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ABSTRAK
Title : Comparison on the effectiveness of the insersion of i-gel based on the ear size and body weight in children 1-11 years old in Cipto Mangunkusumo Hospital Objective To compare the effectiveness of i-gel insertion in children aged 1- 11 years based on the ear size and body weight. Study design 104 subjects were included in the inclution criteria for randomization.. Patients was given midazolam for premedication 0,01-0,02 mg / kg as needed. Patients who has no prior venous access were induced with sevoflurane 8%, 50% oxygen fraction combined with air, and patient who has venous access induction was done with propofol 2-2.5 mg / kg, then continue administering 100% oxygen. Ear measurement by ruler measurement vertically, from the top to the bottom and horizontally from the tragus to the outer portion of the ear. Anesthesia continue by administration of fentanyl 2 mcg / kg, and atracurium 0.5 mg / kg. After 3 minutes insertion i-gel was performed. Data of seal pressure, the number of the insertion attemp, post-discharge complications of blood stains and sore throat 24 hours after surgery were obtained. Results This research was followed by 104 children aged 1-11 years with general anesthesia using i-gel. There were no differences in demographics between the two groups The statistical results were p> 0.05 for each variable seal pressure criteria, the number of insertion attempts, complications of blood stains and sore throat. Conclusion Insertion of i-gel based on the ear size has an equal effectiveness with body weight

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ABSTRACT
Judul : Perbandingan keefektifan pemasangan i-gel berdasarkan ukuran daun telinga dengan berat badan pada anak 1-11 tahun di Rumah Sakit Cipto Mangunkusumo Jakarta Tujuan Penelitian ini bertujuan untuk mengetahui perbandingan keefektifan pemasangan i-gel pada anak usia 1-11 tahun yang pemilihan ukurannya didasarkan kepada ukuran daun telinga dengan ukuran berat badan. Metode 104 subjek yang masuk dalam kriteria inklusi dilakukan randomisasi. Pasien diberikan premedikasi midazolam 0,01-0,02 mg/kgBB sesuai dengan kebutuhan. Pasien yang tidak terpasang akses vena dilakukan induksi dengan gas sevofluran 8%, fraksi oksigen 50 % kombinasi dengan air, pada pasien yang sudah terpasang akses vena induksi dengan propofol 2-2,5 mg/kgBB dan dilajutkan dengan pemberian oksigen 100%. Pengukuran daun telinga menggunakan penggaris secara vertikal, dari bagian teratas sampai dengan terbawah dan horizontal dari tragus sampai dengan bagian terluar daun telinga. Anestesi dilanjutkan dengan pemberian fentanyl 2 mcg/kgBB dan atrakurium 0,5 mg/kgBB. Setelah 3 menit dilakukan insersi i-gel. Dinilai seal pressure, jumlah upaya pemasangan, komplikasi noda darah pasca pelepasan dan nyeri tenggorok 24 jam pasca operasi. Hasil Penelitian ini diikuti oleh 104 anak usia 1-11 tahun dengan anestesi umum menggunakan i-gel. Secara demografi tidak terdapat perbedaan diantara kedua kelompok. Hasil penelitian didapatkan p>0,05 pada masing-masing uji statistik untuk kriteria seal pressure, jumlah upaya pemasangan, komplikasi noda darah dan nyeri tenggorok. Kesimpulan Pemasangan i -gel berdasarkan ukuran daun tel inga sama efekt ifnya dengan berat badan

