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Abstrak :
Propofol merupakan agen anestesi intravena yang paling banyak digunakan karena menghasilkan anestesi yang baik dengan masa pulih singkat. Namun sering disertai nyeri saat injeksi sampai dengan 70-90% pasien. Di Rumah Sakit Saiful Anwar Malang, nyeri sering diatasi dengan pencampuran lidokain tetapi angka kegagalannya masih mencapai 32%. Sedangkan ondansetron (diberikan sebagai anti muntah) terbukti mengurangi nyeri akibat injeksi propofol sehingga dipilih untuk diujikan pada penelitian ini karena tidak menambah biaya tetapi hanya merubah waktu pemberian. Tujuan penelitian ini adalah mengetahui perbandingan nyeri premedikasi ondansetron dengan pencampuran lidokain saat induksi anestesi menggunakan propofol di Rumah Sakit Umum Dr. Saiful Anwar Malang. Pasien ASA I dan II sejumlah 50 orang yang menjalani operasi elektif dengan pembiusan umum menggunakan Propofol di Instalasi Bedah Sentral Rumah Sakit Umum Dr. Saiful Anwar Malang. Sampel dirandomisasi sederhana menjadi dua kelompok perlakuan yaitu kelompok Lidokain (lidokain 40 mg dicampurkan dalam 100 mg Propofol yang kemudian disuntikkan intra vena) dan kelompok Ondansetron (injeksi ondansetron 4 mg intra vena 1 menit sebelum propofol). Derajad nyeri kemudian dinilai berdasarkan Observer Pain Scale (OPS) oleh peneliti. Hasil penelitian menunjukkan bahwa ondansentron (68% pasien tidak nyeri, 20% nyeri ringan, 8% nyeri sedang, dan 4% nyeri berat) mengurangi nyeri yang sebanding dengan pencampuran lidokain (72% pasien tidak nyeri, 20% nyeri ringan, dan 8% nyeri sedang) dengan nilai p = 0,700 (p bermakna < 0,05) pada uji Mann Whitney. Kesimpulan dari penelitian ini bahwa premedikasi ondansetron mengurangi nyeri yang sebanding dengan pencampuran lidokain saat induksi anestesi menggunakan propofol di Rumah Sakit Umum Dr. Saiful Anwar Malang. ...... Propofol is the most popular intravenous anesthetic agent used. Propofol is a good anesthetic agent with short recovery time but often accompanied with pain in 70-90% patient. Lidocaine mixture is often used in Saiful Anwar Hospital Malang to relief pain but still with 32% failure. While ondansetron (antivomiting agent) proven to reduce pain caused by propofol injection, therefore chosen to be used because it will not increase medical cost by only changing time of injection. Purpose of this research is to compare pain score between ondansentron premedication with lidocaine mixture during anesthesia induction with propofol in Saiful Anwar Hospital Malang. All 50 patients diagnosed with ASA I and II undergo elective surgery in Sentral Operating Theater Saiful Anwar General Hospital with general anesthesia using Propofol is our sample. All sample undergo simple randomization into two groups. First is Lidocaine Group (Lidocaine 40 mg mixed in 100 mg Propofol and injected intravenously). Second is Ondansetron Group (Ondansetron 4 mg injected intravenously 1 minute before propofol). Pain score is evaluated with Observer Pain Scale (OPS) by the researcher. Our result shows that ondansentron (68% patient has no pain, 20% mild pain, 8% moderate pain, and 4% severe pain) reduce pain similar with lidocaine mixture (72% patient has no pain, 20% mild pain, and 8% moderate pain) with p value = 0,700 (p significant < 0,05) with Mann Whitney test. Conclusion of this research is that ondansetron premedication reduce pain similar with lidocaine mixture during anesthesia induction using propofol in Saiful Anwar Hospital Malang.

