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"ABSTRAKLatar Belakang: Penelitian yang menghubungkan parameter kraniofasial dengankesulitan visualisasi laring banyak dilakukan, namun tidak satu pun digunakansecara baku dalam pemeriksaan praoperatif pasien anak. Penelitian serupa padaras Melayu baru dilakukan satu kali dan tidak menentukan parameter yang palingberkorelasi dengan kesulitan visualisasi laring.Metodologi: Penelitian ini merupakan penelitian prospektif. Pengumpulan datadilakukan secara konsekutif pada 295 pasien anak 1-3 tahun yang akan menjalanianestesia umum. Dilakukan pengukuran jarak tepi bawah bibir ke ujung mentum,jarak tragus telinga ke sudut mulut dan jarak mentohioid. Tingkat kesulitanvisualisasi laring menggunakan klasifikasi skor Cormack-Lehane dengan kategorimudah dan sulit visualisasi laring. Dilakukan analisis data untuk mencariparameter yang paling tepat untuk memprediksi kesulitan visualisasi laring.Hasil: Kesulitan visualisasi laring (Cormack-lehane III dan IV) ditemukansebesar 8.1%. Analisis multivariat dengan variabel bebas skala numerikmenunjukkan tidak ada parameter yang berkorelasi dengan kesulitan visualisasilaring (p>0.05) sedangkan berdasarkan variabel bebas berskala kategorikdidapatkan jarak tragus telinga ke sudut mulut memiliki hubungan bermaknadengan kesulitan visualisasi laring (p=0.013), namun hasil ini secara klinis tidakbermakna.Kesimpulan: Parameter kraniofasial tidak dapat memprediksi kesulitanvisualisasi laring anak ras Melayu usia 1-3 tahun. Harus dicari parameterparameterlain pada anak ras Melayu yang lebih baik memprediksi kesulitanvisualisasi laring.

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ABSTRACTBackground: Many research have been done to observe correlation betweencraniofacial parameters with difficulty of larynx visualization, but none of themare used as a gold standard for preoperative examination in children patients. Asimilar research in Malay race children has ever done but it did not determinewhich parameters that most correlated with difficulty of larynx visualization.Methodology: In a prospective study, data collection was performedconsecutively in 295 pediatric patients 1-3 years whose received generalanesthesia. Distance from edges lower lip to mental tip, ear tragus to the mouthangle and mentohioid are measured in this study. Difficulty level of larynxvisualization is using Cormack-Lehane scores and categorized into easy anddifficult larynx visualization. Data analysis was performed to find the mostappropiate parameters which can predict difficulty of larynx visualization.Results: Difficulty of larynx visualization (Cormack-Lehane III and IV) wasfound as many as 8.1%. Multivariat analysis with numeric scale as independentvariable show no parameter correlated with the difficulty of larynx visualization(p> 0.05). Multivariat analysis with categoric scale as independent variableobtained only distance from ear tragus to the mouth angle which has significantrelationship (p = 0.013), but these results is not clinically significant.Conclusion: Craniofacial parameters can not be used to predict difficulty oflarynx visualization in Malay race children 1-3 years. Research using other betterparameters should be done to predict difficulty of larynx visualization."

"ABSTRAK LatarBelakang: Menentukan prediktor yang paling akurat dalam menilaisulitvisualisasi laring(DVL) dengan menggunakan skor mallampati (MMT) ,Jarak sternomental(SMD) dan jarak buka mulut(IIG), baik secara tunggal maupundalam kombinasi.Metode: Sebanyak 283 pasien ikut serta dalam penelitian dan dievaluasikemungkinan mereka mengalami sulit visualisasi laring. Kesulitan visualisasilaring dinilai dengan laringoskopi langsung berdasarkan klasifikasi CormackLehane (CL). Skor CL derajat III dan IV ditentukan sebagai sulit visualisasilaring. Kondisi ini juga diperkirakan dengan menggunakan prediktor jalan napas,yaitu MMT, SMD dan IIG. Titik potong untuk masing-masing prediktor adalahskor Mallampati III dan IV, ≤ 12,5 cm, dan ≤ 3 cm. Selanjutnya, ditentukan nilaisensitivitas, spesifisitas, nilai prediksi positif dan negatif serta nilai area di bawahkurva (AUC) dari setiap prediktor tersebut, baik secara tunggal maupun dalamkombinasi. Prediktor independen DVL ditentukan dengan melakukan analisisregresi logistik.Hasil: Sulit visualisasi laring ditemukan pada 29 (10,2%) subyek penelitian. Nilaisensitivitas, spesifisitas, prediksi positif dan luas AUC prediktor jalan napasadalah: MMT (20,8%; 99,7%; 71,4%; 68%), SMD (72,4%; 97,2%; 75%; 88%),dan IIG (41,4%; 99,4%; 85,7%; 73%). Penelitian kami menunjukkan bahwakombinasi prediktor terbaik adalah gabungan prediktor SMD + IIG. Kombinasitiga prediktor MMT + SMD + IIG ternyata menunjukkan nilai AUC yang samadengan kombinasi dua prediktor SMD + IIG.Kesimpulan: Penelitian ini menganjurkan gabungan prediktor IIG + SMDsebagai model diagnostik yang optimal untuk memperkirakan sulit visualisasilaring pada populasi ras Melayu di Indonesia.