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Latar belakang: Aritmia jantung merupakan komplikasi yang sering terjadi pada operasi jantung. Stroke merupakan komplikasi penting dari fibrilasi atrial pascaoperasi (FAPO). Lama rawat di rumah sakit bertambah dengan adanya FAPO. Terapi medikamentosa yang sudah ada untuk penanganan FAPO belum memuaskan hasilnya. Neuromodulasi saraf vagus menggunakan Transcutaneous Vagus Nerve Stimulation (TVNS) berpotensi untuk mengurangi FAPO dan inflamasi pascaoperasi jantung sehingga layak untuk diteliti.
Metodologi: Penelitian ini merupakan uji klinis acak tersamar tunggal yang dilakukan terhadap pasien dewasa yang menjalani operasi jantung pintas koroner dan katup elektif di Rumah Sakit Umum Pusat Dr. Kariadi Semarang pada bulan April-Juli 2023. Sebanyak 66 subjek yang memenuhi kriteria inklusi dibagi secara acak menjadi dua kelompok secara tersamar. Kelompok pertama mendapat perlakuan TVNS dan kelompok kedua sham TVNS. Perekaman dan pengamatan EKG kontinyu selama 3 hari pasca operasi dan kadar IL-6 diukur 24 jam praoperasi dan 72 jam pascaoperasi. Uji statistik menggunakan Chi Square dan Mann Whitney.
Hasil penelitian: Pada luaran primer, tidak didapatkan perbedaan yang bermakna durasi per episode FAPO (p=0,069) dan peningkatan kadar IL-6 pascaoperasi (p=0,64) pada kelompok TVNS dan sham TVNS. Demikian juga pada luaran sekunder, tidak didapatkan perbedaan bermakna pada durasi awal tanpa terapi standar fibrilasi atrial (p=0,64), kebutuhan vasopressor inotropik (p = 0,517 dan 0,619) dan beban fibrilasi atrial (p=0,07).
Kesimpulan: TVNS tidak memberikan perbedaan bermakna pada durasi per episode FAPO dan derajat inflamasi pascaoperasi bedah jantung dewasa. ......Background: Postoperative arrhythmia is a frequent complication in cardiac surgery. Stroke is an important complication of postoperative atrial fibrillation (POAF). The length of hospital stay increases with POAF. Existing medical therapy for POAF has not shown satisfactory results. Vagus nerve neuromodulation using Transcutaneous Vagus Nerve Stimulation (TVNS) has a potential effect to reduce FAPO and inflammation after cardiac surgery, so it is beneficial to study.
Methodology: This study was a single-blind randomized control trial conducted on adult patients undergoing elective coronary bypass graft and heart valve surgery at Dr. Kariadi General Hospital in April-July 2023. A total of 66 subjects who met the inclusion criteria were randomly divided into two groups in a blinded manner. The first group received TVNS treatment and the second group received sham TVNS. Continuous ECG recording and reading for 3 days after surgery and IL-6 levels were measured 24 hours preoperatively and 72 hours postoperatively. Statistical analysis using Chi-Square and Mann-Whitney test.
Results: In the primary outcome, there was no significant difference in duration per episode of POAF (p=0.069) and the increase of postoperative IL-6 levels (p=0.64) in the TVNS and sham TVNS groups. Similarly in secondary outcomes, there were no significant differences in the initial duration without standard therapy of atrial fibrillation (p=0.64), the need for inotropic vasopressors (p = 0,517 and 0,619), and the burden of atrial fibrillation (p=0.07).
Conclusion: No significant difference in the duration per episode of FAPO and the degree of inflammation after adult cardiac surgery with TVNS treatment.

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ABSTRAK
Pendahuluan Di RSCM algoritme penanganan pasien trauma belum ada. Waktu yang dibutuhkan untuk penanganan pasien trauma juga tidak pernah tercatat dengan baik. Tujuan dari studi ini adalah untuk mengetahui rerata waktu penanganan pasien trauma di ruang resusitasi RSCM. Selain itu, mortalitas akibat trauma juga dicatat.

Metode Semua pasien trauma yang masuk ke ruang resusitasi RSCM pada bulan Juni-November 2012 diikutsertakan. Waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai primary survey dan tindakan diagnosis yang dibutuhkan serta waktu sampai pasien keluar dari ruang resusitasi baik ke kamar operasi maupun ke ruang rawat juga dicatat. Mortalitas yang terjadi di rumah sakit pasca trauma juga dicatat.

Hasil Selama periode penelitian tercatat ada 41 pasien trauma yang masuk ke ruang resusitasi RSCM. Rerata waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai primary survey selesai dikerjakan adalah 10(5-60) menit; sampai hasil pemeriksaan laboratorium didapatkan adalah 55(5-185) menit; sampai hasil pemeriksaan rontgen didapatkan adalah 30(15-210) menit; sampai hasil pemeriksaan USG didapatkan adalah 12,5(5-30) menit; sampai hasil pemeriksaan CT-scan didapatkan adalah 75(15-360) menit. Rerata waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai dikirim ke kamar operasi adalah 222,5(25-660) menit; sampai dikirim ke ruang rawat tanpa melalui operasi adalah 1440(170-1440) menit. Mortalitas yang terjadi di rumah sakit pasca trauma adalah 41,4%.

