nefrektomi 5/6 yang diberi kuersetin dengan dosis 100 mg/kgbb/hari/p.o. (NxQ), nefrektomi 5/6 dan diberi kaptopril dengan dosis 10 mg/kgbb/hari/p.o. (NxK). Hewan coba diterminasi diakhir perlakuan untuk diambil darah, urin, dan organ ginjalnya. Pemeriksaan yang dilakukan adalah pemeriksaan proteinuria, kreatinin urin dan plasma, ureum plasma, kadar MDA plasma dan jaringan, aktivitas glutation peroksidase (GPx), kerusakan jaringan (histopatologi) dan ekspresi Nrf2 (imunohistokimia). Hasil: Hasil penelitian menunjukkan bahwa nefrektomi 5/6 dapat menimbulkan peningkatan proteinuria, ureum plasma, dan derajat fibrosis ginjal secara signifikan. Nefrektomi 5/6 cenderung meningkatkan kreatinin plasma, kadar MDA ginjal, aktivitas GPx, dan menurunkan MDA plasma serta ekspresi Nrf2. Kuersetin tidak mempengaruhi proteinuria, ureum dan kreatinin plasma, dan derajat fibrosis ginjal. Kuersetin cenderung menurunkan kadar MDA dan meningkatkan aktivitas enzim GPx serta ekspresi Nrf2. Kesimpulan: Kuersetin tidak mempengaruhi proteinuria, ureum dan kreatinin plasma serta kerusakan struktur jaringan atau fibrosis ginjal. Kuersetin cenderung menurunkan kadar MDA dan meningkatkan aktivitas enzim GPx serta cenderung meningkatkan ekspresi Nrf2.

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Background: Chronic Kidney Disease (CKD) is a progressive and irreversible condition that has several serious complications and currently there has no single therapy that can repair kidney damage was occurred. Some studies suggest a role of oxidative stress in the pathogenesis of this disease. Oxidative stress is caused by an imbalance of ROS production and antioxidant defenses. Nrf2 is a transcription factor involved in cell defense mechanisms againts oxidative stress. This study was aimed to determine the quercetin activity as Nrf2 activator in inhibit the progression of 5/6 nephrectomy induced CKD in male rats.

Method: Sprague-Dawley rats were randomly divided into normal control group (C), untreated 5/6 nephrectomy (Nx), quercetin-treated 5/6 nephrectomy, NxQ (100 mg / kg / day orally), captopril-treated 5/6 nephrectomy, NxK (10 mg / kg / day orally). Animal models was sacrificed at the end of intervention to take blood to measure creatinine, urea, and MDA, urine to measure protein and creatinine, and kidney organ to measure levels of MDA, glutathione peroxidase (GPx) activity, and renal damage (histopathology) and Nrf2 expression (immunohistochemistry).

Results: The results showed that 5/6 nephrectomy may cause an increased of proteinuria, plasma urea, and grade of renal fibrosis significantly. 5/6 nephrectomy has trend to increased plasma creatinine, renal MDA levels, GPx activity, and decreased plasma MDA and Nrf2 expression. Quercetin did not decrease proteinuria, plasma urea and creatinine, and renal fibrosis grading. Quercetin tend to reduced levels of MDA, increased GPx enzyme activity, and expression of Nrf2.

Conclusion: Quercetin does not affect proteinuria, plasma urea,plasma creatinine, and tissue damage or kidney fibrosis. Quercetin tend to reduced levels of MDA and increased the activity of GPx and Nrf2 expression."