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ABSTRAK Background: To determine the most accurate predictor in evaluating difficultvisualization of larynx (DVL) using indicators of modified mallampati test(MMT), sternomental distance (SMD) and inter incisor gap (IIG), either inisolation or in combination.Methods: Two hundred eighty three patients were participated in the study andevaluated for their possibility of having DVL. The difficulty of larynx visualizationwas evaluated using direct laryngoscopy based on grading of the Cormack andLehane (CL) classification. The CL grades III and IV were considered as difficultvisualization of larynx. DVL was also predicted using the airway predictors ofMMT, SMD and IIG. The cut-off points for the airway predictors wereMallampati III and IV; ≤ 12,5 cm, and ≤ 3 cm, respectively. Moreover, sensitivity,specificity, positive and negative predictive value and area under the curve (AUC)of each predictor were determined, either in isolation or in combination.Independent predictors of DVL were determined using logistic regressionanalysis.Results: Difficulty to visualize the larynx was found in 29 (10.2%) subjects. Thesensitivity, specificity, positive predictive value and AUC for the airwaypredictors were: MMT (20.8%; 99.7%; 71.4%; 68%), SMD (72.4%; 97.2%; 75%;88%), and IIG (41.4%; 99.4%; 85.7%; 73%). The best combination of predictorswas SMD + IIG with an AUC of 90.2%. Triple combination of MMT + SMD +IIG showed the same value of AUC with combination of two predictors, SMD +IIG.Conclusion: This study suggests the combination of IIG + SMD predictors as theoptimal diagnostic model to predict DVL in a Malay race population inIndonesia."

"Latar belakang: Skor Mallampati dan jarak tiromental (TMD) banyak digunakan sebagai prediktor kesulitan visualisasi laring preoperatif, namun akurasi kedua penanda tersebut masih dipertanyakan. Penelitian ini mengevaluasi kemampuan memprediksi kesulitan visualisasi laring (DVL) dari prediktor preoperatif baru yaitu rasio lingkar leher (NC) terhadap jarak tiromental TMD dibandingkan dengan skor Mallampati dan jarak tiromental. Metode: Sebanyak dua ratus tujuh belas pasien yang menjalani anestesia umum untuk bedah elektif dievaluasi dengan menggunakan skor Mallampati, TMD dan rasio NC/TMD. Dan titik potong untuk masing-masing prediktor jalan nafas adalah skor Mallampati III dan IV, < 6,5 cm, ≥ 5. Pada saat dilakukan laringoskopi langsung, visualisasi laring dinilai berdasarkan klasifikasi Cormack Lehane (CL). Skor CL derajat III dan IV dianggap sulit visualisasi. Kemudian ditentukan dan dibandingkan nilai area dibawah kurva (AUC), sensitifitas, spesifisitas untuk setiap prediktor jalan nafas. Hasil: Kesulitan untuk memvisualisasi laring ditemukan pada 20 (9,7%) pasien. Area dibawah curve (AUC) rasio NC/TMD (96,2%) lebih baik dibandingkan dengan skor Mallampati (64%) dan TMD (83%). Kesimpulan: Akurasi rasio NC/TMD lebih baik dibandingkan dengan skor Mallampati dan TMD.