Abstrak :
Latar Belakang : Pemberian tiopental intravena dengan turniket selama 30 detik sebelum penyuntikan propofol akan mengurangi nyeri yang diakibatkan propofol. Penelitian ini akan membandingkan keefektifan antara tiopental dan lidokain dalarn pencegahan nyeri yang disebabkan oleh penyuntikan propofol. Metode : Acak, tersamar ganda . Sebanyak 124 pasien (N=62) , ASA 1-2 dibagi dalam 2 kelompok secara acak. Kelompok L mendapat Lidokain 2% (30 mg), Kelompok T mendapat Tiopental 37.5mg , kedua kelompok obat dibuat daiam L5 ml. Propofol diberikan setelah oklusi pada lengan atas dilepas. Penilaian nyeri 10 detik setelah penyuntikan propofol, dinilai dengan Verbal Kategori Scoring dan VAS (Visual Analog Scale). Hasil :Sebelas pasien (19,4%) mengeluh nyeri pada kelompok lidokain, pada kelompok tiopental dua pasien (3,2%), 1 pasien nyeri ringan dan 1 pasien nyeri sedang Hasil statistik didapat perbedaan bermakna dengan p < 0.05. Kesimpulan : Pemberian tiopental 37.5 mg dengan oklusi selarna 30 detik dapat digunakan sebagai altematif untuk mencegah nyeri akibat penyuntikan propofol .

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Background : Thiopental administered intravenously (IV) after tourniquet for 30 second immediately before injection of propofol, will reduce pain induced by propofol injection. In this study, these two different techniques in reducing propofol injection pain with thiopental were compared with lidocaine to evaluate the most effective method in reducing propofol injection pain. Methods : In a randomized, double blind treatment, 124 patients were included into this study. Patients in group L were pretreated with lidocaine 2% (30 mg) IV , and group T received thiopental 2.5% (37.5 mg). All pretreatment drugs were made in 1.5 ml and were accompanied by manual venous occlusion for 30 second. Propofol was administered after release of venous occlusion. Pain was assessed with a verbal category scoring system and VAS . Result : In group of Lidocaine 12 (19.4%) patients were complained pain. Thiopental group 2 (3.2 %) patients complained pain , 1 patient with mild pain , and 1 patient moderate pain. There was significant difference between thiopental and lidocaine in reducing propofol injection pain using a tourniquet technique. Conclusion : We conclude that IV retention of thiopental is better than lidocaine and may be a usefull alternative for reducing pain on propofol injection.

Abstrak :
Tujuan : Mengetahui tingkat kedalaman anestesi 30 detik setelah pemberian propofol dosis 2,5 mg/kg berat badan dengan 3,5 mg/kg berat badan. Disain : Prospektif, data dikumpulkan pada satu pusat penelitian dengan uji klinis acak tersamar ganda. yang akan menjalani bedah terencana dengan anesthesia umum fisertakan dalam penelitian ini. Pasien diberikan premedikasi midazolam dan fentanil 5 menit sebelum induksi. Kemudian pasien diinduksi dengan propofol dosis 2,5 mg/kg berat badan dan 3,5 mg/kg berat badan. Tekanan darah, nadi dan saturasi diukur 1 ( satu ) menit sebelum dan sesudah induksi. Setelah 30 detik dinilai hilangnya refleks bulu mata dan respon terhadap sungkup muka. Pada keiompok I 24 pasien tidak memberikan respon terhadap sungkup muka, sedangkan kelompok II berjumlah 26 pasien. Hasil ini menunjukkan perbedaan yang tidak bermakna ( P > 0,05 ) Kesimpulan : Pemberian propofol dosis induksi 2,5 mg / kg berat badan memberikan tingkat kedalaman anestesi yang sama dengan dosis 3,5 mg/kg berat badan.

