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"Introduksi: Iskemia yang terjadi di suatu lokasi di tubuh mengakibatkan kerusakan pada lokasi yang berjauhan; kondisi ini dikenal dengan sebutan cedera reperfusi. Vili intestinal merupakan satu target organ terjadinya kerusakan pada cedera reperfusi dan menjadi motor kegagalan multi organ sistemik. Hipotermia yang ditakuti pada syok justru menunjukkan keuntungan karena bersifat proteksi terjadinya kerusakan vili. Penelitian ini bertujuan membandingkan efek protektif hipotermia dan pre-conditioning pada iskemia.Metode. Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (hipotermia dan pre-conditioning). Dilakukan ligasi a. iliaca communis selama 4 jam, hipotermia sedang (28°C), dan iskemia pre-conditioning pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Setelah dekapitasi, diambil sampel ileum untuk pemeriksaan histopatologi.Hasil: Dari 18 kelinci eksperimental, 1 mengalami drop out karena infeksi. Dilakukan skoring kerusakan vili intestinal berdasarkan kriteria Pusponegoro yang dimodifikasi dengan nilai minimal 4 dan maksimum 12. Kelompok perlakuan pre-conditioning mengalami kerusakan paling minim (= 6,2 ) diikuti kelompok hipotermia (= 7,1).Konklusi: Pre-conditioning menunjukkan kerusakan paling minim; dengan kata lain memberi efek proteksi lebih baik dibandingkan dengan kelompok lainnya.

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Introduction: Ischemia occurring in a location in the body results in damage to distant locations; this condition is known as reperfusion injury. Intestinal vilia is a target organ of the occurrence of damage to reperfusion injury and a motor failure of multi-organ systemic. The dreaded hypothermia in shock actually shows an advantage because it protects the occurrence of villous damage. This study aimed to compare the protective effect of hypothermia and pre conditioning on ischemia.

Methods: Experimental studies were conducted on New Zealand White rabbit (n = 18) with one control group (ischemia) and two treatment groups (hypothermia and pre-blocking). Conducted ligation a. iliaca communist for 4 hours, moderate hypothermia (28°C), and preconditioning ischemia in each group. Then the rabbit is left alive for 8 hours. After decapitation, ileum samples were taken for histopathologic examination.

Results: Of the 18 experimental rabbits, 1 had dropped out due to infection. Scores of villus intestinal damage were performed based on modified Pusponegoro criteria with a minimum score of 4 and a maximum of 2. The pre-treatment group experienced the least damage (=6.2) followed by the hypothermia group (=7,1).

Conclusion: Pre conditioning shows the least damage; in other words gives a better protective effect compared to other groups."

"[Latar Belakang : Iskemia yang terjadi pada lokasi di tubuh mengakibatkan cedera otot reversible sampai ireversibel. Tindakan reperfusi ternyata dapat memperburuk keadaan yang disebabkan oleh kondisi iskemik. Beberapa penelitian terdahulu mencoba mencari teknik proteksi untuk mengurangi efek iskemik reperfusi diantaranya teknik iskemik prekondisi dan teknik hipotermi.Metode : Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (preconditioning dan hipotermia). Dilakukan ligasi a. iliaka komunis selama 4 jam, hipotermia sedang (28oC), dan iskemik prekondisi pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Sampel jaringan otot femoralis di ambil untuk pemeriksaan derajat kerusakan otot secara histopatologi.Hasil : Terdapat penurunan secara histopatologi derajat kerusakan otot yang di berikan perlakuan IPC dan perlakuan Hipotermi terhadap kelompok control. Analisis statistik tampak perbedaan bermakna pada sebagian parameter.Kesimpulan : Iskemik Prekondisi dan Hipotermi memberikan efek protektif pada otot dari akibat iskemik reperfusi tungkai bawah akut.;Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic.Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes.Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parametersConclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia., Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic.Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes.Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parametersConclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia.]"

