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Abstrak :
[Kejadian Systemic Inflammatory Response Syndrome (SIRS) pasca bedah jantung terbuka masih merupakan salah satu komplikasi yang banyak ditemukan. Salah satu faktor risikonya adalah durasi pintas jantung. Studi kohort retrospektif dilakukan terhadap 187 pasien bedah jantung terbuka di RSUPN Cipto Mangunkusumo tahun 2014-2015. Subjek dibedakan menjadi 2 kelompok berdasarkan durasi pintas jantung (durasi >60 menit dan ≤60 menit). Sebanyak 107 (57,2%) pasien mengalami SIRS dalam 24 jam pasca operasi. Kejadian SIRS ditemukan pada 75 (65,8%) pasien dari kelompok durasi >60 menit dan 32 (43,8%) pasien dari kelompok durasi ≤60 menit. Melalui analisis multivariat regresi logistik, didapatkan hubungan bermakna (p<0,05) antara durasi CPB dan SIRS dengan OR2,04 (IK95% 1,05-3,93). Durasi CPB merupakan faktor risiko independen dari kejadian SIRS pasca bedah jantung terbuka.

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Sytemic inflammatory Response Syndrome (SIRS) is a major complication foundat patient following open heart surgery. One of the risk factors is the duration of the cardiopulmonary bypass. A historical cohort study had been done on 187 postcardiac surgery patients in RSUPN Cipto Mangunkusumo. The subjects were divided into 2 separate groups based on the duration of cardiopulmonary bypass (duration >60 minutes and ≤60 minutes). There were 107 (57.2%) patients having SIRS within 24 hours following the surgery. SIRS was found on 75 (65.8%) patients from group with duration >60 minutes and 32 (43.8%) patients from group with duration ≤60 minutes. Through logistic regression multivariate analysis, there was a significant difference (p<0.05) with OR 2.04 (CI95% 1.05-3.93) between two groups. Therefore, duration of cardiopulmonary bypass was an independent risk factor of post open heart surgery SIRS.;Sytemic Inflammatory Response Syndrome (SIRS) is a major complication found at patient following open heart surgery. One of the risk factors is the duration of the cardiopulmonary bypass. A historical cohort study had been done on 187 postcardiac surgery patients in RSUPN Cipto Mangunkusumo. The subjects were divided into 2 separate groups based on the duration of cardiopulmonary bypass (duration >60 minutes and ≤60 minutes). There were 107 (57.2%) patients having SIRS within 24 hours following the surgery. SIRS was found on 75 (65.8%) patients from group with duration >60 minutes and 32 (43.8%) patients from group with duration ≤60 minutes. Through logistic regression multivariate analysis, there was a significant difference (p<0.05) with OR 2.04 (CI95% 1.05-3.93) between two groups. Therefore, duration of cardiopulmonary bypass was an independent risk factor of post open heart surgery SIRS;Sytemic Inflammatory Response Syndrome (SIRS) is a major complication found at patient following open heart surgery. One of the risk factors is the duration of the cardiopulmonary bypass. A historical cohort study had been done on 187 postcardiac surgery patients in RSUPN Cipto Mangunkusumo. The subjects were divided into 2 separate groups based on the duration of cardiopulmonary bypass (duration >60 minutes and ≤60 minutes). There were 107 (57.2%) patients having SIRS within 24 hours following the surgery. SIRS was found on 75 (65.8%) patients from group with duration >60 minutes and 32 (43.8%) patients from group with duration ≤60 minutes. Through logistic regression multivariate analysis, there was a significant difference (p<0.05) with OR 2.04 (CI95% 1.05-3.93) between two groups. Therefore, duration of cardiopulmonary bypass was an independent risk factor of post open heart surgery SIRS, Sytemic Inflammatory Response Syndrome (SIRS) is a major complication found at patient following open heart surgery. One of the risk factors is the duration of the cardiopulmonary bypass. A historical cohort study had been done on 187 postcardiac surgery patients in RSUPN Cipto Mangunkusumo. The subjects were divided into 2 separate groups based on the duration of cardiopulmonary bypass (duration >60 minutes and ≤60 minutes). There were 107 (57.2%) patients having SIRS within 24 hours following the surgery. SIRS was found on 75 (65.8%) patients from group with duration >60 minutes and 32 (43.8%) patients from group with duration ≤60 minutes. Through logistic regression multivariate analysis, there was a significant difference (p<0.05) with OR 2.04 (CI95% 1.05-3.93) between two groups. Therefore, duration of cardiopulmonary bypass was an independent risk factor of post open heart surgery SIRS]

