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"Rasa nyeri merupakan hal yang umum terjadi pada pasien pasca operasi sebagai akibat dari cedera, prosedur invasif, atau keberadaan penyakit. Nyeri mempunyai konsekuensi klinis, ekonomi dan sosial, seperti perubahan sistem kekebalan tubuh, memperlambat penyembuhan, berkurangnya kemampuan untuk melakukan pekerjaan tertentu dan perasaan menderita akibat nyeri yang sebenarnya tidak perlu. Penanganan nyeri pasien pasca operasi harus dilakukan secara adekuat, sehingga diharapkan dapat mengurangi waktu perawatan di rumah sakit, pasien dapat kembali melakukan rutinitas seperti sebelum menjalani operasi dan tidak menderita akibat nyeri pasca operasi. Telah dilakukan penelitian untuk mengetahui proporsi dan profil penggunaan analgesik pada pasien pasca operasi di Instalasi Rawat Inap A (IRNA-A) RS Dr. Cipto Mangunkusumo (RSCM) Jakarta. Penelitian ini merupakan studi deskriptif prospektif dengan cara mengambil data primer dan sekunder. Pengambilan data primer melalui wawancara dengan pasien / keluarga pasien dan dengan dokter, sedangkan pengambilan data sekunder dari rekam medis pasien pasca operasi yang dirawat di IRNA-A lantai tiga sampai lantai lima RSCM selama awal Maret-akhir April 2007. Selain pengamatan jumlah pasien yang menggunakan analgesik, juga dilakukan pengamatan efek analgesia dari berbagai analgesik yang digunakan ditinjau dari aspek dosis, cara pemberian dan lama pemberian. Hasil penelitian menunjukkan bahwa proporsi penggunaan analgesik sebesar 81,6% (284 pasien dari 348 pasien), dengan proporsi terbanyak ialah penggunaan analgesik non-opioid pada semua jenis bedah. Persentase efek analgesia baik tertinggi masing-masing ditemukan pada pasien yang menggunakan analgesik pada dosis lazim, menggunakan analgesik dengan durasi lama dan menggunakan analgesik dengan cara pemberian per oral."

"Pembedahan dapat memicu respons stres metabolik yang dapat menimbulkan hiperglikemia. Mekanisme hiperglikemia pascaoperasi dihubungkan dengan resistensi insulin, peningkatan glukoneogenesis, dan glikogenolisis, serta penurunan glucose transporter-4. Hiperglikemia diduga sebagai respons adaptasi fisiologis “fight or flight” tetapi juga dikaitkan dengan peningkatan morbiditas dan mortalitas pascaoperasi. Risiko hiperglikemia pascaoperasi dan potensi bahaya yang ditimbulkan belum banyak disadari oleh para dokter. Penelitian ini bertujuan untuk mengetahui karakteristik pasien pascaoperasi di Pediatric Intensive Care Unit (PICU) di Rumah Sakit Ciptomangunkusumo, insidens hiperglikemia pada anak pascaoperasi, dan faktor-faktor yang memengaruhi hiperglikemia pascaoperasi. Penelitian ini merupakan suatu studi potong lintang terhadap 199 pasien di RSCM yang dirawat di ruang PICU pascaoperasi sepanjang Januari – Desember 2020. Data demografi serta gula darah pascaoperasi diambil dari rekam medis. Kejadian hiperglikemia pascaoperasi dalam 24 jam pertama adalah 42%. Faktor-faktor yang memengaruhi hiperglikemia pascaoperasi pada penelitian ini adalah usia > 60 bulan (rasio odds 1,92 (95% IK 1,08-3,41) p=0,025) dan median durasi operasi>5 jam (p=0,001)......Surgery can trigger metabolic stress response that can lead to hyperglycemia. Mechanism of postoperative hyperglycemia is associated with insulin resistance, increased gluconeogenesis, and glycogenolysis, and decreased glucose transporters-4. Hyperglycemia is thought to be a physiological “fight or flight” adaptive response but also associated with increased postoperative morbidity and mortality. The risk of postoperative hyperglycemia and the potential dangers that it causes have not been widely realized by doctors. This study aims to determine the characteristics of postoperative patients at the Pediatric Intensive Care Unit (PICU) at Ciptomangunkusumo Hospital (RSCM), incidence of hyperglycemia in postoperative children, related factors of postoperative hyperglycemia. This study is a cross-sectional study of 199 patients at RSCM who admitted in PICU postoperative during January – December 2020. Demographic data and postoperative blood sugar were taken from medical records. The incidence of postoperative hyperglycemia in the first 24 hours was 42%. Related factors of postoperative hyperglycemia in this study were age > 60 months (Odds ratio 1,92 (95% CI 1,08-3,41); p=0,025 and median operative duration > 5 hours (p=0,001)."

