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"Latar Belakang: Anestesia spinal pada wanita hamil sangat dipengaruhi oleh posisi pasien. Pendant position merupakan posisi yang baru diperkenalkan pada laporan kasus. Penelitian ini bertujuan untuk membandingkan keberhasilan penempatan jarum spinal pada usaha pertama antara pendant position dengan traditional sitting position untuk pasien yang menjalani pembedahan Sesar. Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subjek dilakukan randomisasi untuk menentukan perlakuan pendant position atau traditional sitting position. Keberhasilan penempatan jarum spinal dinilai dari jumlah usaha, jumlah kontak tulang dan lama waktu penempatan jarum spinal. Hasil: Sebanyak 308 subjek penelitian, tidak ada yang termasuk kriteria penolakan dan pengeluaran. Keberhasilan penempatan jarum spinal pada usaha pertama untuk pendant position lebih baik (142 subjek (92%) vs 121 subjek (78%), p 0,001), total jumlah kontak tulang lebih sedikit (185 vs 421, p<0,001) dan median lama waktu yang dibutuhkan untuk penempatan jarum spinal lebih cepat ( 9 (4-350) vs 12 (5-486) detik, p<0,001) jika dibandingkan dengan traditional sitting position. Simpulan: Pendant position lebih baik dalam hal keberhasilan penempatan jarum spinal pada usaha pertama untuk pasien yang menjalani pembedahan Sesar jika dibandingkan traditional sitting position.

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Background: Spinal anesthesia in pregnant women is strongly influenced by the position of the patient. Pendant position is a new position introduced in the case report. This study aimed to compare the successful placement of spinal needle on the first attempt between pendant position and traditional sitting position for patients who underwent sectio Caesarean.

Methods: The study was a randomized controlled trial (RCT), conducted openly (not blind). Subject randomization to determine treatment pendant position or traditional sitting position. The successful placement of spinal needle judged from the number of first attempt, the amount of bone contact and the duration of the placement of spinal needle.

Results: A total of 308 subjects, none of which include criteria for exclusion and drop out. The successful placement of spinal needle on the first attempt of pendant position is better (142 subjects (92%) vs. 121 subjects (78%), p 0.001), the total amount of bone contact is less (185 vs. 421, p <0.001) and the median length of time required for placement of spinal needle is faster (9 (4-350) vs. 12 (5-486) seconds, p <0.001) when compared to the traditional sitting position.

Conclusion: Pendant position is better in terms of the successful placement of spinal needle on the first attempt for a patient who underwent sectio Caesarean compared to traditional sitting position."