"[ABSTRAK LatarBelakangDelayedgraftfunction(DGF)adalahkomplikasiyangumumdijumpaipadatransplantasidarimayat.Berdasarkanstuditerdahulu,DGFdanfactorresikonyamemilikihasilyangbervariasipadadonornefrektomihidupMetodePenelitimelakukananalisisretrospektifdarirekammedicdonordanresipientransplantasiginjalpada100kasuslaparoskopidonornefrektomihidupdiRumahSakitCiptoMangunkusumodariNovember2011hinggaFebruari2014.KriteriaDGFadalahpasiendidialisispada1minggupostoperasidan/ataukreatininlebihdari2.5mg/dlpadaharike7postoperasi.PasienyangtidakmasukdalamkriteriatersebutdidefinisikanmemilikirenalallograftyangberfungsinormalHasilPrevalensiDGFpadapenelitianiniadalah14%.Indeksmassatubuhresipien,coldischemiatime,waktuanastomosisvaskular,dantotalischemiatimelebihtinggipadagrupDGF,tetapitidakditemukanfaktorresikoDGFyangsignifikansecarastatisticsaatdilakukananalisismultivariatKesimpulanInsidensiDGFpadastudiinimasukdalamrentangyangdiamatipadastudi-­‐studisebelumnya.FaktorresikoyangdilaporkansebagaifaktorresikoDGFpadalaparoskopidonornefrektomihiduptidaksignifikansecarastatistikdenganDGFpadastudikaliini.

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ABSTRACTBackgroundDelayed graft function (DGF) is a common complication affecting deceaseddonor renal transplantation. Based on previous studies, DGF and its risk factors inlive donor nephrectomy (LDN) have a various results.MethodsWe retrospectively analyzed the medical records of donor and recipient from ourfirst 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital fromNovember 2011 to February 2014. The criteria used to define DGF were therequirement for dialysis in postoperative week 1 and/or serum creatinine greaterthan 2.5 mg/dl at postoperative day 7. Patients who did not match any of thesecriteria were define as having normal renal allograft function.ResultsThe overall prevalence of DGF was 14%. Recipients body mass index, coldischemia time, vascular anastomosis time, and total ischemia time were higheramong the delayed graft function group, but no risk factors for DGF weresignificantly associated after multivariate analysis.ConclusionsThe incidence of DGF in our study was in the range of that observed in previousstudies. The factors that previously reported and believed as risk factors of DGFin laparoscopic LDN were not significantly associated with the development ofDGF in our study.;BackgroundDelayed graft function (DGF) is a common complication affecting deceaseddonor renal transplantation. Based on previous studies, DGF and its risk factors inlive donor nephrectomy (LDN) have a various results.MethodsWe retrospectively analyzed the medical records of donor and recipient from ourfirst 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital fromNovember 2011 to February 2014. The criteria used to define DGF were therequirement for dialysis in postoperative week 1 and/or serum creatinine greaterthan 2.5 mg/dl at postoperative day 7. Patients who did not match any of thesecriteria were define as having normal renal allograft function.ResultsThe overall prevalence of DGF was 14%. Recipients body mass index, coldischemia time, vascular anastomosis time, and total ischemia time were higheramong the delayed graft function group, but no risk factors for DGF weresignificantly associated after multivariate analysis.ConclusionsThe incidence of DGF in our study was in the range of that observed in previousstudies. The factors that previously reported and believed as risk factors of DGFin laparoscopic LDN were not significantly associated with the development ofDGF in our study.;BackgroundDelayed graft function (DGF) is a common complication affecting deceaseddonor renal transplantation. Based on previous studies, DGF and its risk factors inlive donor nephrectomy (LDN) have a various results.MethodsWe retrospectively analyzed the medical records of donor and recipient from ourfirst 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital fromNovember 2011 to February 2014. The criteria used to define DGF were therequirement for dialysis in postoperative week 1 and/or serum creatinine greaterthan 2.5 mg/dl at postoperative day 7. Patients who did not match any of thesecriteria were define as having normal renal allograft function.ResultsThe overall prevalence of DGF was 14%. Recipients body mass index, coldischemia time, vascular anastomosis time, and total ischemia time were higheramong the delayed graft function group, but no risk factors for DGF weresignificantly associated after multivariate analysis.ConclusionsThe incidence of DGF in our study was in the range of that observed in previousstudies. The factors that previously reported and believed as risk factors of DGFin laparoscopic LDN were not significantly associated with the development ofDGF in our study., BackgroundDelayed graft function (DGF) is a common complication affecting deceaseddonor renal transplantation. Based on previous studies, DGF and its risk factors inlive donor nephrectomy (LDN) have a various results.MethodsWe retrospectively analyzed the medical records of donor and recipient from ourfirst 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital fromNovember 2011 to February 2014. The criteria used to define DGF were therequirement for dialysis in postoperative week 1 and/or serum creatinine greaterthan 2.5 mg/dl at postoperative day 7. Patients who did not match any of thesecriteria were define as having normal renal allograft function.ResultsThe overall prevalence of DGF was 14%. Recipients body mass index, coldischemia time, vascular anastomosis time, and total ischemia time were higheramong the delayed graft function group, but no risk factors for DGF weresignificantly associated after multivariate analysis.ConclusionsThe incidence of DGF in our study was in the range of that observed in previousstudies. The factors that previously reported and believed as risk factors of DGFin laparoscopic LDN were not significantly associated with the development ofDGF in our study.]"