Abstrak :
Latar Belakang: Sedasi yang efektif adalah terjaganya kedalaman sedasi dan analgesia serta mengendalikan pergerakan pasien selama prosedur ERCP berlangsung. Propofol merupakan obat anestetik sedasi yang tidak memiliki efek analgesia dan memiliki efek depresi kardiovaskular dan respirasi yang tergantung dosis. Penambahan ketamin dosis kecil diharapkan dapat menurunkan kebutuhan dosis propofol dalam mempertahankan kedalaman sedasi dan analgesia serta kestabilan hemodinamik dan respirasi. Penelitian ini akan membandingkan keefektifan sedasi antara campuran ketamin dan propofol (ketofol) konsentrasi 1:4, dan propofol - fentanil pada prosedur ERCP. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda pada 36 pasien yang menjalani prosedur ERCP, dengan usia 18-60 tahun, ASA I-III, BMI 18-30 kg/m 2, yang dibagi menjadi dua kelompok yaitu kelompok KF (n=18) dan kelompok PF (n=18). Kedua kelompok obat menggunakan metode infus kontinyu dengan syringe pump. Kedalaman sedasi diukur dengan menggunakan Ramsay Sedation Scale (RSS). Hasil: Dari hasil penelitian didapatkan rerata konsumsi propofol permenit kelompok campuran ketamin propofol (ketofol) ( 93,71±11,82) lebih rendah bermakna secara statistik dibandingkan kelompok propofol fentanil (141,18±19,23) (p<0.05). Jumlah median kebutuhan fentanil pada kelompok ketofol ( 0,00(0-25)) lebih rendah bermakna dibandingkan kelompok propofol fentanil (25,00 (25-50)) (p<0.05). Mula kerja dan waktu pulih pada kelompok propofol fentanil (3,00(2-4)) dan (5,00(2-15)) lebih cepat dibandingkan kelompok ketofol (4,50(2-5)) dan (15,00 (5-20)) (p<0.05). Kejadian hipotensi pada kelompok ketofol 1,00 (5,56%) tidak berbeda bermakna secara statistik dengan kelompok propofol fentanil 3 (16,67%) (p=0,603). Tidak didapatkan kejadian desaturasi dan mual/muntah pada kedua kelompok. Kesimpulan: Campuran ketamin propofol (ketofol) efektif dalam menjaga kedalaman sedasi dan analgesia serta memiliki efek samping yang minimal. ...... Background: The effectiveness of sedation is the ability of the drugs to maintain the depth of sedation and analgesia as well as to control the patient movement during the ERCP procedure. Propofol is a sedation agent that has no analgesia effect and has cardiovascular and respiratory depressant effect which is dose dependent. The addition of small dose of ketamin is expected to reduce the dose required to maintain hemodinamic and respiratory stability. This study will compare the effectiveness of sedation between the used of 1:4 of ketamin propofol mixtures (ketofol) and propofol fentanyl in ERCP procedure. Methods: This study is a double blind randomised clinical trial in 36 patients who underwent ERCP procedure, aged 18-60 y.o, ASA I-III, BMI 18-30 kg / m2, which is divided into two groups: KF (n = 18) and the PF group (n = 18). Both group is using continuous syringe pump infusion. The depth of sedation was measured by using Ramsay Sedation Scale (RSS). Results: From the results, the average consumption of propofol per minute of group propofol ketamine mixtures (ketofol) (93.71 ± 11.82) was significantly lower than fentanyl propofol group (141.18 ± 19.23) (p <0.05). The median fentanyl consumption of ketofol group (0.00 (0- 25)) was significantly lower than fentanyl propofol group (25.00 (25-50)) (p <0.05). The onset and the time to recover in fentanyl propofol group (3.00 (2-4)) and (5.00 (2-15)) were faster than ketofol group (4.50 (2-5)) and (15.00 (5-20)) (p <0.05). The incidence of hypotension in group ketofol 1.00 (5.56%) was not significantly different from fentanyl propofol group 3 (16.67%) (p = 0.603). There were no desaturation events or nausea/vomiting in both groups. Conclusion: The mixture of ketamine propofol (ketofol) is effective in maintaining the depth of sedation and analgesia and has minimal side effects.