"[Latar Belakang: Posisi pasien selama tindakan anestesia spinal menentukan keberhasilan penempatan jarum spinal. Traditional sitting position (TSP) merupakan posisi standar untuk anestesia spinal, namun angka keberhasilannya masih cukup rendah. Crossed leg sitting position (CLSP) merupakan salah satu posisi alternatif dalam anestesia spinal yang memiliki kelebihan berupa derajat fleksi lumbal yang lebih besar. Penelitian ini bertujuan untuk membandingkan CLSP dan TSP terhadap keberhasilan penempatan jarum spinal pada pasien bedah urologi. Metode: Penelitian ini adalah uji klinik acak tidak tersamar terhadap pasien yang menjalani anestesia spinal untuk prosedur urologi pada bulan Maret-April 2015 di RSUPN dr. Cipto Mangunkusumo. Setelah mendapatkan persetujuan izin etik dari Komite Etik Penelitian Kesehatan FKUI-RSCM, sebanyak 138 subjek dialokasikan ke dalam dua kelompok posisi penusukan jarum spinal yaitu kelompok CLSP dan TSP. Proporsi keberhasilan penempatan jarum spinal di rongga subarakhnoid, kemudahan perabaan landmark, dan jumlah needle-bone contact pada kedua kelompok kemudian dinilai.Hasil: Enam subjek masuk kriteria pengeluaran berupa kegagalan penempatan jarum spinal setelah lebih dari sembilan kali percobaan. Tersisa 132 subjek, 67 subjek pada kelompok CLSP dan 65 subjek pada kelompok TSP, yang berhasil menyelesaikan penelitian. Keberhasilan penempatan jarum spinal secara one shot pada kelompok CLSP dan TSP tidak berbeda bermakna (64.2% vs 53.8%, p=0.227). Kemudahan perabaan landmark pada kelompok CLSP berbeda bermakna dengan TSP (94% vs 75%, p=0.003). Jumlah needle-bone contact pada kedua kelompok tidak berbeda bermakna (p=0.337). Simpulan: Keberhasilan penempatan jarum spinal pada kelompok CLSP tidak berbeda bermakna dibandingkan dengan keberhasilan penempatan jarum spinal pada kelompok TSP pada pasien bedah urologi.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.;Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients., Background: Patient position during spinal anesthesia plays a major role in determining the success of spinal needle insertion to subarachnoid space. Traditional sitting position (TSP) is a standard position for spinal anesthesia, but the success rate for spinal anesthesia in TSP is still quite low. Crossed leg sitting position (CLSP) is one of the alternative positions in spinal anesthesia, which can increase the degree of lumbar flexion. This study aimed to compare CLSP and TSP to the successful insertion of spinal needle in urologic surgery patients.Methods: This study was a non-blinded randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures between March-April 2015 in RSUPN dr. Cipto Mangunkusumo. After obtaining approval from FKUI-RSCM Ethical Committee, 138 subjects were allocated into two groups, CLSP group and TSP group. The proportion of successful spinal needle insertion to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contact in both groups were then analyzed and assessed.Result: Six subjects met dropout criteria, which was failure of obtaining successful spinal needle insertion after nine consecutive redirections. The remaining 132 subjects, 67 subjects in the CLSP group and 65 subjects in TSP group, successfully completed the study. The proportion of successful spinal needle insertion in a one-time shot, was not significantly different between CLSP and TSP group (64.2% vs. 53.8%, p = 0227). Ease of landmark palpation in CLSP group was significantly different with TSP group (94% vs. 75%, p = 0.003). The number of needle-bone contact in both groups was not significantly different (p = 0337).Conclusion: The proportion of successful spinal needle insertion in CLSP group was not significantly different compared to TSP group for urologic surgery patients.]"

"Hipotensi merupakan komplikasi yang sering terjadi pada pasien yang menjalani bedah sesar dengan anestesi spinal. Kejadian hipotensi dapat membahayakan baik ibu maupun janin. Penelitian yang telah dilakukan di luar negeri menunjukan angka kejadiannya mencapai 70-80% tanpa penggunaan profilaksis farmakologis, namun di Indonesia penelitian tentang subjek ini masih sangat minim, termasuk tentang faktor-faktor yang berhubungan dengan kejadian hipotensi tersebut.Untuk itu, penelitian ini dilakukan untuk mengetahui karakteristik sosio demografik dan klinik pasien yang menjalani bedah sesar dengan anestesi spinal di RSUPN Ciptomangunkusumo (status hipotensi, jenis cairan yang diberikan, usia, penyakit penyerta, lokasi penyuntikan, dosis cairan anestesi, dan tinggi badan) serta hubungan status hipotensi dengan berat badan lahir bayi.Penelitian ini merupakan penelitian cross sectional dengan 107 subjek yang didapatkan melalui pemenuhan kriteria penelitian serta metode consecutive sampling. Subjek penelitian merupakan pasien yang menjalani bedah sesar emergensi di Instalasi Gawat Darurat RSUPN Ciptomangunkusumo. Pengertian hipotensi yang digunakan dalam penelitian ini yaitu penurunan tekanan darah sistolik dibawah 80% tekanan darah awal yang diukur sebelum operasi dilakukan. Penelitian menggunakan data sekunder.Hasil penelitian ini menunjukan bahwa hipotensi ditemukan pada 24,3% subjek. Dari segi karakteristik lainnya, mayoritas subjek tidak memiliki faktor risiko hipotensi berdasarkan penelitian terdahulu kecuali dari segi jenis cairan yang diberikan. Tidak ditemukan hubungan yang bermakna secara statistik antara berat badan lahir bayi dengan status hipotensi, namun ratarata berat badan lahir bayi dari subjek pada kelompok hipotensi lebih besar daripada kelompok non-hipotensi.

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Hypotension is a common complication in patients undergoing caesar surgery with spinal anesthesia. Hypotension could endanger both the mother and the fetus. Studies done abroad show that the event rate of hypotension could reach 70-80% without pharmacologic profilaxis, but in Indonesia the number of studies on this subject is very limited, including about factors correlated with the event of hypotension.

