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

"Latar Belakang: Tindakan pembedahan dengan invasi minimal seperti laparoskopi abdomen seringkali menjadi modalitas terpilih dengan perkembangan teknologi. Selama pembedahan, digunakan teknik anestesi umum pada pasien. Teknik anestesi yang ideal adalah teknik yang dapat menjaga kestabilan kardiovaskular dan respirasi, mengurangi kejadial mual muntah pascabedah, serta dapat mengurangi derajat nyeri pascabedah. Namun, prosedur laparoskopi menyebabkan perubahan fisiologis akibat kondisi pneumoperitoneum yang disebabkan oleh insuflasi gas karbon dioksida selama pembedahan, yang merupakan sebuah tantangan tambahan dalam pemberian anestesi yang ideal. Maka, penelitian ini bertujuan untuk membandingkan efektivitas penggunaan kombinasi anestesi umum dan spinal dengan anestesi umum saja dalam pembedahan laparoskopi abdomen.Metode: Penelitian ini merupakan uji klinik acak terkendali tanpa penyamaran pada pasien laparoskopi abdomen di Rumah Sakit Cipto Mangunkusumo. Pemberian anestesi umum menggunakan lidokain, fentanyl, propofol, dan rocuronium. Pemberian anestesi spinal menggunakan bupivakain 10 mg. Luaran yang dinilai berupa kebutuhan opioid intraoperatif, kestabilan MAP, nyeri pascabedah, dan kejadian post-operative nausea and vomiting (PONV).Hasil: Kombinasi anestesi umum dan spinal menyebabkan penurunan kebutuhan opioid fentanyl intraoperatif (p<0.001), kestabilan MAP yang lebih baik (p<0.009), dan penurunan nyeri pascabedah secara signifikan dibandingkan kelompok anestesi umum. Tidak terdapat perbedaan signifikan dari tingkat kejadian PONV. Simpulan: Kelompok anestesi umum dan spinal menunjukan penurunan kebutuhan opioid intraoperatif dan MAP yang lebih stabil pada tindakan laparaskopi dibandingkan dengan kelompok anestesi umum.

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Background: Minimally invasive surgical procedures such as laparoscopic abdominal surgery have often become the preferred modality with technological advancements. During surgery, general anesthesia techniques are employed in patients. The ideal anesthesia technique is one that can maintain cardiovascular and respiratory stability, reduce postoperative nausea and vomiting, and alleviate postoperative pain. However, laparoscopic procedures induce physiological changes due to pneumoperitoneum conditions caused by the insufflation of carbon dioxide gas during surgery, posing an additional challenge in achieving ideal anesthesia. Therefore, this study aims to compare the effectiveness of using a combination of general and spinal anesthesia with general anesthesia alone in laparoscopic abdominal surgery.

Methods: This research is a controlled randomized clinical trial without masking on patients undergoing laparoscopic abdominal surgery at Cipto Mangunkusumo Hospital. General anesthesia is administered using lidocaine, fentanyl, propofol, and rocuronium, while spinal anesthesia is administered using bupivacaine. The assessed outcomes include intraoperative opioid requirements, MAP stability, postoperative pain, and the incidence of postoperative nausea and vomiting (PONV).

Results: The combination of general and spinal anesthesia resulted in a significant reduction in intraoperative fentanyl opioid requirements (p<0.001), better MAP stability (p<0.009), and a significant decrease in postoperative pain compared to the general anesthesia group. There was no significant difference in the incidence of PONV .

Conclusion: The combination of general and spinal anesthesia group showed decreased intraoperative opioid requirements and more stable in mean arterial pressure (MAP) during laparoscopic procedures compared to general anesthesia group."