Abstrak :
Tujuan : Mengetahui kondisi intubasi 60 delik setelah peinberian rokuronium 0,6 mg/kg berat badan dengan menggunakan teknik induksi kombinasi propofol-efedrin 10 mg intravena dan teknik induksi propolbl intravena. Desain: Prospektif, data dikumpulkan pada salah pusat penelilian dengan uji acak tersamar ganda. Metode: 42 pasien dengan status fisik ASA 1 atau 2 yang akan dilakukan pembedahan berencana dengan anestesia uimnl dan intubasi endotrakea disertakan dalaah penelitiaa ini. Pasien dibagi dalam dua kelompok, kelompok I diberikan kombinasi propofol 2,5 mg/kg berat badan-efedrin 10 mg intravena (kelompok efedrin) dan kelompok II diberikan propofol 2,5 mg/kg berat badan intravena (kelompok salin). Premedikasi dengan midazolam 0,05 mg/kg berat badan dan fentanyl 1 pg/kg berat badan diberikau 3 merit sebeluin induksi. Setelah pemberian obat induksi, diberikan rokuronium 0,6 mg/kg berat badan. Kondisi intubasi dinilai bcrdasarkan kritcria Krieg dan peman[auan neuromuskular dengan nicnggunakan Train-of-four pada otot adductor pollicir. Hasil: Kelompok efedrin didapatkan kondisi intubasi yang sangat baik 85,7% dan baik 14,3%. Kelompok satin didapatkan kondisi intubasi yang sangat balk 75% dan baik 25%. Kesimpulan . Kondisi intubasi 60 delik selclah pemberian rokuronium 0,6 mg/kg berat badan dengan inenggunakan teknik induksi kombinasi propofol-efedrin 10 ing intravena saina baiknya dengan teknik induksi propofol intravena.

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Objective : The aim of this study was to evaluate intubating conditions 60 second after rocuronium 0,6 mg/kg body weight administration using induction technique propofol-ephedrine 10 mg intravenous in combination and induction technique propofol intravenous. Design : Prospective, randomiked controlled trial study. Methods : 42 patients with physical status ASA 1 or 2 who were scheduled for elective surgery requiring general anaesthesia and tracheal intubation. Patients were randomly assigned to receive either propofol 2,5 ing/kg body weight-ephedrine 10 mg intravenous in combination (ephedrine group) or propofol 2,5 mg/kg body weight intravenous (saline group). Premedication drugs were midazolam 0,05 mg/kg body weight and fenlanyl l }mg/kg body weight, 3 minute prior to induction. Alter induction drugs were administered. then rocuronium 0,6 inglkg body weight was given. Criteria of Krieg was used to evaluate when intubating conditions and neuromuscular function which was assessed by using Train-of dour monitoring at the adductor pollicis. Results : In the ephedrine group the intubating conditions were excellent 85,7% and good 14,3%. In the saline group the intubating condition were excellent 75% and good 25%. Conclusion : intubating conditions 60 second after rocuronium 0,6 mg/kg body weight administration using induction technique propofol-ephedrin 10 mg intravenous in combination as good as induction technique propofol intravenous.