"Pengaruh Prekondisi dan Hipotermia pada Cedera Iskemia-Reperfusi Terhadap Endotel Pembuluh Darah Perifer pada Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih3 1Program Studi Ilmu Bedah, Fakultas Kedokteran Universitas Indonesia2Departemen Medik Ilmu Bedah, RSUPN Cipto Mangunkusumo Pendahuluan. Cedera iskemia -reperfusi CI/R merupakan masalah serius yang dihadapi pascahipoksia; menyebabkan kerusakan sel yang letaknya remote organ injury. Intervensi prekondisi iskemia-reperfusi PI/R merupakan fenomena jaringan yang diberikan stimulasi hipoksia berulang sebelum mendapatkan keadaan iskemia lama. Keadaan hipotermia iskemia reperfusi HI/R menyebabkan metabolisme sel menurun termasuk respon sel terhadap iskemia. Penelitian ini bertujuan untuk mengetahui efek intervensi PI/R dan HI/R terhadap perubahan morfologi endotel pembuluh darah dan peningkatan kadar malondialdehyde MDA sebagai respon stress oksidatif pada jaringan endotel a/v femoralis komunis distal obstruksi iskemia dan kontralateral CI/R. Metode: Studi eksperimental yang bersifat deskriptif analitik pada Oryctolagus cuniculus, Pada kelompok CI/R dilakukan ligasi arteri femoralis komunis dalam pembiusan selama empat jam untuk menginduksi iskemia. Pada kelompok PI/R dilakukan dengan ligasi berulang arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus, kemudian diligasi selama empat jam. Pada kelompok hipotermia, dilakukan ligasi arteri femoralis komunis selama empat jam yang disertai dengan membungkus ekstremitas bawah kanan dengan es dengan target suhu antara 31-33 C, kemudian pada ketiga intervensi ligasi dibuka dan kelinci dibiarkan beraktivitas selama delapan jam. Setelah itu, dilakukan pengambilan sampel a.v yang berasal dari distal dari ligasi ipsilateral dan kontralateral untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Pada pemeriksaan histomorfologi menunjukan perbedaan bermakna antara skoring kerusakan endotel jaringan a.v. ipsilateral pada ketiga sampel intervensi dibanding kontrol dan nilai sampel intervensi preventif lebih baik daripada sampel CI/R p< 0,05 . Pada sampel a.v kontralateral kelompok PI/R dan HIR tidak memiliki perbedaan bermakna dengan kontrol p> 0,05 . Pada evaluasi kadar MDA ditemukan kadar MDA meningkat pada semua intervensi baik pada CIR, PI/R, dan HI/R yang tidak berbeda bermakna dengan kontrol p> 0,05. Konklusi: Keadaan CI/R menyebabkan disfungsi endotel bukan hanya pada daerah iskemik, namun pada organ yang letaknya berjauhan. Kerusakan endhotelial lining dapat dicegah dengan tindakan PI/R dan HI/R dan peningkatan kadar MDA merupakan respon fisiologis jaringan terhadap iskemia dan cedera reperfusi yang terjadi baik pada CI/R, PI/R, dan HI/R.

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The Effect of Preconditioning and Hypothermia in Ischemia Reperfusion Injury to the Endothelial Cells from Peripheral Blood Vessels in Oryctolagus cuniculusM Febriadi Ismet1 Yefta Moenadjat2 Aria Kekalih31General Surgery Science Study Program, Faculty of Medicine Universitas Indonesia2Department of Surgery, Dr. Cipto Mangunkusumo National General HospitalIntroduction. Ischemia reperfusion injury IRI is a serious problem in the post hypoxia period, which causes remote organ injury. Ischemic preconditioning IPC is a phenomenon where tissues are subjected to repeated hypoxic stimulations to protect against subsequent prolonged period of ischemia. Hypothermia during ischemia reperfusion injury HI decreases metabolism of cells including their response to ischemia. The goal of this study is to investigate the effects of interventions such as IPC and HI on the morphology of endothelial cells in blood vessels and the increased level of malondialdehyde MDA as an oxidative stress response in endothelial tissues of distal common femoral artery and vein obstruction ischemia and its contralateral IRI.