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Background: Mallampati score and thyromental distance (TMC) has widely use to identify potentially difficult laringoscopies preoperative, however it's predictive reliability is unclear. This research purpose are to evaluate the ability to predict difficult visualization of the larynx (DVL) from new preoperative airway predictors neck circumference ratio to thyromental distance (NC/TMD) compare to Mallampati score and thyromental distance.

Methods: Two hundred and seventeen consecutive patients undergoing general anesthesia for elective surgery were evaluated using the Mallampati score, TMD, NC/TMD ratio and the cut-off points for the airway predictors were Mallampati score III and IV; ≤ 6,5 cm; ≥ 5. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grade III and IV were considered difficult visualization. Area under curve (AUC), sensitivity, specificity for each airway predictors were determined and compared.

Result: Difficult to visualize the larynx was found in 20 (9,7%) patients. The AUC of NC/TMD ratio (96,2%) is better tcompared to TMD (83%) and much better if compared to Mallampati score (64%).

Conclusion: NC/TMD ratio had better accuracy in predicting difficult laryngoscopy than Mallampati score and TMD."

"Latar belakang: Dalam setiap kunjungan pra anestesia, penilaian jalan nafas sangat penting, terutama pada pasien anak. Namun, pedoman yang ada pada dewasa tidak dapat dipakai pada populasi pediatri. Tujuan: Mengetahui hubungan antara lima ukuran parameter kraniofasial dengan skor Cormack-Lehane pada populasi anak usia 4-12 tahun di Indonesia. Metodologi: Data dikumpulkan secara consecutive pada 134 pasien yang menjalani anestesia umum. Dilakukan pengukuran jarak tepi bawah bibir ke ujung mentum, jarak angulus mandibula ke ujung mentum, jarak tragus telinga ke sudut bibir, jarak mentohioid dan jarak antara angulus mandibula kanan dan kiri. Dilakukan penilaian tingkat kesulitan laringoskopi menggunakan skor Cormack-Lehane, kemudian dibagi menjadi mudah dan sulit laringoskopi. Kemudian dilakukan analisa data untuk mencari hubungan antara lima parameter ini dengan skor Cormack-Lehane. Hasil: Insidens skor Cormack-Lehane I sampai IV masing-masing 47,4%; 43,6%; 6,8%; dan 2,3%. Kesimpulan: Tidak terdapat hubungan bermakna antara lima parameter kraniofasial dengan skor Cormack-Lehane pada anak usia 4-12 tahun.

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Background: In every pre anesthesia visite, airway assessment is very important, especially in pediatric patient. However, adult airway guidelines can not be applied in pediatric population.

Objective: To perform the association between five craniofacial parameters and Cormack-Lehane score for 4 to 12 year-old pediatric in Indonesia.

Methods: Data collected consecutively in 134 patients who underwent general anesthesia. The distance of lower lip to mentum, mandible angle to mentum, ear tragus to mouth, mentohyoid distance and distance of left and right mandible were measured. Laryngoscopic view were counted using Cormack-Lehane score and divide into two groups: easy and difficult for laryngoscopic view. The associations of these five parameters with Cormack-Lehane score were analyzed.

Results: Incidence of Cormack-Lehane score grade I to IV was 47,4%; 43,6%; 6,8%; and 2,3%.

Conclusion: There are no significant association among the craniofacial parameters and Cormack-Lehane score in 4 to 12 years-old pediatric patients."

"[ABSTRAKLatar 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 induksiMetode. 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 4Kesimpulan. Trapezius squeezing test tidak lebih baik daripada jaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring.

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ABSTRACTBackground. 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.]"