Therefore, this study is done to find out the sociodemographic and clinical characteristics of patients undergoing emergency Caesar surgery with spinal anesthesia in RSUPN Ciptomangunkusumo (type of fluid given, age, concurring illness, injection site, dosage of anesthetic solution, height, and hypotension status) and the correlation between hypotension status and the babies? birth weight.

This study is a cross sectional study with 107 subjects acquired through criterias of the study and consecutive sampling. Subjects are patients undergoing emergency Caesar surgery in emergency installation of RSUPN Ciptomangunkusumo. The definition of hypotension used in this study is a decrease of systolic pressure under 80% baseline pressure measured before the surgery. Secondary data is used in this study.

The study shows that hypotension was found in 24.3% subject. Based on other characteristics, majority of the subjects don?t have risk factors for hypotension, except about the type of the fluid given. No statistically significant correlation is found between the babies? birth weight and the hypotension status, but the mean birth weight of babies from the hypotension group is higher than non-hypotension group."

"Insersi jarum spinal dapat menimbulkan nyeri sehingga perlu dilakukan teknik stimulasi kompres dingin guna menurunkan intensitas nyeri yang dialami. Penelitian ini bertujuan untuk mengidentifikasi efektivitas kompres dingin dalam menurunkan intensitas nyeri insersi jarum spinal pada prosedur spinal anestesi. Desain yang digunakan adalah quasy experimental dengan pendekatan post test only design non equivalent control group. Sampel terdiri dari 72 pasien dewasa yang terbagi atas 36 orang kelompok intervensi dan 36 orang kelompok kontrol. Analisis data untuk mengetahui perbedaan rerata kelompok perlakuan (kompres dingin) dan kelompok kontrol (standar prosedur) dengan intensitas nyeri dan menganalisis hubungan variabel jenis kelamin dan pengalaman nyeri insersi spinal dengan intensitas nyeri menggunakan uji Mann Whitney. Analisis data untuk mengetahui hubungan variabel usia, ukuran jarum spinal dan kecemasan dilakukan uji Kruskal Wallis. Hasil analisis menunjukkan terdapat perbedaan bermakna antara kelompok perlakuan (kompres dingin) dan kelompok kontrol (standar prosedur) dan hubungan bermakna antara variabel kecemasan dengan intensitas nyeri (p<0,05). Hasil analisis menunjukkan tidak terdapat hubungan bermakna pada variabel usia, jenis kelamin, pengalaman nyeri insersi dan ukuran jarum spinal (p>0,05). Dapat disimpulkan kompres dingin merupakan intervensi yang terbukti efektif untuk menurunkan intensitas nyeri insersi jarum spinal pada prosedur spinal anestesi.

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Spinal needle insertion may cause pain hence cold compress stimulation technique to reduce the intensity of the pain is required. This study aims to identify the effectiveness of cold compress in reducing the intensity of spinal needle insertion pain in spinal anesthesia procedures. The design used was quasy experimental with post test only design non equivalent control group approach. The sample consisted of 72 adult patients divided into 36 intervention groups and 36 control groups.

Data analysis is to obtain the difference average of treatment group (cold compress) and control group (standard procedure) with pain intensity and analyze the connection of gender and spinal insertion pain variables and the intensity of pain using Mann Whitney test. Data analysis to obtain the correlation of age, spinal needle size and anxiety variables was conducted using Kruskal Wallis test.

Analysis results show that there are significant differences between treatment group (cold compress) and control group (standard procedure) and significant relationship between anxiety variables with pain intensity (p <0.05). The results show no significant association in age, sex, insertion pain experience and spinal needle size (p> 0.05). It can be concluded that cold compress is an effective intervention to decrease the intensity of spinal needle insertion pain in spinal anesthesia procedure."