"ABSTRAKLatar Belakang: Manajemen nyeri yang efektif pascabedah merupakan bagianyang penting pada perawatan pasien yang menjalani pembedahan. Penanganannyeri pascabedah laparoskopi nefrektomi donor ginjal sangat penting untukpemulihan dini. Epidural kontinyu merupakan teknik anestesi regional yangdigunakan pada operasi donor ginjal di RSCM, namun hasilnya belummemuaskan karena masih tingginya persentase pasien dengan derajat nyeri berat.Penelitian ini bertujuan untuk membandingkan efektivitas antara blok QuadratusLumborum (QL) bilateral dengan bantuan USG dan blok epidural kontinyuterhadap derajat nyeri dan kebutuhan morfin pascabedah.Metode: Penelitian ini merupakan uji kontrol acak pada 52 pasien sehat yangmendonorkan ginjal di Rumah Sakit Umum Pusat Nasional CiptoMangunkusumo. Dilakukan proses randomisasi pada subjek penelitian,didapatkan pada kelompok blok QL bilateral sebanyak 26 pasien dan epiduralkontinyu sebanyak 26 pasien. Sesaat sebelum pasien diekstubasi, subjek dalamkelompok blok QL mendapatkan bupivacaine 0,25% sebanyak 20 mL secarabilateral dan subjek pada kelompok epidural mendapatkan infus bupivakain0,125% 6 mL/jam secara kontinyu. Hasil dari penelitian ini dianalisis denganmenggunakan uji statistik Mann Whitney.Hasil: Hasil dari penelitian ini menunjukan tidak ada perbedaan bermaknaterhadap derajat nyeri NRS saat di RR, jam ke-2, jam ke-6, jam ke-12 dan jamke-24 (p = 0,412; 0,881; 0,655; 0,788; dan 0,895). Kebutuhan PCA morfin pada24 jam pascabedah pada setiap waktu pengukuran tidak ditemukan perbedaanbermakna (p = 0,823; 0,985; 0,693; dan 0,854). Skor Bromage, serta waktupertama kali pasien memencet PCA morfin ditemukan sama pada keduakelompok. Pada kelompok blok QL Sebanyak 6 orang (23,10%) yang merasakanmual dan 4 orang (15,4%) yang mengalami muntah. Pada kelompok blok epiduralkontinyu sebanyak 1 orang (3,8%) yang merasakan mual dan 1 orang (3,8%) yangmengalami muntah. Efek samping parestesia tidak ditemukan pada keduakelompok.Simpulan: Blok QL tidak memberikan efek analgesia yang lebih baik dibanding blok epidural kontinyu.