"Pendahuluan. COVID-19 merupakan penyakit infeksi saluran pernapasan yang menular dan saat ini sudah mulai masuk ke Indonesia. Metode surveilans dilakukan dengan membagi pasien menjadi kelompok pasien dalam pengawasan (PDP) dan bukan PDP. Karakteristik tindakan operasi sebagai faktor eskternal, digabungkan dengan faktor internal pasien mungkin dapat berbeda pada masing-masing kelompok, terutama pada pasien pascaoperasi. Penelitian ini bertujuan untuk mendeskripsikan perbedaan karakteristik antara pasien pascaoperasi dengan status PDP dengan bukan PDP.Metode. Sebanyak 120 pasien yang menjalani operasi elektif dan emergensi di RSUPN Dr. Cipto Mangunkusumo dipilih dengan metode consecutive sampling. Data-data tentang faktor eksternal dan faktor internal pasien didapatkan dengan cara melihat catatan pada rekam medis. Data disajikan secara deskriptif dan analitik menggunakan uji perbedaan proporsi chi-square.Hasil. Terdapat perbedaan yang bermakna secara signifikan antara jenis kelamin, status fisik ASA 3, foto toraks praoperasi, dan prosedur operasi level 5 antara kelompok PDP pascaoperasi dengan bukan PDP pascaoperasi (p = 0,014; p = 0,018; p = 0,001; p = 0,019).Simpulan. Perbedaan bermakna yang ditemukan antara pasien PDP dengan bukan PDP pascaoperasi yaitu pada jenis kelamin pasien, status fisik ASA 3, level prosedur operasi level 5, dan foto toraks praoperasi. Perlu dilakukan penelitian lanjutan yang menganalisis hubungan antara faktor internal dan faktor eksternal terhadap penetapan status PDP pascaoperasi.......Introduction. COVID-19 is a contagious respiratory tract infection and currently emerging in Indonesia. The surveillance method is carried out by dividing patients into under surveillance and not under surveillance for COVID-19. The characteristics of surgery as an external factors, combined with the patient's internal factors, may differ between groups, especially in the postoperative patients. This study aims to describe the differences in characteristics between postoperative patients with under surveillance and not under surveillance for COVID-19 status.Methods. A total of 120 patients underwent elective and emergency surgery at Cipto Mangunkusumo general hospital were selected by consecutive sampling. Data regarding the patient's external and internal factors were collected using secondary data from the medical records available. Data were presented in a descriptive and analytical manner using the chi-square test.Results. There were a statistically significant differences between gender, ASA 3 physical status, preoperative lung X-ray, and level 5 surgical procedures between the two groups (p = 0.014; p = 0.018; p = 0.001; p = 0.019).Conclusions. Statistically significant differences were found between postoperative under surveillance and not under surveillance for COVID-19 patients, namely the patient's gender, ASA 3 physical status, surgical procedure level 5, and preoperative lung X-rays. Further research is needed to analyze the relationship between internal and external factors on the determination of postoperative PDP status."