Abstrak :
Latar belakang. Emergence agitation (EA) merupakan gangguan perilaku sementara yang sering terjadi pascaanestesia inhalasi dan berpotensi membahayakan pasien. Pemberian propofol 1-3 mg/kg di akhir anestesia inhalasi mencegah EA tetapi memperpanjang waktu pindah ke ruang pulih. Penelitian ini bertujuan mengetahui efektivitas propofol dosis 0,5 mg/kg di akhir anestesia untuk menurunkan kejadian EA pasien anak yang menjalani anestesia umum inhalasi. Propofol dinilai efektif jika dapat menurunkan kejadian EA tanpa memperpanjang waktu pindah. Metode. Penelitian uji klinik acak tersamar ganda terhadap anak usia 1-5 tahun yang menjalani anestesia umum inhalasi di RSCM pada bulan Mei – Agustus 2018. Sebanyak 108 subjek didapatkan dengan metode konsekutif yang dirandomisasi menjadi dua kelompok. Kelompok propofol (n=54) mendapat propofol 0,5 mg/kg di akhir anestesia, sedangkan kontrol (n=54) tidak mendapat propofol. Kejadian EA, waktu pindah, hipotensi, desaturasi dan mual-muntah pascaoperasi dicatat. EA dinilai dengan skala Aono dan Pediatric Anesthesia Emergence Delirium (PAED). Analisis data menggunakan uji chi-square dan t tidak berpasangan. Hasil. Kejadian EA pada kelompok propofol sebesar 25,9% sedangkan kontrol 51,9% (RR = 0,500; IK 95% 0,298-0,840; p=0,006). Rerata waktu pindah kelompok propofol lebih lama (9,51 ± 3,93 menit) dibandingkan kontrol (7,80 ± 3,57 menit) (selisih rerata 1,71 menit; IK 95% 0,28-3,14; p=0,020). Hipotensi didapatkan pada satu pasien (1,9%) pada kelompok propofol sedangkan pada kontrol tidak ada. Mual-muntah terjadi pada lima pasien (9,3%) pada kelompok propofol dan delapan pasien (14,8%) pada kontrol. Tidak ada desaturasi pada kedua kelompok. Simpulan. Pemberian propofol dosis 0,5 mg/kg di akhir anestesia secara statistik tidak efektif namun secara klinis efektif menurunkan kejadian EA pasien anak yang menjalani anestesia umum inhalasi.

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Background. Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm. Propofol 1-3 mg/kg administration at the end of inhalational anesthesia prevents EA but prolongs transfer time to recovery room. This study evaluated the effectivity of propofol 0,5 mg/kg at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia. Propofol was considered effective if could reduce the incidence of EA without prolonging transfer time. Method. This was a double-blind randomized clinical trial on children aged 1-5 years old underwent general inhalational anesthesia in Cipto Mangunkusumo Hospital. One hundred eight subjects were included using consecutive sampling method and randomized into two groups. Propofol group (n=54) was given propofol 0,5 mg/kg at the end of anesthesia while control group (n=54) was not. Incidence of EA, transfer time, postoperative hypotension, desaturation and nausea-vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium (PAED) scale were used to assess EA. Statistical tests used were chi square and unpaired t test. Result. Incidence of EA in propofol group was 25,9% while in control group was 51,9% (RR = 0,500; 95% CI 0,298-0,840; p=0,006). Mean transfer time in propofol group was longer (9,51 ± 3,93 minute) than control group (7,80 ± 3,57 minute) (mean difference 1,71 minute; 95% CI 0,28-3,14; p=0,020). Hypotension was found in one patient (1,9%) in propofol group while in control group there was none. Nausea-vomiting was found in five patients (9,3%) in propofol group and eight patients (14,8%) in control. There was no desaturation in both groups. Conclusion. Administration of propofol 0,5 mg/kg at the end of anesthesia statistically ineffective but clinically effective in reducing the incidence of EA in children undergoing general inhalational anesthesia.

Abstrak :
[ABSTRAK
Latar Belakang. Manajemen jalan nafas merupakan salah satu tahap yang paling penting dalam bidang anestesiologi. Salah satu jenis Alat bantu jalan nafas yang telah dipergunakan secara luas adalah Laringeal Mask Airway (LMA/Sungkup Laring). Pada pemasangan sungkup laring tanpa menggunakan pelumpuh otot membutuhkan kedalaman anestesi yang cukup, Tes klinis yang mudah, akurat dan aplikatif diperlukan untuk menghindari terjadinya komplikasi. Penelitian ini bertujuan untuk membandingkan trapezius squeezing test dan jaw thrust sebagai indikator kedalaman anestesi pada pemasangan sungkup laring dengan propofol sebagai agen induksi Metode. Sebanyak 128 pasien di randomisasi ke dalam 2 kelompok yaitu jaw thrust dan trapezius squeezing test. Seluruh pasien mendapatkan premedikasi dengan midazolam 0.05 mg/kgBB dan Fentanyl 1 mcg/kgBB. Induksi menggunakan propofol titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saat respon motorik hilang dilakukan pemasangan sungkup laring. Dicatat keberhasilan pemasangan, dosis propofol, tekanan darah, laju jantung, dan insiden apneu. Hasil. Keberhasilan pada kelompok jaw thrust 93.8%, sedangkan trapezius squeezing test yang 90.6%. Penggunaan rerata propofol pada kelompok jaw thrust yaitu sebesar 120.34 mg, sedangkan pada kelompok trapezius squeezing test yaitu sebesar 111,86 mg. Insiden apneu yang pada kelompok jaw thrust terjadi pada 10 (15.6%) pasien, sedangkan pada kelompok trapezius squeezing test sebesar 11 (17.2%) pasien. Tidak terdapat perubahan hemodinamik yang berarti pada kelompok jaw thrust sedangkan sedangkan pada kelompok trapezius squeezing test terdapat perubahan hemodinamik yang berarti di menit ke 3 dan ke 4 Kesimpulan. Trapezius squeezing test tidak lebih baik daripada jaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring.