Kesimpulan Rerata waktu penanganan pasien trauma di ruang resusitasi RSCM, baik untuk tindakan diagnostik maupun operasi emergensi masih lebih dari 60 menit. Mortalitas pasien pasca trauma 41,4%. Dibutuhkan penelitian lebih lanjut untuk mengevaluasi hubungan antara waktu penanganan pasien dengan mortalitas pasien.

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ABSTRACT
Introduction In Cipto Mangunkusumo Hospital trauma algorithm is not available yet. The time spent to manage trauma patients in the resuscitation room also hasn’t been recorded very well. Aim of this study is to analyze how much time needed in the resuscitation room to manage trauma patients. The mortality follow is also recorded.

Methods All consecutive trauma patients who went to the resuscitation room during June to November 2012 are included. The time spent between admission to the resuscitation room until primary survey and diagnostic procedure be done also until patients exit the resuscitation room whether to the operating room or straight to the ward were recorded. In hospitality mortality were also recorded.

Results During the study, there were 41 trauma patients went to the resuscitation room. Median time spent between admission until primary survey was finished was 10(5-60) minutes; until blood work results finished was 55(5-185) minutes; until x-ray results finished was 30(15-210) minutes; until USG results finished was 12,5(5-30) minutes; until CT-scan results finished was 75(15-360) minutes. Median time spent between admission until exiting to the operating room was 222,5(25-660) minutes; until exiting to the ward without operation was 1440(170-1440) minutes. In hospitality mortality was 41,4%.

Conclusion The time spent in the resuscitation room to manage trauma patients both to do the diagnostic procedure and emergency operation was still more than 60 minutes. In hospital mortality was 41,4%. Further study needed to analyze the relationship between those two things.

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LATAR BELAKANG : Hipotensi akibat anestesia spinal pada pasien yang menjalani bedah caesar berbahaya bagi ibu dan janinnya. Sehingga, kombinasi anestetik lokal dosis rendah dengan opioid yaitu bupivakain 0,5% hiperbarik 5 mg dan 6 mg ditambah fentanil 25 mcg diharapkan dapat menurunkan angka kejadian hipotensi dengan kualitas analgesia yang adekuat untuk memfasilitasi bedah caesar. METODE : 394 pasien hamil aterm usia 20 ? 40 tahun yang akan menjalani bedah caesar, baik cito maupun elektif ASA I ? II,yang sesuai dengan kriteria inklusi.Randomisasi menjadi kelompok I yang mendapat bupivakain 0,5% hiperbarik 5 mg ditambah fentanil 25 mcg serta kelompok II (kontrol) yang mendapat bupivakain 0,5% hiperbarik 6 mg ditambah fentanil 25 mcg.Posisi pasien pada kedua kelompok sama yaitu posisi lateral dengan pungsi lumbal setinggi L3-4/L4-5.Total volume 1,7cc disun tikkan dengan kecepatan 0,2 cc/detik.Kemudian telentang dengan posisi left lateral tilt. Dilakukan pencatatan tekanan darah pada menit ke - 3,6,,9,12,15,20,30,40,50,60 setelah disuntikkannya obat anestetik lokal ke ruang subaraknoid. HASIL : Terdapat 3 subyek penelitian yang dikeluarkan pada kelompok I, karena dikonversi menjadi anestesia umum . Terdapat 2 subyek penelitian pada kelompok II yang mendapatkan fentanil 100 mcg intravena. Angka kejadian hipotensi pada kelompok I 9,3% dan pada kelompok II adalah 12,2%. KESIMPULAN : Tidak terdapat perbedaan yang bermakna mengenai angka kejadian hipotensi pada kedua kelompok subyek penelitian.