"Latar Belakang: Prognati mandibula merupakan kasus maloklusi skeletal yang dapat ditemukan dengan fekuensi 15-23% dari seluruh populasi orang di asia tenggara. Koreksi terhadap kondisi ini dapat dilakukan secara bedah ortognatik mandibular setback dengan teknik Bilateral Sagital Split Osteotomy (BSSO). Penelitian telah mengkategorikan bahwa tindakan mandibular setback sebagai prosedur dengan stabilitas paling rendah di antara prosedur bedah ortognatik lainnya. Namun demikian bebrapa penelitian menyatakan bahwa hasil pasca operasinya masih dapat dikatakan stabil dengan kategori tertentu. Tujuan: Mengetahui perbedaan relaps pada varian kategori besaran mandibular setback pasca tindakan tersebut dengan teknik BSSO saja dan BSSO dengan prosedur bedah ortognatik tambahan pada maksila pada pasien-pasien prognati mandibula.Material dan Metode: Rekam medis dan radiograf sefalometri pasien pre operasi, pasca operasi dan H+6 bulan pasca operasi BSSO dan BSSO dengan prosedur bedah ortognatik tambahan pada maksila selama periode tahun 2001 sampai 2017 dari divisi Bedah Mulut dan Divisi Ortodonti R.S. Cipto Mangunkusumo, Jakarta dikumpulkan dan didapatkan 16 sampel sesuai kriteria inklusi. Hubungan antar variabel dievaluasi dengan Uji Fishers Exact pada Chi Square dan Uji hipotesis dengan Mann-Whitney U TestKesimpulan: Tidak ditemukan perbedaan bermakna bermakna antara relaps pada mandibular setback sedang, dan besar pada kelompok BSSO dan BSSO dengan Prosedur bedah ortognatik tambahan pada maksila (Le Fort I). Dari analisis yang dilakukan terdapat kemiripan dengan penelitian sebelumnya yaitu lebih dari 50% sampel terjadi relaps pasca operasi lebih dari 2mm.

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Background: Mandibular prognathism has the frequency among 15% to 23% of the entire population of southeast Asian people. Correction of such malocclusion can be done by performing mandibular setback using Bilateral Sagital Split Osteotomy (BSSO) method. Few research has categorized that setback mandibular as procedure with the low rate of stability among other orthognathic surgery procedures. However, this has become the method of choice until now. Objective: To observe significant difference among post operative relapse on each small, moderate, and large mandibular setback after BSSO and BSSO combined with adjunct orthognathic surgery procedures on the maxilla in patients with mandibular prognathism. Materials and Methods: Patients medical records including cephalometric radiographs preoperative, postoperative, and 6 months after BSSO and BSSO with adjunct orthognathic surgery procedures in the maxilla during year 2001 to 2017 gained from Oral Surgery Division and Orthodontics Division of Cipto Mangunkusumo Hospital, Jakarta was collected. Based on inclusion criteria, 16 samples was observed. Data correlation was analyzed using Fishers Exact test in Chi Square and hypothesis was evaluated using Mann-Whitney U TestConclusion: There is no significant difference was found in term of relapse on each small, moderate, and large mandibular setback in BSSO group and BSSO with adjunct orthognathic surgery procedures in the maxilla (Le Fort I). This study tend to have similarity as the past studies stated in term of more than 50% with post operative relaps more than 2mm"

"Pendahuluan. Adenoma pituitari atau pituitary neuroendocrine tumor (PitNET)meliputi 10% hingga 15% dari seluruh tumor intrakranial. Sekitar 30%-40% pasienadenoma pituitari membutuhkan tatalaksana pembedahan. Dari pasien yangdilakukan operasi tersebut sekitar 25%-40% memiliki luaran yang kurang baikseperti menginvasi secara lokal, resisten terhadap terapi konvensional, memilikitingkat rekurensi yang tinggi serta dapat mengalami metastasis. Tujuan penelitianini untuk mengetahui apakah faktor-faktor klinikopatologi tertentu yaitu ukuranadenoma, tipe/ subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, danp53), dan grade adenoma mempengaruhi luaran yang agresif pada adenomapituitari pasca operasi.Metode. Penelitian