"Latar belakang : Penelitian ini membandingkan efek ropivakain hiperbarik 15 mg + morfin 0,15 mg dengan ropivakain hiperbarik 12 mg + morfin 0,15 mg untuk bedah sesar dengan analgesia spinal.Metode : Dilakukan secara acak tersamar Banda. Hipotesis yang dibuat adalah Ropivakain hiperbarik 12 mg dengan morfin 0,15 mg intratekal, mempunyai mula kerja hambatan sensorik dan motorik yang sama dengan ropivakain hiperbarik 15 mg ditambah morfin 0,15 mg intratekal, namun dengan masa kerja hambatan sensorik dan motorik lebih singkat, dan dapat digunakan untuk anestesia spinal pada bedah sesar. Sebanyak 66 wanita hamil yang akan menjalani beddah sesar, ASA I -- II diberikan ropivakain hiperbarik 15 mg + morfin 0,15 mg (n=33) atau ropivakain hiperbarik 12 mg + morfin 0,15 mg (n-33) dengan teknik blok subaraknoid. Perubahan blok sensorik diukur dengan tes pinprick, dan perubahan hambatan motorik diukur dengan modifikasi skala bomage, VAS diukur 3 kali.Basil : Tidak ada perbedaan bermakna pada data demografi kedua kelompok. Kelompok ropivakain 15 mg mempunyai penyebaran hambatan sensorik maksimal lebih tinggi (median [min-max]) : Th 4 (th 1 - 6) vs Th 5 (Th 2 -- 6), tidak ada perbedaan bermakna pada mula kerja hambatan sensorik (median [min-max]) : 3,2 mnt (2 - 5 mnt) vs 3,0 (1- 5 mnt), tidak ada perbedaan bermakna pada mula keija hambatan motorik (median [min-max]) : 3,3 mnt (1-10 mnt) vs 3 mnt (1-7 mnt), masa kerja hambatan sensorik lebih lama pada kelompok ropivakain 15 mg (median [min-max]) : 60 mnt (45 -120mnt) vs 52 mnt (30 - 103 mnt), masa kerja hambatan motorik lebih lama pada kelompok ropivakain 15 mg (median[min-max]) : 60 mnt (35-118 mnt) vs 57 mnt (32 -102 mnt), dan basil yang sama pada pengukuran VAS sebanyak 3 kali.Simpulan : Ropivakain hiperbarik 15 mg + morfin 0,15 mg dan ropivakain hiperbarik 12 mg + mofin 0,15 mg dapat digunakan untuk analgesia spinal untuk operasi bedah sesar.

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Background This study was designed to evaluate the effects of intrathecal hyperbaric ropivacaine 15 mg plus morln 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg in women undergoing cesarean section.Methods : This was a prospective, randomized, doubleblinded study. We hypothesized that hyperbaric ropivacaine 12 mg plus morphin 0,15 mg has the same onset of sensory and motoric block, with longer duration of sensory and motoric block with hyperbaric ropivacaine 15 mg plus morphine 0,15 mg. Sixtysix parturients, physical status ASA I - II were given either hyperbaric ropivacaine 15 mg plus morphine 0,15 mg (n=33) or hyperbaric ropivacaine 12 mg plus morphine 0,15 mg (n=33), for cesarean section with spinal analgesia. Changing of sensory block was assessed by pinprick test and motoric block was assessed by bromage score (modification). Visual analogue score was measured three times.Results : There were no significant differences in demographic variable between groups. Higher cephalic spread (median [range]) maximum block height to pinprick hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg : Th 4 (th 1 - 6) vs Th 5 (Th 2 - 6), no significant difference of sensory block onset (median [range]) : 3,2 min (2 - 5 minutes) vs 3,0 (1 - 5 min), no significant difference of motoric block onset (median [range]) : 3,3 min (1-10 min) vs 3 min ( 1-7 min), longer sensoric block duration hyperbaric ropivacaine 15 mg compare to hyperbaric ropivacaine 12 mg (median [range]) : 60 min (45 -120min) vs 52 min (30 -- 103 min), longer motoric block duration in hyperbaric ropivacaine 15 mg compare hyperbaric ropivacaine 12 mg (median[range]) : 60 min (35-118 min) vs 57 min (32 - 102 min), and no significant difference in visual analogue score in three times measurements.Conclusion : Hyperbaric ropivacaine 15 mg plus morphine 0,15 mg and hyperbaric ropivacaine 12 mg plus morphine 0,15 mg are sufficient for spinal analgesia in patients undergoing cesarean section."