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BACKGROUND: Hypotension due to spinal anesthesia in patients undergoing cesarean section is dangerous for both mother and fetus. So with a combination of low doses of local anesthetics 0.5% hyperbaric bupivacaine 5 mg and 6 mg plus fentanyl 25 mcg is expected to reduce the incidence of hypotension with adequate quality of analgesia to facilitate cesarean section. METHODS: 394 pregnant patients at term age 20-40 years undergo caesarean section, either cito and elective ASA I - II, in accordance with the criteria I inclusion. Randomization into groups that received 0.5% hyperbaric bupivacaine 5 mg plus fentanyl 25 mcg and group II (controls) who received 0.5% hyperbaric bupivacaine 6 mg plus fentanyl 25 mcg.Posisi patients in both groups were the same, namely the lateral position with the highest lumbar puncture L3-4/L4-5.Total injected volume is 1.7 cc with speed of injection 0.2 ml / second. Then move patient to supine position with left lateral tilt. Do blood pressure recording in minute - 3.6,9,12,15,20,30,40,50,60 after injection of local anesthetic drugs into the subarachnoid space. RESULTS: There were three subjects that excluded subjects in group I, because converted to general anesthesia. There are two subjects in group II who received fentanyl 100 mcg intravenously. The incidence of hypotension in group I and 9.3% in group II was 12.2%. CONCLUSION: There was no significant difference in the incidence of hypotension in both groups.

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ABSTRAK
Latar Belakang. Nitrous oxide merupakan gas anestesia inhalasi yang sering ditambahkan pada saat induksi anestesia inhalasi pada anak. Kontroversi penggunaan N2O sendiri masih ada hingga saat ini. Tujuan penelitian ini adalah untuk mengetahui perbedaan laju induksi anestesia, respons hemodinamik, dan komplikasi yang timbul selama menggunakan N2O saat induksi inhalasi anestesia pada pasien anak. Metode. Delapan puluh orang anak usia 1-5 tahun ASA 1 dan 2 yang menjalani anestesia umum, dibagi menjadi 2 kelompok perlakuan secara acak. Kelompok A sevofluran 8 vol% ditambah oksigen, dan kelompok B sevofluran ditambah oksigen dan N2O 50%. Hasil utama yang diukur adalah laju induksi, dan hasil lainnya adalah respons laju nadi, tekanan darah sistolik, diastolik, serta insidens komplikasi desaturasi, eksitasi, laringospasme, dan breath holding.. Hasil. Laju induksi kelompok B yaitu 35+8.13 detik, lebih cepat dibandingkan kelompok A yaitu. 54.12+5.89 detik Respons laju nadi, tekanan darah sistolik, tekanan darah diastolik tidak berbeda bermakna di antara kedua kelompok. Insidens komplikasi desaturasi dan laringospasme tidak terjadi pada penelitian ini. Eksitasi terjadi lebih sedikit pada kelompok B yaitu 10.3% dibandingkan 26.8% pada kelompok A, namun tidak bermakna secara statistik. Breath holding terjadi pada 2 orang (4.9%) di kelompok A, dan tidak terjadi di kelompok B, insidens breath holding tidak berbeda bermakna antara kedua kelompok. Kesimpulan. Laju induksi inhalasi pada anak menggunakan sevofluran ditambah oksigen dan N2O lebih cepat dibandingkan tanpa N2O Respons hemodinamik dan insidens komplikasi tidak berbeda bermakna antara kedua kelompok.

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ABSTRACT
Background. Nitrous oxide is an anesthetic agent that are often added during inhalation induction of anesthesia in pediatric patients. Controversy over the use of N2O is still there to this day. The purpose of this study was to determine differences in the induction time of anesthesia, hemodynamic response, and the complications that arise during the use of N2O inhalation induction of anesthesia in pediatric. Methods. Eighty children aged 1-5 years old ASA 1 and 2 who underwent general anesthesia, were divided into 2 treatment groups at random. Group A was 8 vol% sevoflurane plus oxygen, and group B was oxygen plus sevoflurane and 50% N2O. We measured the induction time, hemodynamic response heart rate, systolic and diastolic blood pressure, and also the incidence of complications desaturation, excitation, laryngospasm, and breath holding. Result. Induction time of group B was 35+8.13 seconds, faster than group A 54.12 +5.89 seconds. The response of heart rate, systolic blood and diastolic blood pressure was not significantly different between the two groups. Desaturation and laryngospasm did not occur in this study. Excitation occurs less in group B that was 10.3% compared to 26.8% in group A, but that was not statistically significant. Breath holding occurred in 2 patients (4.9%) in group A, and did not occur in group B, breath holding incidence also did not differ significantly between the two groups. Conclusion. Inhalation induction time in children using sevoflurane, oxygen and N2O was faster, than without N2O. Hemodynamic response and the incidence of complications was not significantly different between groups.