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Acute Kidney Injury (AKI) pada anak dengan penyakit jantung bawaan mencakup 5-33% dari seluruh pasien anak yang melalui bedah jantung terbuka, dengan dampak yang signifikan terhadap kualitas hidup dan luaran pasien. Salah satu faktor yang mempengaruhi kejadian AKI adalah durasi penggunaan mesin pintas jantung paru. Penelitian metode kohort retrospektif dilakukan terhadap 122 pasien dengan durasi panjang dan 73 pasien dengan durasi pendek pasca bedah jantung terbuka di PJT RSUPN Cipto Mangunkusumo. Data rekam medis yang dianalisis menunjukkan bahwa terdapat kemaknaan (p<0,05) hubungan antara durasi CPB dengan AKI dengan OR 2,95. Kesimpulan penelitian adalah durasi CPB >60 menit merupakan faktor risiko terjadinya AKI pasca bedah jantung terbuka. ......Acute kidney injury (AKI) in children with congenital heart disease consists of 5-33% pediatric patients who went through open heart injury, with significant impact on the quality of life and outcome of the patient. One of the factors affecting the incidence of AKI is the duration of cardiopulmonary bypass machine. Retrospective cohort study was done on 122 patients with bypass duration >60 minute and 73 patients with bypass duration <60 minute after open heart surgery in PJT RSUPN Cipto Mangunkusumo. Analysis of medical records shown that there was a significant difference (p<0,05) between the duration of cardiopulmonary bypass with the incidence of AKI with OR of 2,95. It was concluded that duration of bypass >60 minutes was a risk factor of post open heart surgery AKI.

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ABSTRAK
Nama : Ponisih Program Studi : EpidemiologiJudul : Determinan Mediastinitis Pascabedah Pintas Arteri KoronerDi RSUPN Dr.Cipto MangunkusumoPembimbing : Prof. Dr.dr. Bambang Sutrisna, M. HSc.Tujuan: Mediastinitis pascabedah BPAK adalah komplikasi yang jarang namunmematikan. Tujuan penelitian ini adalah mengetahui determinan dan sistem skoringmediastinitis pascabedah BPAK.Metode: Studi kohort retrospektif yang melibatkan 706 pasien operasi BPAK di RSUPNDr. Cipto Mangunkusumo dari Januari 2011 hingga Desember 2017. Definisimediastinitis disesuaikan dengan definisi CDC infeksi kasus spesifik, yangmelatarbelakangi resternotomi debridement. Terdapat delapan faktor risiko yangberpotensi mediastinitis dalam analisa univariate.Hasil: Dari 706 pasien BPAK, terjadi insiden mediastinitis sebanyak 35 pasien. Lima daridelapan variable tersebut bertahan dalam analisa multivariate yaitu diabetes mellitusdengan OR sebesar 4.46 IK95 = 2,01-9,89 , IMT ge; 26,5 kg/m2 dengan OR 3,34 IK95 =1,61-6,97 dan lama operasi ge; 300 menit dengan OR 3,43 IK95=1,67-7,04 , usia ge;60 tahun dengan OR 2,01 IK 95 =0,97-4,19 , dan pemedahan ulang karena perdarahandengan OR sebesar 3,10 IK 95 = 0,94-10,27 .Kesimpulan: Determinan utama yaitu diabetes mellitus, obesitas, usia, lama operasi danpembedahan ulang karena perdarahan.Kata kunci: bedah pintas arteri koroner; determinan mediastinitis.