"Latar belakang. Tingginya angka bedah sesar menunjukkan tingginya anestesia spinal, komplikasi yang disebabkan oleh anestesia spinal yang berhubungan dengan morbiditas ibu dan janin adalah hipotensi. Penelitian ini bertujuan untuk mengetahui apakah posisi reverse Trendelenburg (RT) dapat mencegah atau menurunkan angka kejadian hipotensi pada operasi bedah sesar yang menggunakan teknik anestesia spinal dengan bupivakain dosis 10 mg dengan fentanil 25 mcg.Metode. Penelitian ini merupakan uji klinis, acak, tidak tersamar pada pasien yang menjalani bedah sesar dengan anestesia spinal di RSIA Budi Kemuliaan pada bulan Oktober sampai November 2018. Sebanyak 108 subjek diambil setelah memenuhi kriteria inklusi. Analisis data menggunakan uji komparatif non-parametris Chi Square.Hasil. Angka kejadian hipotensi pada kelompok reverse Trendelenburg 10 derajat sebesar 15/54 (27,8%) sedangkan kelompok posisi netral sebesar 31/54 (57,4%). Posisi RT menurunkan risiko hipotensi sebesar 2.08 kali dibandingkan posisi netral (Risk ratio 0,48) dengan Interval Kepercayaan 95% berada pada rentang 0,3 – 0,8. Secara statistik dengan uji Chi square didapatkan perbedaan yang bermakna antara kelompok posisi RT dan netral dalam menyebabkan terjadinya hipotensi dengan nilai p 0,004.Simpulan. Posisi reverse Trendelenburg 10 derajat menurunkan angka kejadian hipotensi dua kali lipat dibandingkan posisi netral.

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Background. The high number of caesarean section procedure describes amount of spinal anesthesia method. Complication caused by spinal anesthesia which related to maternal and fetal comorbidities is hypotension. The main aim of this research is to study reverse Trendelenburg 10 degree position to prevent or lowering incidence of hypotension for patient undergo caesarean section with spinal anesthesia using bupivacaine 10 mg and fentanyl 25 mcg.

Method. This research is randomized but not blinded clinical trial to patient undergo caesarean section with spinal anesthesia at Budi Kemuliaan hospital during October to November 2018. Total 108 subjects were selected after fulfilling the inclusion criteria. Data were analyzed using nonparametric and comparative test with Chi Square.

Results.The incidence of hypotension in reverse Trendelenburg (RT) group is 15/54 (27.8%) while the incidence of hypotension in neutral group is 31/54 (57.4%). RT position lowering the incidence of hypotension in the amount of 2.08 times compared with neutral position (risk ratio 0.48), confidence interval 95% within 0.3-0.8. There is significant difference between groups with p 0.004."

"Latar Belakang : Brakhiterapi intrakaviter merupakan terapi keganasan pada stadium lanjut yang sering digunakan pada bidang ginekologi. Pasien brakhiterapi pada umumnya dilakukan dengan pelayanan rawat jalan sehingga anestesia yang menjadi pilihan selama ini adalah anestesia spinal.Pemilihan obat yang memiliki waktu pulih anestesia spinal yang lebih cepat membuat pasien dapat pulang kerumah lebih cepat. Penelitian ini mencoba mengetahui waktu pulih anestesia spinal levobupivakain 5 mg hiperbarik + fentanil 25 mcg dibandingkan dengan bupivakain 5 mg hiperbarik + fentanil 25 mcg pada brakhiterapi intrakaviter rawat jalan. Metode : Penelitian ini merupakan penelitian eksperimental dan uji klinik acak tersamar ganda yang akan dilaksanakan di unit radioterapi RSCM pada bulan Oktober 2015. Sebanyak 60 orang subyek penelitian akan dibagi menjadi dua kelompok perlakuan yaitu levobupivakain 5 mg hiperbarik + fentanil 25 mcg (LV) dan bupivakain 5 mg hiperbarik + fentanil 25 mcg (BV) untuk menilai waktu pulih anestesia spinal antara kedua kelompok perlakuan tersebut. Hasil : Pengukuran waktu pulih dilakukan dengan menilai waktu kesiapan pulang pasien, waktu ambulasi dan waktu pasien dapat miksi spontan. Pada variabel waktu ambulasi, miksi spontan, dan waktu kesiapan pulang didapatkan hasil berbeda bermakna (p < 0,05). Simpulan : Waktu pulih anestesia spinal, waktu ambulasi dan waktu miksi pada kelompok levobupivakain 5 mg hiperbarik + fentanil 25 mcg lebih cepat jika dibandingkan dengan bupivakain 5 mg hiperbarik + fentanil 25 mcg pada brakhiterapi intrakaviter rawat jalan.