Method: This is a descriptive and analytic experimental study using Oryctolagus cuniculus. In the IRI group, the common femoral artery was ligated during anesthesia for four hours to induce ischemia. In the IPC group, the right common femoral artery was continually ligated for two minutes, which was then released for three minutes for two cycles, and then ligated for four hours. In the hypothermia group, the common femoral artery was ligated for four hours and the right lower extremity was wrapped in ice with the target temperature range between 31 33o C. Then the arteries from the three interventions were unligated and the rabbit was released to observe its activity for eight hours. Next, samples of artery and vein distal from the ligation ipsilateral and its contralateral were obtained for histopathological and biochemical examinations. The biochemical analysis was performed using malondialdehyde MDA.

Results: The histomorphological examination showed significant difference in the injury scores between the endothelial tissues from ipsilateral artery and vein in the three interventional samples compared with control, and the scores for the preventive intervention groups were better than the IRI sample p0.05.

Conclusion: Ischemic reperfusion injury can cause not only endothelial dysfunction in the ischemic area, but also remote organ injury. Endothelial lining injury can be prevented by IPC and HI. The elevated level of MDA is a physiological response of tissue after ischemia reperfusion injury which could be found on IRI, IPC, and HI."

"Pendahuluan: Cedera iskemia reperfusi CI/R merupakan masalah serius yang dihadapi pascahipoksia menyebabkan kerusakan sel yang letaknya berjauhan remote organ injury. Strategi yang digunakan untuk mengurangi kerusakan hepar pascaiskemia adalah melalui penerapan ischemic pre conditioning PI/R dan hiportemia. PI/R telah terbukti mengurangi kerusakan jaringan melalui mekanisme resistensi terhadap iskemia dan kebutuhan energi lebih rendah. Sedangkan hipotermia menghambat laju kematian sel sehingga dapat diterapkan sebagai terapi awal pada tatalaksana trauma dengan tujuan mencegah kerusakan bertambah berat. Penelitian ini bertujuan untuk diketahuinya efek protektif PI/R dan hipotermia terhadap perubahan morfologi jaringan hepar dan peningkatan kadar malondialdehyde MDA sebagai respon stress oksidatif. Metode: Studi eksperimental pada 24 ekor Oryctolagus cuniculus. Kelompok iskemia dilakukan ligasi arteri femoralis komunis dalam pembiusan selama empat jam untuk menginduksi iskemia, kemudian ligasi dibuka dan kelinci dibiarkan beraktivitas selama delapan jam. Pada kelompok PI/R dilakukan ligasi berulang arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus, kemudian diligasi selama empat jam. Kelompok hipotermia, dilakukan iskemia disertai membungkus ekstremitas bawah kanan dengan es, suhu antara 31-33oC Kemudian dilakukan laparotomi, dan diambil organ hepar. Pemeriksaan histopatologi hepar dilihat dari 3 zona, sentral, midzonal, perifer. Untuk menilai stress oksidatif jaringan dilakukan pemeriksaan biokimia dengan malondialdehyde MDA. Dilakukan uji statistik terhadap variabel tersebut dengan kemaknaan. Hasil: Pada pemeriksaan histomorfologi terdapat perbedaan perubahan histomorfologi pada sampel kontrol PI/R, dan Hipotermia terhadap iskemia (p<0,05). Derajat kerusakan histomorfologi pada kelompok PI/R lebih rendah dibandingkan kelompok iskemia reperfusi pada semua zona (p sentral = 0,015, p medial = 0,019, p perifer = 0,026). Analisis kadar MDA memperlihatkan terjadi peningkatan pada kelompok iskemia reperfusi menujukkan adanya stress oksidatif. Kadar MDA pada kelompok PI/R dan hipotermia lebih rendah dibandingkan kelompok iskemia.(p = 0,002). Konklusi: Keadaan iskemia reperfusi menyebabkan perubahan histomorfologi dan stres oksidatif sel–sel hepar. PI/R dan hipotermia mempunyai efek protektif pada cedera iskemia reperfusi. Efek protektif PI/R lebih baik dari hipotermia.