ini merupakan studi meta analisis dengan menggunakan sumberdata elektronik maupun pencarian manual. Studi-studi yang disertakan adalah studiobservasional. Pemilihan studi didasarkan pada strategi penelusuran literatur sesuaipanduan PRISMA dan kriteria eligibilitas yang telah ditentukan sebelumnya.Variabel bebas yang dinilai antara lain ukuran adenoma, tipe/ subtipe, sifat invasif,sifat proliferatif, ki-67, tingkat mitosis, p53, dan grade. Luaran yang dinilai adalahagresivitas pasca operasi yang terdiri atas rekurensi atau progresi. Penilaian kualitasdan risiko bias pada tiap studi terpilih mengunakan perangkat Newcastle OttawaScale. Analisis data dilakukan baik secara kualitatif maupun kuantitatif. Semuatahapan dalam penelitian ini dilakukan oleh setidaknya 2 peneliti.Hasil. Dari 736 studi awal yang terjaring terdapat 10 studi terpilih. Jumlah subjekpenelitian 2727 orang dengan 632 orang kasus. Durasi pemantauan berkisar antara3 hingga 11 tahun. Seluruh studi memiliki kualitas sedang hingga baik. Metaanalisis dilakukan pada masing-masing variabel bebas terhadap agresivitasadenoma pituitari pasca operasi dengan hasil ukuran adenoma ≥10mm dengan<10mm OR 1,79 (CI 1,29-2,48), tipe kortikotrof dengan non kortikotrof OR 1,91(CI 1,41-2,58), sifat invasif dengan non invasif OR 3,67 (CI 1,95-6,90), sifatproliferatif dengan non proliferatif OR 4,78 (CI 3,61-6,32), Ki-67 ≥ 3% dengan <3% OR 4,13 (CI 2,94-5,81), tingkat mitosis > 2 dengan ≤2 OR 3,91 (CI 2,74-5,57),p53 positif dengan negatif OR 1,92 (CI 1,28-2,90), dan grade 2b dengan non 2bOR 4,56 (CI 3,0-6,91).Simpulan. Faktor-faktor klinikopatologi tertentu yaitu ukuran adenoma, tipe/subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, dan p53), dan gradeadenoma mempengaruhi luaran yang agresif pada adenoma pituitari pasca operasi.......Introduction. Pituitary adenoma/ pituitary neuroendocrine tumor (PitNET)comprise of 10% up to 15% of intracranial tumor. About 30%-40% of pituitaryadenoma patients need surgery. For those who have undergone surgery about 25%-40% will have bad outcomes like locally invasive, resistant to conventionaltreatment, high rate of recurrence, and malignant tendency. The aim of this studywas to determine whether certain clinicopathologic factors consisting of size, type/subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and gradeinfluenced the aggressive outcome of post-operative pituitary adenoma.Methods. This meta-analysis study used electronic and manual data source.Included studies were observational studies. Study selection was based to literaturesearching strategy according to PRISMA guideline and predetermined eligibilitycriteria. Independent variables reviewed were size, type/ subtype, invasiveness,proliferative, ki-67, mitotic rate, p53, and grade. Outcome reviewed were postoperativeaggressiveness comprised of recurrence or progressive. Quality and riskof bias assessment to each study included were based on Newcastle Ottawa Scale.Data analysis was carried out both qualitatively and quantitatively. All stages in thisstudy were carried out by at least 2 reviewers.Results. Of the 736 initial studies, 10 were selected. The number of researchsubjects were 2727 people with 632 cases. The duration of monitoring ranged from3 to 11 years. All studies had moderate to good quality. Meta-analysis were carriedout on each independent variable on the aggressiveness of post-operative pituitaryadenoma with the results were size ≥10mm vs <10mm OR 1,79 (CI 1,29-2,48),corticotroph vs non-corticotroph OR 1,91 (CI 1,41-2,58), invasive vs non-invasiveOR 3,67 (CI 1,95-6,90), proliferative vs non proliferative OR 4,78(CI 3,61-6,32),Ki-67 ≥ 3% vs < 3% OR 4,13 (CI 2,94-5,81), mitotic rate > 2 vs ≤2 OR 3,91 (CI2,74-5,57), p53 positive vs negative OR 1,92 (CI1,28-2,90), and grade 2b vs non2b OR 4,56 (CI 3,0-6,91).Conclusions. Certain clinicopathologic factors consisting of size, type/ subtype,invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced theaggressive outcome of post-operative pituitary adenoma."