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ABSTRACTBackground: Post operative pain management is substantial. Regional anesthesia for renal transplant donor is advantageous for early recovery. Continous epidural regiment often used in renal donor patients. However, the benefits are not fully met due to high incidence of severe post operative pain. This study compares the effectivity of USG guided bilateral Quadratus Lumborum (QL) block with continous epidural block for post operative pain management. We evaluate the degree of pain and morphine consumption.Methods: This is a random clinical trial in Cipto Mangunkusumo hospital. The subjects were random clinical trial. Fifty two subjects were renal donors who underwent surgery in RSCM. Subjects were randomized and divided into two groups, continous epidural (26 subjects) and QL block (26 subjects). Prior extubation, the QL block groups received bilateral QL block with 20 ml of Bupivacain 0.25% and the epidural group were given 6 ml/hr of Bupivacain 0.125% continously via epidural. The subjects pain were rated with NRS pain score. Morphine consumption and adverse events (nausea, vomiting, and paresthesias) were noted. Data were analyzed with Mann-Whitney test.Results:This study showed no difference between both group regarding NRS pain score in RR, the first 2, 6, 12 and 24 hour (p = 0,412; 0,881; 0,655; 0,788; dan 0,895). There are no difference in morphine consumption in both group (first 2 hour p=0,823; first 6 hour p=0,985; first 12 hour p=0,693; and first 24 hour p=0,854). Bromage score and the first time subjects pressed the PCA device are similar. There are 6 subjects (23.1%) who experienced nausea and 4 subjects (15.4%) who experienced vomitus from the QL block group. One subject (3.8%) experienced nausea and 1 (3.8%) subject vomitted from the epidural group.Conclusion: The efficacy of QL block for 24 hour post-operative pain management is comparable with continous epidural analgesia following laparoscopic nephrectomy."

"Tujuan: untuk mengetahui profil dan faktor-faktor apa saja yang memepengaruhi kesintasan pada pasien-pasien paska radikal nefrektomi di Rumah Sakit Kanker Dharmais. Metode Penelitian: Semua pasien keganasan ginjal paska operasi radikal nefrektomi di Rumah Sakit Kanker Dharmais pada periode Juni 2009- September 2016 diinklusikan, dan data diambil secara retrospektif melalui rekam medis pasien. Variabel yang dinilai dalam studi ini meliputi: jenis kelamin, usia, stadium, histopatologi subyek, tindakan pembedahan, tindakan sistemik setelah tindakan pembedahan, ureum dan kreatinin sebelum dan sesudah operasi, metastais, pemeriksaan penunjang setelah tindakan pembedahan. Hasil Penelitian: Pada penelitian ini, distribusi Fuhrman grade pada subjek adalah grade I 6,1 ; grade II 37,9 ; grade III 43,9 ; dan grade IV 12,1 . Fuhrman grade 3-4 mempunyai prognosis yang lebih buruk dibandingkan grade 1-2. Fuhrman stage 3-4 memiliki hazard risk 2,829x terhadap Fuhrman grade 1-2 p:0,011 .Selain itu, T3-T4 mempunyai prognosis yang lebih buruk dibandingkan dengan T1-2, TNM stage 3 dan 4 memiliki hazard risk masing-masing 13,076x dan 113x dibandingkan TNM stage 1 P

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Objective to find out the profiles and factors that influence survival in post radical nephrectomy patients at the Dharmais Cancer Hospital. Methods All patients of post operative renal malignancy of nephrectomy at Dharmais Cancer Hospital from June 2009 to September 2016 were included, and the data were retrospectively retrieved through the patient 39 s medical record. The variables assessed in the study included sex, age, stage, histopathology of the subjects, surgical action, systemic action after surgery, urea and creatinine before and after surgery, metastasis, investigation after surgery. Results In this study, the distribution of Fuhrman grade on the subject was grade I 6.1 grade II 37.9 grade III 43.9 and grade IV 12.1 . Fuhrman grade 3 4 has a worse prognosis than grade 1 2. Fuhrman stage 3 4 has a hazard risk of 2.829x against Fuhrman grade 1 2 p 0.011 . In addition, T3 T4 has a worse prognosis compared to T1 2, TNM stage 3 and 4 have a respective hazard risk 13.076x and 113x compared to TNM stage 1 P "

"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."