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ABSTRACT
Name PonisihStudy Program Magister EpidemiologyTitle Deteminants MediastinitisPost Coronary Artery Bypass Graft CABG SurgeryIn Cipto Mangunkusumo HospitalCounsellor Prof. Dr.dr. Bambang Sutrisna, M. HSc.Objective Mediastinitis post CABG is a rare but serious complication. This studiobjective is to asses determinants and scoring system of mediastinitis post CABG.Methode A retrospective cohort study of 706 patients from January 2011 until December2017 in Cipto Mangunkusumo Hospital. The definition of mediastinitis according toCenter Disease Control Surveylance and patient had a resternotomy debridement surgeryfor the infections. There are eight factors potential as a determinants from univariateanalysis age, obesity, diabetes mellitus, duration of surgery, surgical reintervention,delay sternal closure, valve surgery involves and ventilatory day , where necessaryfollowed in multivariate analysis.Result 35 out of 706 patients develop mediastinitis. Five variable were identifed as aindependent predictor of mediastinitis diabetes mellitus OR 4.46 95 CI 2.01 9.89 ,body mass index ge 26.5 kg m2 OR 3,34 95 CI 1.61 6.97 duration surgery ge 300minutes OR 3,43 95 CI 1.67 7.04 , age ge 60 years OR 2.01 95 CI 0.97 4.19 , andsurgical reintervention OR 3.10 95 CI 0.94 10.27 Conclusion Determinants of mediastinitis post CABG in Cipto Mangunkusumo Hospitalwere age, obesity, diabetes mellitus, duration of surgery and surgical reintervention.Key words coronary artery bypass graft surgery determinants mediastinitis

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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.

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ABSTRAK Latar Belakang: Manajemen nyeri pascabedah yang efektif dapat memberikan pemulihan cepat, mengurangi biaya perawatan dan tercapainya kenyamanan serta kepuasan pasien. Pemberian analgesia epidural dapat digunakan secara Continuous Epidural Infusion/ CEI. Epidural kontinu memberikan  derajat analgesia yang stabil, mencegah fluktuasi dalam meredakan nyeri dengan gangguan kardiovaskular minimal. Saat dilakukan chest physiotherapy pascabedah dengan pemberian CEI, pasien lebih kooperatif sehingga meningkatkan kepuasan pasien. Tujuan penelitian ini untuk mengetahui perbandingan efektivitas antara teknik CEI dengan IEB pada pemberian morfin 4 mg dan bupivakain 0.125%  per 24 jam. Metode: Penelitian uji klinik acak tidak tersamar ini melibatkan 36 subjek pascabedah abdomen bawah, urologi dan ginekologi  dari Januari sampai Maret 2018. Dilakukan consecutive sampling kemudian dibagi melalui  randomisasi menjadi 2 kelompok CEI dan IEB. Pada kelompok CEI mendapatkan morfin 4 mg + bupivakain 0,125% 60 mg (total volume 48 ml) kecepatan 2 ml/jam drip selama 24 jam, tanpa inisial bolus. Kelompok IEB, mendapatkan morfin 2 mg + bupivakain 0,125% 5 mg (total volume 4 ml) tiap 12 jam. Penelitian ini Membandingkan derajat nyeri istirahat dan bergerak pada menit ke-0, jam ke-6, jam ke-12 dan jam ke-24, saat pertama kali pasien membutuhkan analgesik tambahan  dan jumlah pemberian ketorolak dan efek samping analgesia epidural pada kedua grup dalam 24 jam pertama. Hasil: Kedua kelompok sama efektif dalam  mengontrol nyeri pascabedah secara klinis. Saat menit ke-0, jam ke-6, jam ke-12 dan jam ke-24 berdasarkan rentang NPS termasuk nyeri ringan-sedang, dengan nilai median derajat nyeri bergerak 2-3 dan derajat nyeri istirahat 1-2, meski tidak  ada perbedaan bermakna secara statistik. Simpulan : Tidak ada perbedaan efektivitas antara teknik CEI dengan IEB pada pemberian morfin 4 mg dan bupivakain 0.125%  per 24 jam.