"ABSTRAKKeluhan utama pasien dengan pascapembedahan fraktur ektremitas bawah adalah nyeri. Nyeri yang dialami pasien dapat menjadi salah satu penyebab ketidaknyamanan pada pasien pasca pembedahan fraktur. Edukasi nyeri dan terapi dzikir dapat menurunkan nyeri dan meningkatkan kenyamanan. Penelitian ini Mengidentifikasi pengaruh edukasi nyeri dan terapi dzikir terhadap nyeri dan kenyamanan pada pasien pascapembedahan fraktur ekstremitas bawah.Desain penelitian yang digunakan dalam penelitian ini adalah quasi experiment pretest-posttest with control group design dan teknik sampling yang digunakan yaitu probability sampling, yaitu randomisasi blok. Besar sampel yang digunakan dalam penelitian ini adalah 40 responden. Hasil penelitian menunjukkan adanya perbedaan yang signifikan antara tingkat nyeri sebelum dan sesudah diberikan edukasi nyeri dan dzikir dengan p value= 0.0000. Nilai kenyamanan pasien juga menunjukkan adanya perbedaan yang signifikan antara kenyamanan sebelum dan sesudah diberikan edukasi nyeri dan terapi dzikir Penelitian ini merekomendasikan penerapan edukasi nyeri dan terapi dzikir untuk membantu pasien pascapembedahan fraktur ektemitas bawah untuk menurunkan nyeri dan meningkatkan kenyamanannya.

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ABSTRACTPain is the most common problem on patient with a lower extremity post operative fracture. Pain becomes one aspect that makes patient with fracture experience discomfort. Pain education and dhikr theraphy can to reduce pain and impoved comfort. The purpose of this study was to examine the influence pain education and dhikr theraphy y to pain and level of comfort in patient with closed fracture. This is quasi experiment pretest-posttest with control study using probability sampling (block randomization) recruiting 40 respondents. The result shows that there was a significant difference in pain level before and after pain education and dikr theraphy (p value=0.000). There was also significant difference on level of comfort before and after pain education and dikr theraphy (p value=0.000). It is recommended that pain education and dikr theraphy should be applied to decrease pain and level of discomfort in patient with fracture."

"ABSTRAK Latar belakang: Tesis ini bertujuan untuk mengetahui insidens retensio urin pasca rekonstruksi POP dan faktor-faktor yang berhubungan.Retensio urinmerupakan komplikasi akut tindakan rekonstruksi dan banyak dijumpai padaprosedur operasi, termasuk operasi POP (POP). Untuk menghindari morbiditaslebih lanjut, penelitian ini bertujuan untuk mengetahui insidens rertensio urinpasca rekonstruksi POP faktor-faktor risiko yang berhubungan.Metode: Penelitian ini adalah penelitian kohort prospektif yang dilaksanakan diRS Cipto Mangunkusumo dan RS Fatmawati dengan mengikutsertakan wanitayang hendak mengalami rekonstruksi POP dalam rentang waktu April 2013hingga April 2015. Kriteria inklusi dan eksklusi subjek meliputi wanita denganPOP derajat 2,3 dan 4 tanpa riwayat retensio urin sebelumnya, konsumsi obatobatanyangdapat menyebabkan retensio urin dan tanpa cedera kandung kemih.Pasca rekonstruksi, subjek dilakukan pemasangan kateter urin selama 24 jam.Kemudian, enam jam pasca pelesapan kateter, dilakukan pengukuran residu urinpada kandung kemih. Retensio urin didefinisikan dengan didapatkannya residuurin >100 ml.Hasil: Dari 200 subjek, ditemukan 59 subjek (29,5%) mengalami retensio urin.Tidak ada hubungan antara faktor risiko umur, Indeks Massa Tubuh (IMT),derajat POP, derajat sistokel, kejadian infeksi saluran kemih, dan durasi