"Latar Belakang: Laparoskopi nefrektomi merupakan teknik pembedahan pilihan untuk pasien donor ginjal di RSCM karena memiliki beberapa keunggulan dibandingkan laparotomi. Pembedahan akan mengaktivasi respon stress yang mempengaruhi perubahan hemodinamik intraoperatif. Kombinasi anestesi regional epidural dengan anestesi umum dapat mengurangi respon stress intraoperatif. Teknik yang digunakan adalah epidural. Blok Quadratus Lumborum (QL) merupakan blok interfasia efektif sebagai analgesia pasca bedah abdomen. Penelitian ini bertujuan untuk menilai respon stress hemodinamik intraoperatif antara blok QL dan epidural pada pasien laparoskopi nefrektomi. Parameter yang dinilai adalah tekanan arteri rata-rata (MAP), laju nadi, indeks kardiak (CI), dan gula darah. Kebutuhan fentanyl intraoperatif juga turut dinilai. Metode: Penelitian ini adalah uji klinis acak tidak tersamar terhadap pasien donor ginjal yang menjalani laparoskopi nefrektomi di RSCM selama bulan Juni hingga September 2018. Dilakukan randomisasi sebanyak 36 subjek menjadi 2 kelompok. Setelah induksi, kelompok epidural diberikan epidural kontinyu bupivacain 0.25% sebanyak 6 ml/jam dan pada kelompok QL diberikan 20 ml bupivacain 0.25% secara bilateral. Variabel MAP, laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif dicatat. Analisis data dilakukan melalui uji bivariat t-test tidak berpasangan, Mann-Whitney serta uji multivariat general linear model. Hasil: Perubahan MAP pada kelompok QL lebih baik secara signifikan dibandingkan dengan epidural. Tidak terdapat perbedaan yang bermakna pada variabel laju nadi, CI, gula darah dan kebutuhan fentanyl intraoperatif. Kesimpulan: Blok QL tidak lebih baik dari epidural dalam menurunkan respon stress intraoperatif pada laparoskopi nefrektomi. Akan tetapi perubahan MAP pada blok QL lebih stabil.

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Background: Laparoscopic nephrectomy is a surgical technique preferred for renal donor in RSCM because of its advantages over laparotomy. Surgery activated stress responses thus affected intraoperative hemodynamics. Regional epidural anesthesia often combined with general anesthesia to reduce stress responses. Quadratus Lumborum (QL) block is an interfacial block and effective as abdominal surgery analgesia. This study was aimed to assess intraoperative hemodynamic stress response between QL and epidural block in laparoscopic nephrectomy patients. Mean arterial pressure (MAP), pulse rate, cardiac index (CI), and blood sugar was collected. Intraoperative fentanyl consumption also noted.

Methods: This was a randomized clinical trial of renal donor patients who underwent laparoscopic nephrectomy at RSCM during June to September 2018. A total of 36 subjects were randomized into 2 groups. After induction of general anesthesia, the epidural group received continuous epidural infusion of 0.25% 6 ml / hour of bupivacaine and QL group received 20 ml of 0.25% bupivacaine. MAP variables, pulse rate, CI, blood sugar and intraoperative fentanyl consumption were recorded in both groups. Data was analyzed with bivariate paired t-test, Mann-Whitney and multivariate general linear model test.

Results: MAP changes in QL group is significantly better than epidural group. There was no difference in heart rate, CI, blood glucose and fentanyl consumption intraoperative between two groups.

Conclusion : QL block compared to epidural did not have better result in reducing intraoperative stress response. However, MAP changes in QL group have better stability than epidural group."