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ABSTRACT
Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent. Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented. Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth. Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.;Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent. Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented. Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth. Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion., Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent. Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented. Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth. Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.]

Abstrak :
Latar Belakang: Propofol adalah salah satu agen induksi yang sering digunakan dalam anestesia umum. Efek samping yang sering menimbulkan rasa tidak nyaman pada pasien adalah nyeri injeksi. Telah dilakukan beberapa penelitian untuk mengatasi nyeri injeksi propofol. Lidokain 40 mg disertai dengan oklusi vena menggunakan turniket adalah metode yang banyak digunakan dan paling efektif. Ondansetron rutin digunakan sebagai pencegahan PONV pada pasien anestesia umum dan terbukti memiliki potensi analgesia serta efektif dalam mencegah nyeri injeksi propofol. Penelitian uji klinis acak tersamar ganda ini membandingkan efektivitas pemberian premedikasi lidokain 40 mg dengan ondansetron 8 mg disertai penggunaan turniket untuk mencegah nyeri injeksi propofol. Metode: Penelitian ini bersifat uji klinis acak tersamar ganda pada pasien yang menjalani anesthesia umum di Instalasi Bedah Kirana RSUPN Cipto Mangunkusumo Jakarta. Setelah mendapatkan izin komite etik dan informed consent, sebanyak 104 subyek didapatkan dengan consecutive sampling pada bulan Juli hingga September 2016. Setelah pemasangan turniket selama 60 detik diikuti dengan pemberian liodakin 40 mg atau ondansetron 8 mg, dilakukan penilaian nyeri menggunakan verbal rating scale pada detik 0 injeksi propofol 0,5 mg/kg dan 20 detik pascainjeksi propofol. Dengan menggunakan uji Chi square dengan alternatif fisher dilakukan perbandingan keefektifan antara kedua kelompok. Hasil: Tidak terdapat perbedaan bermakna kekerapan nyeri injeksi propofol pada kelompok lidokain 40 mg disertai turniket dan ondanetron 8 mg disertai turniket pada detik 0 dan detik 20 pascainjeksi propofol p 0,051 dan p 0,062. Simpulan: Pemberian ondansetron 8 mg intravena disertai dengan penggunaan turniket memiliki efektivitas yang sama dengan lidokain 40 mg intravena disertai dengan penggunaan turniket untuk mencegah nyeri injeksi propofol. ...... Background: Propofol is one of the induction agent that is often used in general anesthesia. Pain on injection propofol often cause discomfort in patient. A number of research has been done to solve this problem. Lidocaine 40 mg accompanied by venous occlusion using a tourniquet is a method that is widely used and most effective. Ondansetron routinely used as PONV prevention in patients with general anesthesia and shown to have analgesia potential as well as effective in preventing propofol injection pain. This randomized double blind clinical trial compared the effectiveness of premedication with lidocaine 40 mg ondansetron 8 mg with the use of a tourniquet to prevent pain on injection propofol. Methods: This study was a double blind randomized clinical trial in patients undergoing general anesthesia in at Kirana surgical center Cipto Mangunkusumo. The study has been approved by FKUI RSCM Research Ethical Committee Jakarta. A total of 104 obtained by consecutive sampling in July until September 