operasiterhadap retensio urin. Jenis prosedur total vagina hysterectomy + kolporafianterior + kolpoperineorafi + sacrospinous fixation dan durasi operasi > 130menit berhubungan dengan retensio urin dengan RR 3,66 95% IK 2,91-4,60p<0,001 dan 1,66 95%IK 1,07-2,59 p=0,02, berturut-turutKesimpulan: Insidens retensio urin cukup tinggi pasca rekonstruksi POP. Jenistindakan rekonstruksi tertentu dan semakin lamanya durasi rekonstruksiberhubungan dengan kejadian retensio urin.ABSTRACT Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR.;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR.;Background: The objective of this study was to know the incidence of post operativeurinaryretention after pelvic organ prolapse surgery and associatedfactors.Post operative urinary retention (POUR) is considered as an acutecomplication after a surgey in many operative procedures, including pelvic organprolpase (POP) surgery. To avoid further morbidity, this study aimed to know theincidence of POUR after POP surgery and its risk factors. Methods: This is a prospective cohort study conducted in Cipto Mangunkusumohospital and Fatmawati Hospital from April 2013 to April 2015. Subjects werewomen who wanted to undergo POP surgery with two to four degree of POP.Subjects with history of urinary retention, drugs consumption that tend to causeurinary retention or bladder unjury were excluded. After the reconstruction,urinary catheter was placed for 24 hours. Then, after six hours, catheter wasremoved and residual urine was measured. Urinary retention was defined asresidual urine more than 100 ml. Results: Of 200 subjects recruited, 59 (29.5%) had POUR. There were noassociation between age, body mass index, degree of uterine POPe, degree ofcystocele, urinary tract infectionand POUR. Duration of surgery > 130 minute andTotal vagina hysterectomy +anterior colporraphy + colpoperineorraphy +sacrospinous fixation procedure and duration of surgery > 130 minute were associated with POUR (RR 3.66, 2.91-4.60 95% CI, p<0.001 and 1.66 , 072.5995%CI,p=0.02;respectively)Conclusion: POUR incidence after POP surgery was quite high. Type of theprocedure and duration of surgery were associated with POUR."

"Latar belakang: Angka kejadian mual-muntah pascabedah sekitar 20-30 % dari seluruh pembedahan umum dan lebih kurang 70-80% pada kelompok risiko tinggi. Ketersediaan obat-obatan untuk mencegah mual-muntah pascabedah (PONV) sering sulit didapat, tidak hanya di daerah terpencil, tetapi juga di RSUPN Cipto Mangunkusumo. Terdapat bukti bahwa terapi nonfarmakologis seperti mengunyah permen karet efektif untuk menurunkan risiko PONV. Dalam penelitian ini, kami mengevaluasi efek mengunyah permen karet sebagai ajuvan metoklopramide dalam mengurangi PONV.Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal. Sejumlah 116 subjek yang akan menjalani pembedahan mata dibagi menjadi 2 kelompok (metoklopramid 10 mg iv dan metoklopramid 10 mg iv ditambah aktivitas mengunyah). Metoklopramide IV diberikan pada akhir pembedahan, sebelum pasien diekstubasi. Kelompok kedua diminta mengunyah permen karet selama 15 menit di ruang pemulihan. Efektivitas mual-muntah pascabedah dinilai dari kejaidan mual-muntah dan derajatnya sampai 24 jam pascabedah (jam ke-2, jam ke-6, jam ke-12, jam ke-18, dan jam ke-24).Hasil: Terdapat perbedaan bermakna antara dua kelompok untuk kejadian PONV dengan nilai p= 0,016. Namun, penilaian derajat keparahan PONV tidak bermakna secara statistik.Simpulan: Penambahan aktivitas mengunyah permen karet sebagai ajuvan metoklopramid efektif untuk pencegahan PONV.