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ABSTRACT Background: An Effective post-operative pain management can improve recovery period, reduce cost, and give comfort and satisfaction to the patient. Epidural analgesia can be given continuously (Continuous Epidural Infusion/ CEI) or intermittently (Intermittent Epidural Bolus/IEB). However, continuous epidural analgesia provides stable analgesia level. It prevents fluctuation in pain with minimal cardiovascular disruption. Patient with CEI is more cooperative in the effectiveness chest physiotherapy hence improve patient satisfaction. This study aims to compare the effectiveness between CEI and IEB for lower abdomen and urology post-operative epidural analgesia using of 4 mg morphine and bupivacaine 0125% in 24 hours. Methode: This study was a randomized control trial. 36 Subjects were taken from January to March 2018. Were selected consecutively randomized into two groups: In CEI group, morphine 4 mg + bupivacaine 0,125% 60 mg (total volume 48 ml) with speed 2 ml/hour in 24 hour) was given post-operatively, without initial boluses. In IEB group, morphine 2 mg + bupivacaine 0.125% 5 mg (total volume 4 ml)  was give every 12 hours. This study evaluate the degree of pain (rest and active condition) in 0 minute, 6 hour, 12 hour, and 24 hour post-operative, rescue analgesia time (ketorolac iv), and side effect of epidural analgesia in two groups within first 24 hour. Result: The effectiveness in controlling post-operative pain between two groups was similar. Clinically, pain in 0 minute, 6 hour, 12 hour, and 24 hour in two groups according to NPS range were classified as mild-moderate pain, with median value of pain degree (active condition) was 2-3 and pain degree (rest) was 1-2, although not statistically significant. Conclusion: There is no difference the effectiveness between CEI and IEB for lower abdomen and urology post-operative epidural analgesia using of 4 mg morphine and bupivacaine 0125% in 24 hours.

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Latar Belakang. Puasa sebelum pembiusan merupakan hal yang lazim dilakukan untuk menghindari aspirasi perioperatif. Lama puasa dapat menentukan volume lambung yang tersisa. Puasa yang terlalu singkat dapat meningkatkan risiko aspirasi, namunpuasa yang berkepanjangan dapat menyebabkan dehidrasi dan hipoglikemia. Penelitian ini bertujuan untuk menganalisa volume lambung setelah puasa 6 jam dan 8 jam setelah makan padat pada pasien yang akan menjalani operasi elektif. Metode. Penelitian ini merupakan studi kohort terhadap 37 subjek penelitian selama Januari hingga Februari 2019. Subjek penelitian adalah pasien yang akan menjalani pembedahan elektif non-disgestif di RSUPN Dr. Cipto Mangunkusumo dengan usia antara 18-60 tahun, tidak mengalami kelainan status gizi, dinilai dengan status fisik ASA 1 atau 2. Kriteria penolakan adalah pasien dengan penyakit diabetes mellitus, kehamilan, distensi abdomen, riwayat dispepsia dan gangguan motilitas usus. Hasil. Pada penelitian ini, didapatkan volume lambung setelah puasa makan padat 6 jam adalah 35,07±39,17 dan setelah puasa 8 jam adalah 14,16±19,24. Selisih antara kedua rerata tersebut adalah 20,91±38,60, p=0,002. Setelah puasa 6 jam, 5.4% subjek memiliki volume lambung di atas 1,5 ml/kg, sedangkan setelah puasa 8 jam, volume lambung seluruh pasien di bawah 1,5 ml/kg. Simpulan. Volume lambung setelah puasa 6 jam lebih kecil secara signifikan dibandingkan dengan puasa 8 jam. ......Background. Preoperative fasting was a common practice to decrease perioperative aspiration risk. Duration of fasting was proportional to gastric volume. Short fasting duration may increase aspiration risk. However, prolonged perioperative fasting duration may lead to dehydration and hypoglycemia. The objective of this study was to analyze gastric volume after 6-hour and 8-hour duration of fasting after consumption of solid meal in patient scheduled for elective surgery. Methods. This was a cohort study for 37 subjects from January to February 2019. Subjects were patient scheduled for elective non-digestive surgery in RSUPN Dr. Cipto Mangunkusumo, with age between 18 to 60 years old, no nutritional status disorder and physical status of ASA 1 or 2. Exclusion criteria were patients with diabetes mellitus, pregnancy, abdominal distention, history of dyspepsia and intestinal motility disturbances. Results. In this study, gastric volume 6-hour after solid intake was 35.07±39.17 and gastric volume 8-hour after solid intake was 14.16±19.24. Difference of gastric volume between 6-hour and 8-hour after solid intake was 20.91±38.60, p=0.002. After 6-hour of fasting, 5.4% of the subjects had gastric volume above 1,5ml/kg, while after 8-hour of fasting, gastric volume of all subjects were below 1,5ml/kg. Conclusion. Gastric volume 8-hour after solid intake was smaller than gastric volume 6-hour after solid intake.