2016. After placement a tourniquet for 60 seconds followed by administration of 40 mg lidocaine or 8 mg ondansetron, an assessment of pain using a verbal rating scale is done at seconds 0 propofol injection of 0.5 mg kg and 20 seconds after the injection. By using the chi square test and fisher as an alternatives, were compared effectiveness between the two groups. Result: There were no significant differences in the incidence of propofol injection pain in group lidocaine 40 mg with the use of tourniquet and 8 mg ondansetron with a tourniquet in seconds 0 and 20 seconds after injection of propofol p 0.051 and p 0.062. Conclusion: Ondansetron 8 mg with the use of a tourniquet has the same effectiveness with Lidocaine 40 mg with the use of a tourniquet to prevent pain on injection propofol

Abstrak :
Latar Belakang. Propofol merupakan obat anestesi intravena yang paling sering digunakan dalam pembiusan umum tetapi propofol dapat menimbulkan rasa nyeri pada lokasi injeksi dengan angka kejadian 28-90%. Pemberian lidokain sebelumnya paling sering digunakan untuk mengurangi nyeri yang ditimbulkan propofol, akan tetapi tingkat kegagalannya 13-32. Tujuan penelitian ini adalah untuk mengetahui perbandingan pemberian pre-emptive ketamin 0,1 mg/kg dan lidokain 1 mg/kg untuk mengurangi derajat nyeri pada saat induksi anestesi menggunakan propofol. Metode. Penelitian ini merupakan uji klinis tersamar ganda, bersifat eksperimental. Pasien dengan kriteria klinis ASA I-II sejumlah 50 orang yang akan menjalani operasi elektif dengan pembiusan umum, dilakukan randomisasi sederhana menjadi 2 kelompok yaitu kelompok I (lidokain 1 mg/kg) dan kelompok II (ketamin 0,1 mg/kg) yang diberikan 1 menit sebelum induksi propofol. Derajat nyeri dinilai berdasarkan Verbal Rating Scale (VRS). Hasil. Penelitian menunjukkan pemberian pre-emptive ketamin dapat menurunkan derajat nyeri yang lebih baik (84% tidak nyeri, 16% nyeri ringan) dibandingkan kelompok pre-emptive lidokain (56% tidak nyeri, 28% nyeri ringan, 12% nyeri sedang dan 4% nyeri berat) dengan nilai p = 0.021 (p bermakna < 0.05) pada uji statistik menggunakan Mann Whitney. Kesimpulan. Pemberian pre-emptive ketamin 0.1 mg/kg BB intravena lebih baik dibandingkan dengan pemberian pre-emptive lidokain 1 mg/kg BB untuk mengurangi derajat nyeri akibat penyuntikan propofol intravena. ...... Background. Propofol is a popular IV anesthetic induction drug that causes pain when given IV. The incidence of which is between 28-90%. Lidocaine pre-treatment has been commonly proposed to decrease propofol induced pain, but its failure rate is between 13-32%. The purpose of this study was to compare a pre-emptive ketamine 0,1 mg/kg and pre-emptive lidocaine 1 mg/kg to minimize the injection pain of propofol during anesthesia induction. Methods. A comparative, randomized, double blind study of 50 patients (ASA I-II) scheduled surgery under general anesthesia were randomly allocated into two groups. Group I received lidocaine 1 mg/kg and group II received ketamine 0,1 mg/kg one minute before the anesthesia induction with propofol IV. Each patient’s pain score were evaluated by using Verbal Rating Scale (VRS) Result. The result of this study described that pre-emptive ketamine had significantly lower incidence of pain and lower pain score (84% no pain, 16% mild pain) compared with pre-emptive lidocaine (56% no pain, 28% mild pain, 12% moderate pain and 4% severe pain) with p value = 0.021 (significant p < 0.05) using Mann Whitney statistic test. Conclusion. Pre-emptive ketamine 0,1 mg/kg significantly in reducing degree of propofol pain injection compare with pre-emptive lidocaine 1 mg/kg IV.