"ABSTRAKLatar Belakang : Kami mengevaluasi kegunaan dari pemeriksaan rasio jarakhiomental (HMDR,hyomental distance ratio), yang didefinisikan sebagai rasiodari jarak hiomental (HMD,hyomental distance) posisi kepala ekstensi maksimaldengan posisi kepala netral, dalam memprediksi kesulitan visualisasi laring padapasien-pasien normal, yang dilakukan pemeriksaan prediktor-prediktor jalannapas praoperasi dengan skor Mallampati dan jarak tiromental (TMD,tyhyromental distance) sebagai pembanding.Metode Penelitian : Praoperasi, kami menilai empat prediktor jalan napas pada169 orang dewasa yang menjalani anestesi umum. Pelaku laringoskopi adalahresiden anestesiologi minimal tahun ke 2, dan menilai skor Cormack-Lehane(CL)yang dimodifikasi. Sulit visualisasi laring (DVL,difficult visualization of thelarynx) didefinisikan sebagai CL derajat 3 atau 4. Titik potong optimal (The cutoffpoint) untuk setiap tes ditentukan pada titik maksimal daerah di bawahkurva dalam kurva ROC (Receiver Operating Characteristic). Skor Mallampatidengan derajat ≥ 3 sebagai prediktor DVL. Untuk TMD ≤ 65 mm dianggapsebagai prediktor DVL.Hasil : Didapatkan 21 (12,4%) orang pasien dengan sulit visualisasi laring(DVL).HMDR memiliki hubungan yang bermakna terkait dengan DVL. HMDR dengantitik potong optimal 1,2 memiliki akurasi diagnostik yang lebih besar (dengan areadi bawah kurva 0.694), dibandingkan prediktor tunggal lainnya (P <0,05), danHMDR sendiri menunjukkan validitas diagnostik yang lebih besar (sensitivitas,61,9%, spesifisitas, 69,6%) dibandingkan dengan prediktor lainnya.Kesimpulan :HMDR dengan ambang batas uji 1,2 adalah prediktor klinis handaldalam memprediksi kesulitan dalam visualisasi laring.

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ABSTRACTBackground: We evaluated the usefulness of the hyomental distance (HMD) ratio(HMDR), defined as the ratio of the HMD at the extreme of the head extension tothat in the neutral position, in predicting difficult visualization of the larynx(DVL) in apparently normal patients, by examining the following preoperativeairway predictors: the modified Mallampati test, HMD in theneutral position, HMD and thyromental distance at the extreme of head extensionand HMDR.Methods : Preoperatively, we assessed the four airway predictors in 169 adultpatients undergoing general anesthesia. A second years resident, performed all ofthe direct laryngoscopies and graded the views using the modified Cormack andLehane scale. DVL was defined as a Grade 3 or 4 view. The optimal cutoff pointsfor each test were determined at the maximal point of the area under the curve inthe receiver operating characteristic curve. For the modified Mallampati test,Class ≥ 3 was predefined as a predictor of DVL. And thyromental distance (TMD)≤ 65 mm was predefined as a predictor of DVL.Results : The larynx was difficult to visualize in 21 (12,4%) patients. The HMDRwith the optimal cutoff point of 1.2 had greater diagnostic accuracy (area underthe curve of 0.694), with significantly related to DVL (P <0.05), and it aloneshowed a greater diagnostic validity profile (sensitivity, 61,9%; specificity,69,6%) than any other predictor.Conclusions : The HMDR with a test threshold of 1.2 is a clinically reliablepredictor of DVL."

"Latar Belakang : Tingkat kepuasan pasien merupakan salah satu indikator kualitas pelayanan anestesia, baik rawat inap maupun rawat jalan. Bedah rawat jalan menawarkan banyak kelebihan dibandingkan rawat inap, sehingga berkembang sangat pesat di Indonesia khususnya di RSUPN Cipto Mangunkusumo Jakarta dan sebagian besar jenis anestesia pada bedah rawat jalan adalah anestesia umum. Perkembangan ini harus diimbangi dengan peningkatan kualitas pelayanan anestesia. Oleh karena itu perlu dilakukan penilaian terhadap tingkat kepuasan pasien dan faktor-faktor yang memengaruhinya. Tingkat kepuasan pasien dapat memberikan feedback untuk meningkatkan kualitas pelayanan anestesia pada instalasi bedah rawat jalan. Tujuan : Mengetahui tingkat kepuasan pasien yang menjalani anestesia umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo dan faktor yang memengaruhinya. Metode : Penelitian ini adalah penelitian potong lintang. Dilakukan penilaian tingkat kepuasan pada 76 pasien dengan menggunakan kuesioner yang telah divalidasi. Kriteria penerimaan adalah usia 18-65 tahun yang menjalani pembiusan umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo Jakarta, dapat berbahasa Indonesia, membaca dan menulis, bersedia berpartisipasi dan menandatangani surat persetujuan penelitian, pulang dihari yang sama setelah pembedahan atau dirawat kurang dari 24 jam. Hasil kuesioner akan diolah menggunakan perangkat lunak SPSS dengan uji univariat dan bivariat. Hasil : Uji univariat menunjukkan tingkat kepuasan pasien terhadap anestesia umum rata-rata diatas 70 %. Sedangkan dari uji bivariat, faktor yang berpengaruh terhadap tingkat kepuasan pasien adalah usia, jenis kelamin dan pekerjaan. Kesimpulan : Pasien merasa puas terhadap pelayanan anestesia umum pada instalasi bedah rawat jalan di RSUPN Cipto Mangunkusumo Jakarta. Karakteristik pasien yang memengaruhi tingkat kepuasan pasien adalah usia, jenis kelamin dan pekerjaan.