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Latar Belakang: Blok psoas merupakan salah satu teknik anestesia untuk operasi ekstremitas bawah. Teknik blok psoas membutuhkan alat stimulator saraf atau USG untuk memfasilitasi prosedur blok tersebut. Belum semua rumah sakit atau instansi kesehatan memiliki alat tersebut. Blok paravertebral lumbal dapat dijadikan alternatif dari blok psoas karena dapat dilakukan dengan teknik blind. Penelitian ini dilakukan untuk mengetahui penyebaran zat pewarna metilen biru 1% pada injeksi 1 titik di ruang paravertebral lumbal 4. Metode: Penelitian ini dilakukan pada 16 kadaver di kamar mayat bagian forensik RSUPN-CM. Penelitian ini merupakan penelitian eksperimental dan sampel adalah kadaver segar yang memenuhi kriteria penerimaan dan tidak terkena kriteria penolakan atau pengeluaran. Penelitian dilakukan dengan menginjeksikan 30 ml zat pewarna metilen biru 1% di ruang paravertebral lumbal 4 menggunakan jarum blok pada posisi miring ke kanan. Kadaver kemudian dikembalikan ke posisi terlentang dan penyebaran zat pewarna didokumentasikan setelah otot psoas diinsisi. Analisis hasil penelitian menggunakan statistik deskriptif. Hasil: Kadaver yang diikutsertakan dalam penelitian ini adalah kadaver segar, tidak diawetkan, tinggi badan ≥ 150 cm, IMT ≤ 30 kg/m2, dan tidak dikenal. Kriteria pengeluaran adalah kadaver dengan kelainan skoliosis torakolumbal, jejas di area punggung dan pinggang, kasus kriminal, dan intoksikasi. Tidak ada kadaver yang dikeluarkan dalam penelitian ini. Penyebaran tertinggi ke arah sefalad mencapai lumbal 1 (6,25%) dengan rata-rata terbanyak pada lumbal 3 (50%). Penyebaran terendah ke arah kaudad mencapai sakral 2 (12,5%) dengan rata-rata terbanyak pada lumbal 5. Penyebaran ke arah kontralateral sebanyak 18,75%. Penyebaran paling sedikit pada 2 segmen (6,25%), paling banyak pada 5 segmen (12,5%), dan rata-rata terbanyak pada 4 segmen (43,75%). Ruang paravertebral lumbal 4 merupakan tempat utama penyebaran (100%), diikuti dengan segmen lumbal 3 (87,5%) dan lumbal 5 (87,5%). Kesimpulan: Injeksi 1 titik 30 ml zat pewarna metilen biru 1% pada blok paravertebral lumbal 4 dapat mencapai area pleksus lumbalis yang diinervasi oleh persarafan lumbal 2-4. Penelitian lebih lanjut diperlukan untuk mengetahui volume dan lokasi injeksi yang optimal dan aman untuk menghasilkan penyebaran yang lebih baik pada persarafan pleksus lumbalis. ......Background: Psoas block is one of the anesthesia techniques for lower limb surgery. Psoas block technique requires nerve stimulator or ultrasound to facilitate the procedure. Not all hospitals or health agencies have the tools. Lumbar paravertebral block can be used as an alternative to the psoas block because it can be done with a blind technique. This study was conducted to determine the spread of methylene blue dye injection 1% at one point in the fourth lumbar paravertebral space. Method: The study was conducted on 16 cadavers in the morgue forensic section RSUPN-CM. This study was an experimental study and the sample is fresh cadavers that meets acceptance criteria and not exposed to rejection or removal criteria. The study was conducted by injecting 30 ml of methylene blue dye 1% in the fourth lumbar paravertebral blocks using needle tilting to the right position. Cadaver then returned to the supine position and the spread of dye documented after psoas muscle incision. Analysis of the results of research using descriptive statistics. Results: Cadaver were included in this study were fresh cadaver, uncured, ≥ 150 cm height, BMI ≤ 30 kg/m2, and unknown cadaver. Exclusion criteria is cadaver with thoracolumbar scoliosis disorder, injury in the back and waist area, criminal cases, and intoxication. No cadaver that was removed in this study. The highest cephalad spread achieving 1st lumbar (6.25%) with the highest average in the 3rd lumbar (50%). The lowest caudad spread achieving 2nd sacral (12.5%) with the highest average in the 5th lumbar. Spread to the contralateral as much as 18.75%. The least spread is 2 segments (6.25%), the most spread is 5 segments (12.5%), and the highest average is 4 segments (43.75%). 4th lumbar paravertebral space is a prime spot spread (100%), followed by 3rd lumbar segment (87.5%) and the 5th lumbar(87.5%). Conclusion: Injection of 1 point 30 ml of methylene blue dye 1% at the 4th lumbar paravertebral block can reach the lumbar plexus area innervated by 2nd-4th lumbar innervation. Further research is needed to determine the volume and location of the optimal and safe injection to produce a better spread of the lumbar plexus innervation.