"[Latar Belakang: Anestesia spinal pada wanita hamil sangat dipengaruhi oleh posisi pasien. Pendant position merupakan posisi yang baru diperkenalkan pada laporan kasus. Penelitian ini bertujuan untuk membandingkan keberhasilan penempatan jarum spinal pada usaha pertama antara pendant position dengan traditional sitting position untuk pasien yang menjalani pembedahan Sesar.Metode: Penelitian ini adalah uji klinik Randomized Controlled Trial (RCT), dilakukan secara terbuka (tidak tersamar). Subjek dilakukan randomisasi untuk menentukan perlakuan pendant position atau traditional sitting position. Keberhasilan penempatan jarum spinal dinilai dari jumlah usaha, jumlah kontak tulang dan lama waktu penempatan jarum spinal.Hasil: Sebanyak 308 subjek penelitian, tidak ada yang termasuk kriteriapenolakan dan pengeluaran. Keberhasilan penempatan jarum spinal pada usaha pertama untuk pendant position lebih baik (142 subjek (92%) vs 121 subjek (78%), p 0,001), total jumlah kontak tulang lebih sedikit (185 vs 421, p<0,001) dan median lama waktu yang dibutuhkan untuk penempatan jarum spinal lebih cepat ( 9 (4-350) vs 12 (5-486) detik, p<0,001) jika dibandingkan dengan traditional sitting position.Simpulan: Pendant position lebih baik dalam hal keberhasilan penempatan jarum spinal pada usaha pertama untuk pasien yang menjalani pembedahan Sesar jika dibandingkan traditional sitting position., Background: Spinal anesthesia in pregnant women is strongly influenced by the position of the patient. Pendant position is a new position introduced in the case report. This study aimed to compare the successful placement of spinal needle on the first attempt between pendant position and traditional sitting position for patients who underwent sectio Caesarean.Methods: The study was a randomized controlled trial (RCT), conducted openly (not blind). Subject randomization to determine treatment pendant position or traditional sitting position. The successful placement of spinal needle judged from the number of first attempt, the amount of bone contact and the duration of the placement of spinal needle. Results: A total of 308 subjects, none of which include criteria for exclusion and drop out. The successful placement of spinal needle on the first attempt of pendant position is better (142 subjects (92%) vs. 121 subjects (78%), p 0.001), the total amount of bone contact is less (185 vs. 421, p <0.001) and the median length of time required for placement of spinal needle is faster (9 (4-350) vs. 12 (5-486) seconds, p <0.001) when compared to the traditional sitting position.Conclusion: Pendant position is better in terms of the successful placement of spinal needle on the first attempt for a patient who underwent sectio Caesarean compared to traditional sitting position.]"

"Latar Belakang : 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."

"[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.]"

"Berbagai studi dan penelitian telah dilakukan di berbagai negara untuk mengetahui pengetahuan pasien terhadap anestesia namun tidak ada instrumen kuesioner yang baku untuk menilai pengetahuan pasien tentang anestesia, dan hal ini belum pernah dilakukan di Indonesia khususnya di RSUPN Cipto Mangunkusumo. Kuesioner pengetahuan yang valid dan reliabel diharapkan menjadi standar untuk menilai pengetahuan masyarakat terhadap anestesia, dan dapat menjadi dasar bagi penelitian selanjutnya.Metode: Kuesioner pengetahuan anestesia sebelumnya telah melalui tahapan pretest oleh ahli dan uji pilot, hasil kuesioner uji pilot disempurnakan sehingga dianggap layak diujicobakan. Penelitian dilakukan pada bulan Januri 2014 sampai dengan Maret 2014 terhadap subyek secara consecutive sampling yang akan menjalani pembiusan dan diperiksa di klinik preoperatif RSUPN Cipto Mangunkusumo Jakarta. Teknik uji validitas menggunakan validitas konstruk dengan koefisien korelasi minimal 0,3 dapat dianggap valid dan uji reliabilitas menggunakan teknik konsistensi internal dengan nilai cronbach α minimal 0,4 dianggap reliabel.Hasil: Penelitian ini diikuti oleh 95 subyek dengan 1 subyek dikeluarkan dari penelitian karena tidak mengisi kuesioner secara lengkap. Kuesioner pengetahuan terdiri dari 20 pertanyaan, 8 pertanyaan diantaranya dinilai tidak valid dan reliabel yang dapat disebabkan oleh pertanyaan dan jawaban kuesioner yang tidak dapat dimengerti oleh subyek, pembahasan terlalu dalam dan penggunaan istilah medis yang tidak familiar. Beberapa jawaban pertanyaan memiliki kesamaan yang dapat membingungkan subyek, serta terdapat inkonsistensi jawaban yang diberikan oleh subyek. Tingkat penghasilan dan pendidikan subyek yang rendah serta pengalaman dan informasi yang kurang, sangat mempengaruhi pengetahuan subyek terhadap anestesia, tercermin dari rendahnya rerata tingkat pengetahuan subyek sebesar + 31,6%.Kesimpulan: Kuesioner penilaian pengetahuan tentang anestesia pada pasien di klinik preoperatif RSUPN Cipto Mangunkusumo tidak dapat dijadikan sebagai suatu standar instrumen yang baku oleh karena dinilai tidak valid dan reliabel.