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Introduction : Intracavitary brachytherapy is one of advanced stage cervical cancer modality treatment. These patients were treated as outpatient clinic fashion and the chosen anesthesia was spinal anesthesia. The regimens of spinal anesthesia will influenced the recovery time. The aim of the study is to compare the recovery time between two spinal anesthesia regimens Levobupivacaine + 25 mcg Fentanyl and 5 mgs Hyperbaric Bupivacaine+ 25 mcg Fentanyl for brachytherapy outpatient clinic patient.

Method: This is a double blind randomized control trial study. The study was taken place at radiotherapy unit RSCM at October 2015. There were 60 patients that divided into two groups Levobupivacaine + 25 mcg Fentanyl group and 5 mgs Hyperbaric Bupivacaine+ 25 mcg Fentanyl group. These two groups will be measured for spinal anesthesia recovery time.

Result : The spinal anesthesia recovery time measured by discharged readiness time, ambulation time, spontaneous micturition time. From the result of the study all of these three variables were significantly different between these two group regimens (P< 0,05).

Conclusion : spinal anesthesia recovery time, ambulation time, spontaneous micturition time of Levobupivacaine + 25 mcg Fentanyl group were faster than 5 mgs Hyperbaric Bupivacaine+ 25 mcg Fentanyl group at intracavitary brachytherapy outpatient clinic."

"Spinal merupakan tempat metastasis tumor terbanyak, menyebabkan defisit neurologis akibat kompresi saraf spinal, berpotensi distres sehingga mengakibatkan rendahnya kualitas hidup. Kerentanan terhadap distres dipengaruhi strategi koping. Penelitian potong lintang untuk mengetahui strategi koping dan faktor terkait distres pada pasien tumor metastasis spinal di RSCM. Sebanyak 104 subjek diambil dari rawat jalan maupun rawat inap. Analisis bivariat dan multivariat menilai hubungan antara gambaran masalah, strategi koping, faktor sosiodemografi, serta karakteristik tumor spinal dengan distres. Proporsi distres subjek penelitian ini adalah 57,7% masalah terbanyak spesifik tumor spinal (87,5%), namun hubungannya tidak bermakna terhadap distres. Hubungan bermakna ditemukan pada masalah keluarga dan masalah emosional. Strategi religious-focused coping paling sering digunakan. Subjek yang mengalami distres memiliki median total skor problem-focused coping (PFC) lebih rendah, emotional-focused coping (EFC) dan avoidance coping lebih tinggi dibandingkan dengan yang tidak mengalami distres. Hubungan bermakna juga ditemukan pada faktor usia dan karakteristik tumor spinal berupa gangguan motorik, sensorik, otonom, dan status pengobatan. Gangguan sensorik berisiko lebih tinggi terjadi distres dibandingkan defisit neurologis lain. Analisis multivariat menunjukkan strategi EFC dan avoidance coping sebagai faktor risiko. Perlunya dilakukan skrining dan pendampingan psikiatri pada pasien tumor metastasis spinal, serta peningkatan kerja sama psikiatri dengan layanan tumor terpadu.

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Spinal is the most site of tumor metastases, causing neurological deficits due to spinal nerve compression, potentially causing distress resulting in low quality of life. Vulnerability to distress is influenced by coping strategies. A cross-sectional study to determine coping strategies and factors related to stress in patients with spinal metastatic tumors in RSCM. A total of 104 subjects were taken from outpatient and inpatient. Bivariate and multivariate analyzes assessed the relationship between problem description, coping strategies, sociodemographic factors, and characteristics of spinal tumors with distress. The proportion of the subject's distress in this study was 57.7%, the most problems were spinal tumor-specific (87.5%), but the relationship was not significant to distress. Significant relationships were found in family problems and emotional problems. Religious-focused coping strategies are most often used. Subjects who experienced distress had a lower median total score of problem-focused coping (PFC), emotional-focused coping (EFC) and higher avoidance coping than those who did not experience distress. A significant relationship was also found in the age factor and spinal tumor characteristics in the form of motor, sensory, autonomic disorders, and treatment status. Sensory disturbances are at a higher risk of developing distress than other neurologic deficits. Multivariate analysis showed EFC strategy and avoidance coping as risk factors. The need for screening and psychiatric assistance in spinal metastatic tumor patients, as well as increasing the cooperation of psychiatry with integrated tumor services"