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Latar Belakang: Disfungsi kognitif pascabedah merupakan komplikasi yang cukup sering pascabedah jantung terbuka. Salah satu faktor yang dikaitkan dengan kerusakan jaringan otak adalah faktor oksigenasi jaringan yang terganggu. Selama periode pascabedah gangguan oksigenasi jaringan masih tidak dapat disingkirkan sebagai penyebab POCD. Penelitian ini bertujuan untuk mengetahui hubungan nilai Hb, PaO2, SaO2 dan ScvO2 pascabedah terhadap kejadian POCD pada bedah jantung terbuka di RSCM. Metode: Penelitian ini adalah kohort prospektif dilakukan di Rumah sakit Cipto Mangunkusumo, Indonesia. Sebanyak 44 pasien bedah jantung terbuka elektif dilakukan uji neurokognisi pada 1 hari sebelum pembedahan dan hari ke 5 pascabedah. Subjek dinyatakan mengalami disfungsi kognitif pascabedah jika terjadi penurunan >20% dibandingkan dengan nilai uji prabedah, pada 2 dari 3 area kognisi. Nilai Hb, PaO2, SaO2 dan ScvO2 diambil dari kateter arteri dan kateter vena sentral pada 6 jam dan 24 jam pascabedah. Analisis data bivariat variabel numerik menggunakan Independent T-test atau Mann-Whitney dengan SPSS 20.0. Variabel dengan nilai p<0.25 pada analisis bivariat selanjutnya dimasukkan kedalam regresi logistik. Hasil: Terdapat 23 dari 44 subjek (52,3%) mengalami POCD. Nilai Hb 6 jam pascabedah lebih rendah secara signifikan pada kelompok subjek dengan POCD (9,13±1,15 vs 10,61±1,10 mg/dL, nilai p<0,001). Sama halnya dengan nilai Hb 24 jam pascabedah juga lebih rendah secara signifikan pada kelompok subjek dengan POCD (9,13±0,68 vs 10,45±0,75 mg/dL, nilai p<0,001). Nilai PaO2, SaO2, dan ScvO2 tidak berbeda bermakna pada kedua kelompok. Analisis multivariat menunjukkan nilai Hb 6 jam dan 24 jam pascabedah sebagai variabel yang paling berpengaruh dengan kejadian POCD. Simpulan: Nilai Hb 6 jam dan 24 jam pascabedah memiliki hubungan dengan angka kejadian POCD pascabedah jantung terbuka. ......Introduction. Postoperative cognitive dysfunction is a compilaction in open heart surgery. Factor that may involve is associated with impaired brain tissue oxygenation. The aim of this study is to investigate the association between postoperative value of Hb, PaO2, SaO2, and ScvO2 with POCD in open heart surgery in RSCM. Purpose: To evaluate association between postoperative value of Hb, PaO2,and ScvO2 with POCD in open heart surgery in RSCM. Methods. This study was prospective cohort held in Cipto Mangunkusumo Hospital, Indonesia. We included 44 elective open heart surgery patients tested forcognitive function on 1 day before surgery and postoperative day 5. Bloods were taken in 6 hours and 24 hours after surgery to measure postoperative value of Hb,PaO2, SaO2 and ScvO2. Subjects were categorized as POCD if there was decline >20% in postoperative neurocognitive test than preoperative. Data were comparedusing SPSS 20.0 software. Bivariate analysis with p-value above 0.25 were includedin logistic regression. Results: There was 23 of 44 subjects (52.3%) became POCD. Hemoglobin value in 6 hours and 24 hours were significantly lower in POCD group [(9,13±1,15 vs10,61±1,10 mg/dL, p value<0,001) and (9,13±0,68 vs 10,45±0,75 mg/dL, p value<0,001)]. PaO2, SaO2, and ScvO2 were not significantly different between twogroups. From multivariate analysis, it was found that hemoglobin value in 6 hours and 24 hours after surgery affect POCD in open heart surgery. Conclusion: There is an association between hemoglobin values in 6 hours and 24 hours after surgery with POCD in open heart surgery.