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[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.]

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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. ...... 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.

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Latar Belakang: Identifikasi risiko mortalitas pascabedah diketahui hanya pada 66 pembedahan dan 34 sisanya tidak teridentifikasi. Modalitas P-POSSUM dianggap lebih superior dibandingkan dengan modalitas ASA dalam memprediksi morbiditas dan mortalitas karena memperhitungkan beban pembedahan. Metode: Uji kesahihan ini dilakukan di RSUPN dr. Cipto Mangunkusumo. Dilakukan penelusuran data fisiologis dan operatif dari enam puluh delapan pasien bedah risiko tinggi elektif kemudian dilakukan perhitungan prediksi risiko dengan koefisien perhitungan skor P-POSSUM dalam situs internet http://www.riskprediction.org.uk dan dibandingkan dengan luaran mortalitas aktual. Kesahihan dinilai dengan penilaian kemampuan kalibrasi dan diskriminasi. Dilakukan analisis untuk mengetahui hubungan parameter-parameter P-POSSUM dengan mortalitas. Hipotesis penelitian ini adalah P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 . Hasil: Kemampuan diskriminasi didapatkan dengan menghitung luas AUC yaitu sebesar 89.2 IK 95 0,756 ndash;1,000; p=0,000 . Kemampuan kalibrasi dinilai baik dari analisis Hosmer-Lemeshow p=0,23 . Pada analisis bivariat hanya hemoglobin p=0,003 , tekanan darah sistolik p=0,031 dan leukosit p=0,007 yang berhubungan dengan mortalitas. Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p=0,043 dan leukosit p=0,010 yang berhubungan dengan mortalitas. Simpulan: P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 . Berdasarkan analisis bivariat didapatkan hemoglobin, tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Setelah analisis regresi logistik didapatkan hanya tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Kata Kunci: kesahihan, P-POSSUM, mortalitas, risiko tinggi

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BACKGROUND Postsurgery mortality risk identified only in 66 surgery and 34 remain unknown. P POSSUM considered more superior than ASA stratification in predicting morbidity and mortality since it calculates surgical risk. METHODS This research was performed in RSUPN dr. Cipto Mangunkusumo. Physiological and surgical parameter of sixty eight high risk patients were taken from medical record and then risk prediction was calculated by calculation coefficient of P POSSUM scoring from http www.riskprediction.org.uk. The comparison between predicted and actual mortality was performed. Validation is assessed by calibration and discrimination ability. The researchers also analyzed the correlation between P POSSUM parameters and mortality. We hypothesized that P POSSUM valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80. RESULTS Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p 0,043 dan leukosit p 0,010 yang berhubungan dengan mortalitas. Discrimination ability was assessed by calculating AUC area which is 89.2 CI 95 0,756 ndash 1,000 p 0,000 . Calibration ability is good based on Hosmer Lemeshow analysis p 0,23 . From bivariat analysis only hemoglobin p 0,003 , sistolic blood pressure p 0,031 and leukocyte p 0,007 have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure p 0,043 and leukocyte p 0,010 have relationship with mortality. CONCLUSION P POSSUM is valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80 . From bivariat analysis only hemoglobin, sistolic blood pressure and leukocyte have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure and leukocyte have relationship with mortality. Keywords validation, P POSSUM, mortality, high risk