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Background : Patient satisfaction has been one of quality indicators in anesthesia services whether it is inpatient or outpatient. Ambulatory surgery offers more advantages compares to inpatient services, thus it developed nicely in Indonesia especially in RSUPN Cipto Mangunkusumo Jakarta where most patients undergone general anesthesia. This development is yet to be offset by improvement in anesthesia quality services. Thus, it is needed to assess patient satisfaction and factors. Patient satisfaction can give feedback to improve quality of anesthesia services in ambulatory surgery.

Purpose : The purpose of this study was to know patient satisfaction toward general anesthesia and influencing factors in ambulatory surgery RSUPN Cipto Mangunkusumo Jakarta.

Methods : This is a cross sectional study. Patient satisfaction was assessed in 76 patients using validated questionnaire. The inclusion criteria were age 18-65 undergoing general anesthesia in Ambulatory Surgery, Bahasa speaking, able to read and write, and agreed to participate in this study by signing research consent and discharged on the same day or hospitalized less than 24 hours after surgery. Result was processed using SPSS with univariate and bivariate test.

Results: Univariate test showed patient satisfaction toward general anesthesia was above 70%. While Bivariate test indicated factors influencing patient satisfaction were age, gender and occupation.

Conclusion : Patients were satisfied with general anesthesia services in Ambulatory Surgery RSUPN Cipto Mangunkusumo Jakarta. Patient characteristics influencing patient satisfaction were age, gender and occupation."

"[ABSTRAK Latar belakang. Penyuntikan berulang pada prosedur anestesia spinal berkaitan dengan tingginya angka komplikasi dan ketidaknyamanan pasien. Sistem prediksi praoperatif yang akurat terhadap kemungkinan kesulitan penempatan jarum spinal dapat membantu mengurangi insiden penyuntikan berulang sehingga mengurangi risiko komplikasi terhadap pasien. Penelitian ini bertujuan untuk mengetahui ketepatan prediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi. Metode. Penelitian ini bersifat observasional analitik terhadap pasien bedah urologi yang menjalani anestesia spinal di Rumah Sakit Cipto Mangunkusumo pada bulan April sampai Mei 2015. Sebanyak 109 subyek diambil dengan metode consecutive sampling. Data pasien (usia, jenis kelamin, indeks massa tubuh, status fisik, gambaran radiologis vertebrae lumbal, dan kualitas penanda anatomis tulang belakang), jumlah penusukan kulit dan redireksi jarum spinal, serta angka kesulitan penempatan jarum spinal dicatat. Kesulitan penempatan jarum spinal ditentukan berdasarkan jumlah penusukan kulit dan redireksi jarum spinal. Variabel yang signifikan ditentukan melalui uji Pearson?s Chi-square dan uji Fisher, kemudian analisis multivariat dengan metode regresi logistik digunakan untuk melihat hubungan antara kesulitan penempatan jarum spinal dengan variabel-variabel yang signifikan. Hasil. Faktor usia memiliki hubungan yang bermakna hanya pada analisis bivariat (p=0,028). Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal memiliki nilai prediksi terhadap kesulitan penempatan jarum spinal (p=0,000 dan p=0,006). Hasil uji kalibrasi menunjukkan kualitas prediksi yang baik. Dari uji diskriminasi didapatkan AUC sebesar 0,84 (IK 95% 0,751-0,929). Simpulan. Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal mampu memprediksi kesulitan penempatan jarum spinal dengan tepat pada pasien bedah urologi. ABSTRACT Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ;Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. , Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.

Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson’s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.

Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).

Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ]"