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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 : Laparoskopi kolesistektomi saat ini menjadi pilihan utama kasus batu kandung empedu simtomatik. Walaupun minimal, laporan mengenai nyeri abdomen dan nyeri bahu masih dirasakan pascalaparoskopi kolesistektomi. Nyeri ini muncul segera setelah operasi dan dapat bertahan selama 3 hari. Penelitian ini bertujuan untuk mengetahui efektivitas instilasi ropivakain 0.375% intraperitonium sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi. Metode : Penelitian ini adalah uji klinik acak tersamar ganda yang dikerjakan di Instalasi Bedah Pusat RSCM pada bulan November 2014 sampai April 2015. Subjek yang memenuhi kriteria dibagi menjadi kelompok ropivakain (R) (n=35) mendapat 40 mL ropivakain 0.375% dan kelompok NaCl (N) (n=33) mendapat 40 mL NaCl 0.9%. Peracikan regimen dikerjakan oleh orang yang berbeda dengan operator dan penilai. Tingkat nyeri statis, dinamis dan nyeri rujuk dinilai pada jam ke-1, 6 dan 24 pascaoperasi. Waktu meminta analgetik tambahan pertama (petidin) juga dicatat. Data regimen yang diterima baru dibuka setelah pengumpulan data selesai. Hasil : Secara statistik terdapat perbedaan bermakna pada proporsi nyeri statis jam pertama antara kelompok R dan N. Kelompok R cenderung memiliki nilai VAS lebih rendah (p=0.05;OR=0.453). Tidak terdapat perbedaan bermakna pada keseluruhan jenis nyeri yang dinilai dalam tiap-tiap waktu penilaian. Median waktu meminta petidin juga tidak berbeda antara kedua kelompok. Simpulan: Instilasi ropivakain 0.375% intraperitonium tidak lebih efektif sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi dibandingkan tanpa ajuvan.

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ABSTRACT
Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy. Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded. Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups. Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.;Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy. Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded. Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups. Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant., Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy. Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded. Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups. Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.]