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Background: Incidence of PONV is around 20-30% in patients who underwent surgery with general anesthesia, and up to 70-80% in high risk patients. Availability of PONV drugs is often limited, not only in rural area, but also in Cipto Mangunkusumo Hospital. Evidence showed that non-pharmacological therapy such as chewing gum is effective in reducing PONV. In this study, we evaluated the effect of chewing gum as adjuvant to metoclopramide for reducing PONV.Method: This is a single-blind randomized controlled trial. One hundred and sixteen adult subjects scheduled for elective ophthalmologic surgery with general anesthesia were allocated into two groups (IV metoclopramide 10 mg and IV metoclopramide 10 mg plus chewing gum). IV metoclopramide was given at the end of surgery, before the patient were extubated. The second group was instructed to chew gum for 15 minutes in recovery room. Effectiveness to prevent PONV was measured by incidence of PONV and its degree of severity up to 24 hours post operatively (2-hour, 6-hour, 12-hour, 18-hour, and 24-hour).Results: The difference in PONV incidence is statistically significant between two groups (p=0.016). However, degree of PONV severity is not significant.Conclusion: Chewing gum as an adjuvant to metoclopramide is effective for PONV prevention."

"Perawatan pasca operasi adalah perawatan yang diterima pasien sesudah dilakukan tindakan pembedahan, dimulai setelah prosedur pembedahan hingga selesainya masa rawat inap pasien di rumah sakit. Dua puluh empat jam pertama pasca operasi adalah periode awal pemulihan pasien setelah menjalani anestesi umum atau regional yang membutuhkan pemantauan dan perawatan khusus. Selama periode ini, perawat bertanggungjawab dalam perencanaan dan pelaksanaan perawatan pasca operasi. Salah satu peran penting perawat adalah sebagai edukator yang mengedukasi pasien agar memahami kondisi pasca operasi dan hal- hal yang harus diperhatikan untuk mencegah komplikasi serta mencapai derajat kesehatan yang optimal. Laporan kasus ini menganalisis implementasi edukasi perawatan post operasi pada 24 jam awal pasca operasi oleh perawat serta rekomendasi untuk mengoptimalkan implementasi. Penilaian implementasi dilakukan dengan observasi partisipatif dan wawancara. Hasil wawancara didapatkan dalam 24 jam periode awal pasca operasi 40% perawat melakukan edukasi. Hambatan yang ditemukan perawat dalam mengimplemetasikan edukasi pasca operasi pada periode awal adalah beban kerja dan keterbatasan sumber daya manusia. Pembuatan tools edukasi periode awal pasca operasi dapat membantu meningkatkan implementasi edukasi perawatan post operasi oleh perawat.......Postoperative care is the care that patients receive after surgery, starting from post surgical procedure until the end of the patient's care in the hospital. First twenty-four hours post-operative is the initial period of recovery for a patient after anesthesia which requires special monitoring and care. During this period, the nurse is responsible for planning and implementing postoperative care. One of the important roles of nurses is as educators who educate patients to understand postoperative conditions and things that must be considered to prevent complications and achieve optimal health status. This case report analyzes the implementation of postoperative care education in the first 24 hours after surgery by nurses and recommendations for optimizing implementation. Implementation assessment was carried out by participatory observation and interviews. The results of the interviews were obtained within 24 hours of the initial postoperative period, 40% of nurses provided education. Obstacles found by nurses in implementing postoperative education in the early period were workload and limited human resources. Making educational tools for the early postoperative period can help improve the implementation of postoperative care education by nurses."