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Introduction: Ischemia-reperfusion injury IRI is a serious problem occuring after hypoxia it causes injuries to cells located remotely from one another remote organ injury. Strategies used to decrease hepatic injuries post ischemic condition are composed as ischemic pre-conditioning IPC and hypothermia management procedures. IPC has been proven to decrease tissue injuries through resistance mechanisms towards ischemia and lower energy requirements. Meanwhile, hypothermia detained the rate of cell deaths, therefore, it can be used as initial therapy on trauma management in order to prevent worsening of the injuries. This research aims to evaluate the protective effects of IPC and hypothermia towards morphological changes of hepatic tissues and the increase of malondialdehyde MDA level as a response to oxidative stress.Methods.

Methods: This research is an experimental, descriptive-analytical study on 24 Oryctolagus cuniculus. The specimens were divided into four groups, with one group as control. The ischemia group underwent femoral artery ligations under anesthesia for four hours to induce ischemia. Afterwards, the ligations were released and the rabbits were free to roam for eight hours. The IPC group underwent repeated ligations of right communal femoral artery for two minutes and three minutes of release in two cycles. Afterwards, the arteries were ligated for four hours. The hypothermia group underwent ischemia and wrapping of right lower extremities using ice, with temperature around 31-33oC. Afterwards, laparotomies were conducted on all groups to obtain and evaluate the liver. Hepatic histopathology assessment were conducted from 3 zones, the central, midzone, and peripheral zone. To evaluate the effects of oxidative stress on the tissue, a biochemical assessment with malondialdehyde MDA was conducted. Statistical tests were then conducted to assess the relationship between the variables with significance level p < 0.05.

Results: On histomorphological assessment, there were histomorphologic changes on control samples for IPC and hypothermia compared to ischemia p < 0.05. On MDA level analysis, there were increases in all four groups p < 0.05. However, there were no significant differences for the histomorphological changes when compared between central, medial, and peripheral zones.

Conclusion: Ischemic reperfusion condition causes histomorphological changes and oxidative stress on hepatic cells. IPC and hypothermia have protective effects from ischemia-reperfusion injuries. The protective effects of IPC was better than hypothermia."

"Pendahuluan: Revaskularisasi segera jaringan yang telah iskemia, tidak selalu membuahkan hasil yang diharapkan. Berbagai reaksi yang timbul dari pembentukan reactive oxygen species dan aktivasi sistem komplemen menyebabkan cedera iskemia reperfusi. Ischemia preconditioning PRC dan hipotermia diduga dapat mengurangi efek dari cedera iskemia reperfusi. Metode: Penelitian eksperimental ini adalah lanjutan dari penelitian sebelumnya, di mana dilakukan uji statistika terhadap kelompok kontrol dan tiga kelompok perlakuan, yaitu cedera reperfusi IRI, ischemia preconditioning PRC, dan hipotermia. Data kelompok kontrol dan IRI diambil dari penelitian sebelumnya. Kelompok PRC dan hipotermia masing-masing menggunakan enam hewan coba Oryctolagus cuniculus. Pada kelompok PRC dilakukan ligasi arteri femoralis komunis kanan selama dua menit, dilepaskan tiga menit sebanyak dua siklus. Pada kelompok hipotermia dilakukan pembungkusan ekstremitas bawah kanan dengan es. Kemudian kedua kelompok dilanjutkan dengan dilakukan pengikatan arteri femoralis komunis kanan selama empat jam, dan kemudian ikatan dilepaskan selama delapan jam. Kemudian dilakukan laparotomi, dan diambil organ gaster. Bagian antrum diambil untuk pemeriksaan histopatologi dan biokimia. Pemeriksaan biokimia dilakukan menggunakan malondialdehid MDA. Hasil: Uji hipotesis dari perbedaan histopatologi dan biokimia secara keseluruhan bermakna secara statistik. Derajat kerusakan secara histopatologi pada kelompok ischemia preconditioning lebih rendah dengan signifikan dibandingkan kelompok IRI; namun secara biokimiawi, lebih tinggi namun tidak signifikan. Derajat kerusakan secara histopatologi pada kelompok hipotermia lebih rendah namun tidak signifikan dibandingkan dengan kelompok IRI; namun secara biokimiawi, lebih tinggi dengan signifikan dibandingkan dengan kelompok IRI. Bila membandingkan PRC dan hipotermia, secara histopatologi, PRC lebih rendah dengan signifikan. Secara biokimia, rerata PRC lebih rendah namun tidak signifikan. Kesimpulan: Ischemia preconditioning memiliki efek protektif terhadap dampak destruktif yang yang dihasilkan oleh ischemia reperfusion injury terhadap organ jauh. terhadap organ jauh. Hipotermi juga memiliki efek protektif, namun tidak sebaik ischemia preconditioning.