Abstrak :
Latar belakang: Prosedur laringoskopi dan intubasi merupakan prosedur di bidang anestesi yang sering dilakukan namun merupakan prosedur yang mencetuskan rangsang nyeri yang hebat. Tekanan darah dan laju nadi dapat meningkat karena rangsang simpatis. Respon kardiovaskular tersebut dapat berbahaya pada pasien yang rentan, terutama yang memiliki masalah gangguan jantung ataupun serebrovaskular. Salah satu metode untuk mengurangi hal tersebut adalah penggunaan anestesi, termasuk dengan lidokain. Peningkatan kadar plasma lidokain yang diberikan dengan intravena dapat menimbulkan berbagai efek samping. Penelitian ini bertujuan untuk menilai efek lidokain yang diberikan secara inhalasi. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap pasien di Instalasi Bedah Pusat RSUPN Cipto Mangunkusumo Jakarta. Sebanyak 24 pasien diberikan inhalasi lidokain 1,5 mg/kgbb dan 25 subjek diberikan inhalasi NaCl 0.9% sebelum tindakan laringoskopi dan intubasi. Paramater kardiovaskular yang diteliti yakni perubahan tekanan darah sistolik, diastolik, mean arterial pressure (MAP) dan laju nadi yang dinilai secara serial. Hasil. Pada menit pertama pasca intubasi, MAP dan laju nadi pada kelompok NaCl lebih tinggi, dengan perbedaan MAP sebesar 15,5 mmHg(9,2-21,7 95%IK; p<0,001) dan laju nadi sebesar 9,5 denyut/menit (4,8-14,2 95% IK; p<0,001). Pada menit ke-3 pasca intubasi, perbedaan MAP dan laju nadi kedua kelompok yakni 16,6 mmHg (9,6-23,6 95%IK; p <0,001) dan 11,2 denyut/menit (5,2-17,2 95%IK ; p<0,001 ). Pada menit ke-5 pasca intubasi, tetap terdapat perbedaan bermakna variabel MAP dan laju nadi kedua kelompok, yakni 16,7 mmHg (11,3-22,2 95%IK; p<0,001) dan 10,0 denyut/menit (3,5-16,5 95%IK; p=0,03). Simpulan. Inhalasi lidokain mampu menekan respon peningkatan tekanan darah dan laju nadi akibat rangsang nyeri dan stimulasi simpatis akibat tindakan laringoskopi dan intubasi.

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Background. Laryngoscopy and intubation are routine anaesthesiological procedures which stimulate great amount of pain. Blood pressure and heart rate can be increased by symphatetic stimulation. Laryngoscopy and intubation procedure is a procedure in the field of anesthesia is often done however is a procedure which sparked great pain stimuli. Blood pressure and pulse rate can be increased by stimulation of the sympathetic. The cardiovascular response can be harmful in patients who are vulnerable, especially those who have cardiac or cerebrovascular problems. One method to reduce these was the use of anesthetics, including lidocaine. Increased plasma levels of lidocaine given intravenously can cause various side effects. This study aimed to assess the effects of lidocain inhalation. Methods. Method. This study was a randomized, double-blind clinical trial on patients at the Surgical Center Installation Cipto Mangunkusumo. A total of 24 patients were given inhaled lidocaine 1.5 mg / kg and 25 subjects were given inhaled NaCl 0.9% before laryngoscopy and intubation. Cardiovascular parameters being investigated were changes in systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate in a serial manner. Results. In the first minute after intubation, MAP and heart rate were higher in NaCl group. The difference in MAP was 15.5 mmHg (95% CI 9.2 - 21.7; p <0.001) while heart rate was 9.5 beats / min (95% CI 4.8 - 14.2; p <0.001). In the 3rd minute after intubation, MAP and heart rate kept different in both groups: 16.6 mmHg (95% CI 9.6 - 23.6; p <0.001) and 11.2 beats / minute (5.2 - 17, 2, 95% CI; p <0.001), respectively. In the 5th minute after intubation, MAP and heart rate remained different between two groups: 16.7 mmHg (95% CI 11.3 - 22.2; p <0.001) and 10.0 beats / min (3.5 - 16.5, 95% CI; p = 0.03), respectively. Conclusions. Lidocain inhalation was able to suppress the increased of blood pressure and heart rate due to pain stimuli and sympathetic stimulation after laryngoscopy and intubation.