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Various studies and researches have been conducted abroad to determine the patient?s anesthesia knowledge, although no standard questionnaires exist. Research on anesthesia?s knowledge questionnaires have never been done specifically in Cipto Mangunkusumo hospital. A valid and reliable questionnaire is aimed to be a standard instrument assessing the community?s knowledge on anesthesia, and as a foundation for future researches.Methods: The anesthesia knowledge questionnaires has been evaluated through a pre-test phase done by experts and pilot test, the results was then revised until it is acceptable and can be tested. Researches was conducted on January 2014 until March 2014 on subjects by consecutive sampling who are going to undergo anesthesia and evaluated at the preoperative clinic Cipto Mangunkusumo Hospital Jakarta. Validity test techniques using construct validity with the minimal correlation coefficient 0.3 is valid. Reliability tests using internal consistency techniques with minimal cronbach alpha value 0.4 is reliable.Results: Research was participated by 95 subjects with 1 subject excluded from the research because of not filling in the questionnaire completely. The knowledge questionnaire included 20 questions, whereas 8 questions was marked to be invalid and unreliable that may be caused by questions and answers were not fully understood by the subjects, the contents was too spesific, usage of medical terms that aren?t familiar. Some of the given answers have similarities that may confuse the subject, and also inconsistency from the subject?s answers. Low level of salary and education with lacking of experience and information from the subjects, has significant influence on the subjects knowledge on anesthesia which is reflected by the low average level of the subject`s knowledge which is + 31.6%.Conclusions: Anesthesia knowledge questionnaires on patients at preoperative clinic Cipto Mangunkusumo hospital is invalid and unreliable therefore fail to be a standard instrument."

"Latar belakang dan tujuan: Anastasia subarahnoid adalah salah satu tindakan anestesia regional yang sexing dilakukan untuk bedah sesar. Bupivakain hiperbarik 0,5% adalah obat anestetik lokal yang lazim dipakai untuk tehnik pembiusan tersebut. Posisi tubuh dan gaya gravitasi memiliki efek dan mempengaruhi penyebaran dari obat yang bersifat hiperbarik. Penelitian ini dilakukan untuk mengetahui pengaruh posisi tubuh saat penyuntikan obat bupivakain hiperbarik 0,5% terhadap efek hipotensi yang ditimbulkan.Metode : Penelitian dilakukan terhadap 90 wanita hamil berstatus ASA I-II usia 17-50 tahun yang menjalani bedah sesar, dibagi secara arak menjadi 2 kelompok duduk dan lateral dekubitus kiri. Setelah dilakukan penyuntikan obat, setelah 2 menit pasien dikembalikan ke posisi terlentang miring kiri 15 derajat, dan dilakukan co loading kristaloid 10 mllkgBB selama 10 menit Dilakukan pencatatan tekanan darah selama operasi setiap 2 menit selama 20 menit pertama clan selanjutnya tiap 5 menit. Ketinggian hambatan sensorik clan ketinggian maksimal hambatan, jumlah total efedrin dan cairan kristaloid yang diberikan selama operasi juga dicatat. Data hasil penelitian diolah dengan menggunakan uji t, uji Mann Whitneydan uji Chi kuadrat.Hasil : Kekerapan hipotensi antara kelompok posisi duduk dan lateral dekubitus kiri tidak berbeda secara statistik meskipun lebih banyak terjadi pada kelompok lateral dekubitus kiri (67%) dibandingkan posisi duduk (51%). Posisi duduk mengalami hipotensi lebih lambat, derajat hipotensinya lebih rendah dan pemakaian efedrin yang lebih sedikit.Kesimpulan: Posisi tubuh saat penyuntikan that bupivakain hiperbarik 0,5% pada anestesia subarahnoid mempengaruhi derajat hipotensi yang terjadi pada kasus bedah sesar.

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Backgrounds and objectives . Spinal anesthesia is one of the regional anesthesia technique frequently performed for cesarean section. Hyperbaric bupivacaine 0.5% is the most frequent local anesthetic used for this technique. Spread of the hyperbaric local anesthetics is affected by the position of the patient and gravity. In the present study we evaluated the effect of maternal posture whether sitting position during the induction of spinal anesthesia using 05% hyperbaric bupivacaine would induce less hypotension as compared with the left lateral position.