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Background: Immediate revascularization of ischemic tissue, does not always produce the expected results. Various reactions that arise from the formation of reactive oxygen species and the activation of the complement system cause ischemia reperfusion injury. Ischemia preconditioning PRC and hypothermia are thought to reduce the effects of ischemic reperfusion injury.

Methods: This experimental study was performed on the control group and three treatment groups, namely reperfusion injury IRI, ischemia preconditioning PRC, and hypothermia. Two experimental animals were used in control group and six experimental animals were used in IRI, PRC and hypothermia groups. In IRI group, right common femoral artery was ligated for four hours, and released for eight hours. In the PRC group, ligation of right common femoral artery was performed for two minutes and released for three minutes in two cycles. In the hypothermia group, right lower extremity was wrapped with ice. Subsequently, in the two groups, the right common femoral artery was ligated and released like IRI group. Then, laparotomy was performed and the stomach was taken. The antrum part is acquired for histopathology and biochemistry assay. Biochemical examination was performed using malondialdehyde MDA.

Results: The hypothesis test of histopathologic and biochemical differences in general was statistically significant. The degree of histopathological damage and MDA in IRI group was significantly higher than control group. The degree of histopathological damage in the PRC group was significantly lower than in the IRI group but biochemically, higher but not significant. The degree of histopathologic damage in the hypothermia group was lower, but not significant, compared to the IRI group but biochemically, significantly higher than the IRI group. When comparing PRC and hypothermia, histopathologically, PRC is significantly lower. Biochemically, the mean PRC is lower but not significant.

Conclusion: Ischemia preconditioning has a protective effect on the destructive impact of ischemia reperfusion injury in distant organs. Hypothermia also has a protective effect, but is not as good as ischemia preconditioning."

"Cedera iskemik reperfusi merupakan suatu kondisi yg sering dijumpai, dan dapat menyebabkan gangguan secara sitemik pada organ tubuh. Antara lain dapat menyebabkan kerusakan ke jaringan hepar secara remote.Tujuan: Mengetahui manfaat perlakuan prekondisi iskemik dan hipotermia pada cedera iskemik reperfusi tungkai bawah guna mencegah terjadinya kerusakan pada jaringan hepar.Metode. Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (hipotermia dan prekondisi iskemik). Dilakukan ligasi a. iliaca communis selama 4 jam, hipotermia (28oC), dan prekondisi iskemia pada masing-masing kelompok. Kemudian ligasi dilepas untuk reperfusi selama 8 jam. Lalu kelinci di euthanasia, jaringan hepar diambil untuk pemeriksaan histopatologi (Skoring penelitian).Hasil: Terdapat kerusakan jaringan hepar yang dinilai secara histopatologi sebagai efek cedera iskemik reperfusi jauh yang di akibatkan oleh iskemik tungkai akut pada hewan coba kelinci. Dengan melakukan skoring terhadap sel hepatosit, sitoplasma, sinusoid, batas interselular, mikrohemoragik, dan infiltrasi leukosit. Skor kelompok kontrol dengan median 89,50 min-max 75-91, Kelompok perlakuan IPC mean 49,17, SD 15,53. Kelompok perlakuan hipotermia mean 42,83 SD 22,02. Prekondisi iskemik dan hipotermia dapat mengurangi terjadi kerusakan jauh pada hepar secara bermakna dengan nilai p=0,002 dan p=0,004.Simpulan: Terbukti terjadinya kerusakan remote iskemik reperfusi pada hepar akibat cedera iskemik reperfusi tungkai akut, Hipotermia dan iskemik prekondisi secara signifikan dapat mengurangi terjadinya kerusakan itu.