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Latar Belakang: Tatalaksana nyeri pascabedah pada pasien pascalaparoskopi nefrektomi merupakan salah satu kunci pemulihan dini pasien. Di RSUPN Cipto Mangunkusomo, hampir semua pasien donor ginjal pascabedah laparoskopi nefrektomi mendapatkan analgesia epidural kontinyu. Masih tingginya persentase pasien dengan derajat nyeri berat, serta terdapatnya efek samping retensi urin pascaanalgesia epidural kontinyu, membuka kemungkinan untuk digunakannya teknik analgesia berbasis anestesia regional lain yang lebih baik. Blok tranversus abdominis plane dapat digunakan sebagai analgesia pascabedah abdomen, aman digunakan pada pasien dengan gangguan fungsi koagulasi dan tidak menyebabkan terjadinya retensi urin dibandingkan dengan teknik blok neuraksial. Metode: Penelitian ini bersifat uji klinis terkendali tidak tersamar tunggal, dengan populasi semua pasien donor ginjal yang menjalani laparoskopi nefrektomi pada bulan Mei-Oktober 2017 di RSUPN Cipto Mangunkusumo. Sebanyak 25 subyek pada dua kelompok diambil dengan metode consecutive sampling. Analisa statistik dilakukan untuk mengetahui efek analgesia penambahan deksametason 8 mg pada blok TAP tiga titik, rata-rata derajat nyeri gerak dan kebutuhan morfin pascabedah pada kedua kelompok dengan menggunakan uji Mann-Whitney dan uji Friedman dan post hoc Wilcoxon.Hasil: Uji Mann-Whitney rata-rata nyeri diam tidak berbeda signifikan p 0,066-0,716 . Uji Mann-Whitney Kebutuhan PCA morfin pada 24 jam pascabedah tidak berbeda signifikan p 0,072-0,200 . Perubahan derajat nyeri pada blok TAP dengan uji Friedman dan post hoc Wilcoxon bermakna signifikan p 0,002 dan 0,020 . Kebutuhan morfin pada blok TAP dengan uji Friedman dan post hoc Wilcoxon bermakna signifikan p 0,023 . Saat pertama menggunakan tambahan morfin dan awal mobilisasi pascabedah tidak ada perbedaan pada kedua kelompok. Kekerapan retensi urin pascabedah lebih tinggi pada epidural kontinyu 58.01 .Simpulan: Penambahan deksametason 8 mg tidak memberikan efek analgesia yang lebih baik pada blok TAP tiga titik dibanding epidural kontinyu. Jumlah penggunaan morfin, saat pertama membutuhkan tambahan morfin, rata-rata derajat nyeri gerak dan awal mobilisasi pascabedah tidak berbeda signifikan pada blok TAP tiga titik dengan epidural kontinyu. Kekerapan retensi urin pascabedah lebih tinggi pada epidural kontinyu.

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Abstract Background Postoperative pain management in laparoscopic nephrectomy is one key to early recovery. At RSUPN Cipto Mangunkusomo, almost all postoperative laparoscopic donor nephrectomy patients acquire continuous epidural analgesia. High percentage of patients with severe degree of pain and presence of postoperative urinary retention related to continuous epidural opens the possibility of better use of other regional anesthesia analgesia techniques. Tranversus abdominis plane block can be used as postoperative analgesia in abdominal surgery, safe in patients with impaired coagulation function and does not cause urinary retention compared with neuraxial block technique. Methods Randomized control trial in all kidney donor patients undergoing laparoscopic donor nephrectomy in RSUPN Cipto Mangunkusomo during May October 2017. Consecutive sampling and random allocation was done to put 25 patients in each TAP block and Continuous Epidural group. Statistical analysis was performed to determine the effect of adding 8 mg of dexamethasone in three point TAP block on degree of pain at rest and with movement and postoperative morphine requirements using Mann Whitney, Friedman and post hoc Wilcoxon test. Results Mann Whitney test showed no significant difference in pain at rest p 0,066 0,716 and 24 hours postoperative morphine requirements p 0,072 0,200 between two groups. Friedman and post hoc Wilcoxon test showed a significant difference in degree of pain p 0,002 and 0,020 and morphine requirement p 0,023 in TAP block group. There is no difference in time to first dose of morphine rescue and early postoperative mobilization. There is higher incidence of postoperative urinary retention in continuous epidural group 58.01 .Conclusion The addition of dexamethasone 8 mg on three point TAP block did not provide better analgesia than continuous epidural. The amount of morphine requirement, time to first dose of morphine rescue, degree of pain at rest and with movement and early postoperative mobilization did not differ significantly between two groups. The frequency of postoperative urinary retention is higher with continuous epidural.