Abstrak :
Latar belakang. Teknik Target Controlled Infusion untuk anestesia umum semakin banyak digunakan. Jumlah pasien geriatri yang harus menjalani prosedur operasi semakin bertambah, serta memerlukan pertimbangan khusus mengingat risiko operasi dan pembiusan yang lebih tinggi pada golongan ini. Penelitian ini bertujuan untuk membandingkan konsentrasi plasma (Cp) dan konsentrasi effect site (Ce) propofol menggunakan rumusan Marsh pada pasien geriatri ras Melayu di RSCM dengan dan tanpa pemberian premedikasi fentanil. Metode. Empat puluh pasien geriatri orang Indonesia Asli status fisik ASA 2, usia > 60 tahun dan BMI 18-30 kg/m2 dirandomisasi. Satu kelompok (20 pasien) mendapatkan Fentanil-Propofol, lainnya (20 pasien) mendapatkan NaCl-Propofol. Pemberian propofol menggunakan TCI rumusan Marsh dengan target konsentrasi plasma. Target Cp dimulai dari 1 µ/ml dinaikkan 1 µ/ml tiap menit sampai tercapai loss of consciousness (LoC) dan diteruskan sampai nilai BIS 45-60 selama 5 menit (steady state). Hasil. Pada kelompok Fentanil-Propofol saat LoC didapatkan Cp 3,15+0,35 µ/ml dan Ce 1,53+0,53 µ/ml dan saat BIS stabil didapatkan Cp 4,14+0,59 µ/ml dan Ce 2,63+0,60 µ/ml. Pada kelompok Nacl-Propofol saat LoC didapatkan Cp 4,20+0,61 µ/ml dan Ce 2,26+0,56 µ/ml dan saat BIS stabil didapatkan Cp 4,78+0,38 µ/ml dan Ce 3,30+0,52 µ/ml. Pasien-pasien yang mendapatkan fentanil terlebih dahulu memiliki Cp dan Ce yang lebih rendah baik saat LoC maupun saat nilai BIS stabil (P < 0,05). Kesimpulan. Terdapat perbedaan bermakna antara Cp dan Ce propofol yang diberikan premedikasi fentanil dan yang tidak. ...... Background. The application of Target Controlled Infusion (TCI) technique in general anesthesia is progressively growing. Number of geriatric patients scheduled for operations increases every year, while this group needs special consideration following the higher risk of surgery and anesthesia. The purpose of our study was to compare the estimated plasma concentration (Cp) and the effect site concentration (Ce) of propofol using Marsh pharmacokinetic model for geriatric patients in Cipto Mangunkusumo Hospital with and without the administration of fentanyl premedication. Methods. Forty patients, physical status ASA 2, aged > 60, BMI 18-30 kg/m2 randomly assigned to a fentanyl-propofol group or a saline-propofol group. TCI propofol was initiated using Marsh pharmacokinetic model. Initial plasma concentration in each group was 1 µ/ml and increased by 1 µ/ml every minute until there was no eyelash reflex, which defined as loss of consciousness (LoC). Propofol plasma concentration was increased and decreased to reach a stable BIS value between 45-60, considered as Cp and Ce at steady state. Results. In the fentanyl-propofol group the estimated Cp at loss of consciousness was 3,15+0,35 µ/ml and Ce 1,53+0,53 µ/ml. At steady state, Cp was 4,14+0,59 µ/ml and Ce 2,63+0,60 µ/ml. In the saline-propofol group Cp 4,20+0,61 µ/ml and Ce 2,26+0,56 µ/ml. At steady state, Cp was 4,78+0,38 µ/ml and Ce 3,30+0,52 µ/ml. The estimated Cp and Ce in the fentanyl-propofol group were lower than saline-propofol group (p < 0.05). Conclusion. There is a significant difference between Cp and Ce in the salinepropofol group and fentanyl-propofol group.