Methods. Ninety pregnant women underwent cesarean delivery were randomly assigned to receive a spinal injection consisting of 12.5 mg 0.5% hyperbaric bupivacaine in either sitting or left lateral position. After 2 minutes, patients were turned to a 15 degrees left lateral position and intravenous infusion of 10 mllkgbodyweigh t of crystalloids was started for 10 minutes along with the induction of spinal anesthesia. Intraoperative blood pressure were recorded , in this study hypotension is defined as a decrease in systolic blood pressure less than 100 mmHg or 20% below baseline values. The height of sensory block was measured, time to T6 spread of the sensory block and the highest level of sensory blockade were noted. Total given of ephedrine and crystalloids rntraopertive were also noted. Statistical evaluation was performed using t?test, Mann Whitney test and Chi square as appropriate.

Result : The incidence of hypotension was not significantly different between sitting and left lateral position but more often in lateral position (51% vs 67%). Sitting position group has longer interval of the first hypotension (p=0.008),less severe of hypotension (p=0.042), less ephedrine supplementation (p=0.014), and longer interval for reaching the T6 dermatome blockade (p <0,0001).

Conclusion: Maternal posture during induction of spinal anesthesia using 0.5% hyperbaric bupivacaine has influence to severity of hypotension for cesarean section."

"Latar Belakang: Penjadwalan operasi yang baik adalah yang mengoptimalkan workflow suatu kamar operasi, mengurangi kasus pembatalan operasi, dan ketidaktepatan prediksi waktu operasi. Unit Pelayanan Bedah Terpadu RSUPN Dr. Cipto Mangunkusumo memiliki peran besar terhadap berlangsungnya operational efficiency sehingga hal-hal terkait efisiensi kerja yang termasuk didalamnya penjadwalan pasien di kamar operasi menjadi fokus perhatian utama. Penelitian ini bertujuan untuk menilai korelasi waktu persiapan, induksi, dan pemulihan anestesi berdasarkan pemilihan teknik anestesi terhadap anesthesia-controlled time (ACT). Metode: Penelitian ini merupakan penelitian observasional yang dilaksanakan di Unit Pelayanan Bedah Terpadu RSUPN Dr. Cipto Mangunkusumo sejak Maret 2019 hingga Desember 2020, dengan total 1727 sampel yang memenuhi kriteria inklusi dan tidak memiliki kriteria eksklusi. Tim anestesi kamar operasi dengan menggunakan jam digital melakukan observasi, pengambilan, dan pencatatan data waktu secara manual kedalam lembar kuesioner yang disediakan di kamar operasi atau secara daring dengan mengakses tautan yang tersedia.Hasil: Terdapat hubungan linier positif yang bermakna antara waktu persiapan anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.1, p 0.009), anestesi umum-ETT, CVC, ABP (r=0.253, p 0.028), dan anestesi umum-ETT/LMA, blok saraf perifer, CVC, ABP (r=0.489, p 0.013); waktu pemasangan monitor dengan ACT pada teknik anestesi umum-ETT (r=0.125, p 0.001), anestesi umum-ETT, CVC, ABP (r=0.502, p 0.000), anestesi umum-ETT/LMA, epidural (r=0.372, p 0.001), anestesi umum-ETT, epidural, CVC (r=0.436, p 0.006), sedasi (r=0.516, p 0.001), spinal (r=0.501, p 0.000), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.321, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.445, p 0.001); waktu induksi anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.513, p 0.000), anestesi umum-ETT, CVC, ABP (r=0.391, p 0.001), anestesi umum-LMA (r=0.312, p 0.017), anestesi umum-ETT/LMA, epidural (r=0.818, p 0.000), anestesi umum-ETT, epidural, CVC, ABP (r=0.559, p 0.000), spinal (r=0.503, p 0.000), kombinasi spinal-epidural (r=0.779, p 0.000), blok saraf perifer (r=0.729, p 0.000), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.511, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.543, p 0.000); waktu insersi CVC dengan ACT pada teknik anestesi umum-ETT/LMA, CVC (r=0.553, p 0.002), anestesi umum-ETT, CVC, ABP (r=0.434, p 0.000), anestesi umum-ETT, epidural, CVC (r=0.415, p 0.010), dan anestesi umum-ETT, epidural CVC, ABP (r=0.288, p 0.023); waktu pemulihan anestesi dengan ACT pada teknik anestesi umum-ETT (r=0.157, p 0.000), anestesi umum-ETT/LMA, CVC (r=0.664, p 0.000), anestesi umum-ETT, CVC, ABP (r=0.374, p 0.001), anestesi umum-LMA (r=0.299, p 0.023), anestesi umum-ETT/LMA, epidural (r=0.557, p 0.000), anestesi umum-ETT, epidural, CVC (r=0.338, p 0.035), anestesi umum-ETT, epidural, CVC, ABP (r= 0.343, p 0.006), sedasi (r=0.351, p 0.033), anestesi umum pediatrik-ETT/LMA, CVC, ABP (r=0.424, p 0.000), dan anestesi umum pediatrik-ETT/LMA, kaudal (r=0.589, p 0.000). Simpulan: Waktu persiapan, induksi, dan pemulihan anestesi tidak berkorelasi dengan anesthesia-controlled time berdasarkan pemilihan teknik anestesi di Unit Pelayanan Bedah Terpadu Rumah Sakit Dr Cipto Mangunkusumo.