"ABSTRAKLatar Belakang: Nyeri pascaoperasi meningkatkan morbiditas, komplikasi pulmonal dan meningkatkan lama perawatan di rumah sakit. Teknik anestesia perioperatif dapat meningkatkan manajemen nyeri dan tingkat kepuasan pasien. Anestesia epidural dapat dikombinasikan dengan ajuvan untuk meningkatkan kualitas analgesia, memperpanjang durasi analgesia, mengurangi kebutuhan opiod dan efek sampingnya. Morfin memberikan kualitas analgesia yang baik tapi berkaitan dengan sering munculnya efek samping. Deksametason merupakan glukokortikoid yang dapat digunakan sebagai ajuvan anestesia epidural. Penelitian ini mencoba mengetahui perbandingan efektivitas penambahan ajuvan deksametason 8 mg dan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah.Metode: Penelitian ini merupakan uji klinik acak tersamar ganda untuk menilai efektivitas penambahan ajuvan deksametason 8 mg dan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah. Setelah mendapat izin komite etik dan informed consent sebanyak 64 subyek dengan consecutive sampling, subyek dirandomisasi menjadi dua kelompok untuk mendapatkan regimen epidural bupivakain 0,125 12,5 mg deksametason 8 mg kelompok bupivakain-deksametason dan bupivakain 0,125 12,5 mg morfin 2 mg pascaoperasi kelompok bupivakain-morfin . Subyek kemudian mendapatkan anestesia umum tanpa pemberian regimen epidural intraoperatif. Sesaat sebelum operasi belum selesai subyek diberikan parasetamol 1 gr iv. PCA morfin pascaoperasi diberikan bila VAS >4. Pasien dilakukan penilaian kebutuhan opioid, saat pertama membutuhkan analgesia tambahan, rerata derajat nyeri dan efek samping analgesia epidural pada kedua kelompok dalam 24 jam pertama pascaoperasi.Hasil: Kebutuhan opioid 24 jam pascaoperasi, saat pertama membutuhkan analgesia tambahan dan rerata derajat nyeri 24 jam pascaoperasi antara kedua kelompok didapatkan hasil tidak berbeda bermakna dengan nilai p 0,701, 0,729, dan 0,817. Kejadian mual/muntah didapatkan pada kelompok bupivakain-morfin 1,6 .Simpulan: Penambahan ajuvan deksametason 8 mg memiliki efektivitas yang sama dengan penambahan morfin 2 mg pada bupivakain 0,125 12,5 mg epidural untuk analgesia pascaoperasi ekstremitas bawah. Dosis deksametason 8 mg tidak berkaitan dengan timbulnya efek samping.Kata Kunci: ekstremitas bawah, pascaoperasi, epidural, bupivakain, morfin, deksametason, nyeri

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ABSTRACTBackground Post operative pain enhances morbidity, pulmonary complications and increases hospital length. The technique of perioperative anesthesia can improve pain management and patient satisfaction. Epidural anesthesia can be combined with adjuvants to improve the quality of analgesia, prolong the duration analgesia, reduce opioid requirements and side effects. Morphine provides good quality analgesia but it associated with adverse effects. Dexamethasone is a glucocorticoid that can be used as an adjuvant of epidural anesthesia. This study attempt to determine the effectiveness comparison of dexamethasone 8 mg and morphine 2 mg addition as adjuvants in bupivacaine 0,125 12,5 mg epidural for post operative analgesia of the lower extremity.Methods In this double blinded randomized clinical trial, we evaluate the effectiveness of adjuvant addition of dexamethasone 8 mg and morphine 2 mg in bupivacaine 0,125 12,5 mg epidural for post operative analgesia of the lower extremity surgery. After obtaining permission from the ethic committee and informed consent, a total 64 subjects with consecutive sampling were randomly allocated to two groups to receive a total volume of 10 ml epidural plain bupivacaine 0,125 12,5 mg with either 8 mg dexamethasone in the bupicaine dexamethasone group or 2 mg morphine in bupivacaine morphine group. Subjects then receive general anesthesia without epidural regimen administration intraoperatively. Shortly before the end of operation subjects were given intravenous paracetamol 1 gr. Patient Controlled Analgesia PCA of morphine was given when Visual Analog Scale VAS 4. Post operative opioid consumption, the time to first analgetic requirement, pain score and adverse effects in both group were recorded within the first 24 hours postoperatively.Result Post operative opioid consumption, the time to first analgetic requirement and pain score between the two groups showed no significant difference with p value respectively 0.701, 0.729 and 0.817. The incidence of nausea vomiting was found in the bupivacaine morphine group 1,6 .Conclusion The addition of dexamethasone 8 mg had the same effectiveness as morphine 2 mg in bupivacaine 0,125 12.5 mg epidural for post operative analgesia in the lower extremity surgery. Dosage of dexamethasone 8 mg was not associated with adverse events.Keywords lower extremity, post operative, epidural, bupivacaine, morphine, dexamethasone, pain "