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ackground: An ideal operating schedule is the one that optimizes the workflow of an operating room, reduces case cancellation and inaccurate prediction of total procedural time. Central Surgical Unit of Dr. Cipto Mangunkusumo Hospital has a major role of ensuring the continuity of operational efficiency so that matters related to work efficiency, including patient scheduling in the operating room, are the main focus of attention. This study aims to assess the correlation of time of preparation, anesthesia induction and recovery time with anesthesia-controlled time (ACT) based on the choice of anesthesia technique. Methodes: This observational research was done in Central Surgical Unit of Dr. Cipto Mangunkusumo Hospital from March 2019 to December 2020, with a total of 1727 samples that fulfilled inclusion criteria, without exclusion criteria. By means of using a digital clock, anesthesia team performs observations, retrieval, and recording of time data manually into a questionnaire sheet provided in the operating room or an online document by accessing the link provided.Results: There is a significant positive linear correlation between anesthesia preparation time and ACT on general anesthesia-ETT (r=0.1, p 0.009), general anesthesia-ETT, CVC, ABP (r=0.253, p 0.028), and general anesthesia-ETT/LMA, peripheral nerve block, CVC, ABP technique (r=0.489, p 0.013); basic monitoring placement time and ACT on general anesthesia-ETT (r=0.125, p 0.001), general anesthesia-ETT, CVC, ABP (r=0.502, p 0.000), general anesthesia-ETT/LMA, epidural (r=0.372, p 0.001), general anesthesia-ETT, epidural, CVC (r=0.436, p 0.006), sedation (r=0.516, p 0.001), spinal (r=0.501, p 0.000), pediatric general anesthesia-ETT/LMA, CVC, ABP (r=0.321, p 0.000), and pediatric general anesthesia-ETT/LMA, caudal technique (r=0.445, p 0.001); anesthesia induction time and ACT on general anesthesia-ETT (r=0.513, p 0.000), general anesthesia-ETT, CVC, ABP (r=0.391, p 0.001), general anesthesia-LMA (r=0.312, p 0.017), general anesthesia-ETT/LMA, epidural (r=0.818, p 0.000), general anesthesia-ETT, epidural, CVC, ABP (r=0.559, p 0.000), spinal (r=0.503, p 0.000), combined spinal-epidural (r=0.779, p 0.000), peripheral nerve block (r=0.729, p 0.000), pediatric general anesthesia-ETT/LMA, CVC, ABP (r=0.511, p 0.000), and pediatric general anesthesia -ETT/LMA, caudal technique (r=0.543, p 0.000); CVC insertion time and ACT on general anesthesia-ETT/LMA, CVC (r=0.553, p 0.002), general anesthesia-ETT, CVC, ABP (r=0.434, p 0.000), general anesthesia-ETT, epidural, CVC (r=0.415, p 0.010), and general anesthesia-ETT, epidural CVC, ABP technique (r=0.288, p 0.023); anesthesia recovery time and ACT on general anesthesia-ETT (r=0.157, p 0.000), general anesthesia-ETT/LMA, CVC (r=0.664, p 0.000), general anesthesia-ETT, CVC, ABP (r=0.374, p 0.001), general anesthesia-LMA (r=0.299, p 0.023), general anesthesia-ETT/LMA, epidural (r=0.557, p 0.000), general anesthesia-ETT, epidural, CVC (r=0.338, p 0.035), general anesthesia-ETT, epidural, CVC, ABP (r= 0.343, p 0.006), sedation (r=0.351, p 0.033), pediatric general anesthesia-ETT/L anesthesia-ETT/LMA, caudal technique(r=0.589, p 0.000). Conclusions: Time of anesthesia preparation, induction, and recovery do not correlate with ACT based on the anesthesia technique used to fascilitate surgery in Central Surgical Unit of Dr Cipto Mangunkusumo Hospital."