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Background: ischemic reperfusion injury is a common condition that may disrupt systemic organs, especially causing liver damage remotely.

Objectives: to evaluate the benefit of ischemic preconditioning and hypothermia on ischemic reperfusion injury of the lower limbs from liver tissue damage.

Methods: this experimental study was performed using New Zealand White Rabbits (n=18) that were grouped into control group (ischemia) and treatment group (ischemic preconditioning and hypothermia). Iliaca communis artery was ligated for 4 hours and treated group had topical cooling until 28oC and performed ischmeic preconditioning. The ligation was released for reperfusion for 8 hours. The rabbits were then euthanized and liver tissue was taken for histopathologic examination.

Result: liver tissue damage was found histopathologically caused by remote ischemic reperfusion of rabbit limbs. By performing scoring of hepatocyte cells, cytoplasm, sinusioids, intercellular cells, microhemorrhage, and leucocyte infiltration. The median score for control group was 89.50 (ranged 75-91), and 49.17 for IPC group (SD 15.53).mean score for hypothermia group is 42.83 (SD 22.02). IPC and hypothermia showed to reduce liver damage significantly (p = 0.002 and p = 0.004)."

"Latar belakang : Penelitian ini bertujuan untuk mengetahui keefektifan pemberian cairan Ringer laktat dan cairan Ringer asetat dalam mencegah hipotermia dan menggigil yang terjadi pada wanita hamil yang menjalani operasi sesar dengan analgesia spinal.Metode : Seratus tiga puluh empat pasien yang menjalani operasi sesar menggunakan analgesia spinal di Instalasi Gawat Darurat Rumah Sakit Umum Pusat Cipto Mangunkusumo, diberikan cairan Ringer laktat dan cairan Ringer asetat. Perubahan suhu membran timpani, perubahan suhu perifer dan kekerapan serta derajat menggigil dinilai sampai 50 menit setelah operasi dimulai.Hasil : Didapatkan perbedaan bermakna (p=0,003) antara penurunan suhu membran timpani di antara kedua kelompok, kelompok yang mendapatkan cairan Ringer asetat mengalami penurunan suhu sebesar 0,730°C, sementara kelompok yang mendapatkan cairan Ringer laktat mengalami penurunan suhu sebesar 1,013°C. Perubahan suhu perifer diantara kedua kelompok juga berbeda bermakna (p=0,005), kelompok yang mendapatkan cairan Ringer asetat mengalami penurunan suhu perifer 0,724°C, sementara kelompok yang mendapat cairan Ringer laktat mengalami penurunan 0,964°C. Kejadian menggigil diantara kedua kelompok berbeda berakna (p=0,012), kejadian menggigil kelompok Ringer asetat 52,23% sementara kelompok Ringer laktat 74,62%. Tidak terdapat perbedaan bermakna derajat meggigil diantara kedua kelompok.Kesimpulan : Bahwa pemberian cairan Ringer asetat lebih efektif mencegah hipotermia dan menggigil pada pasien yang menjalani operasi sesar dengan analgesia spinal

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Background: The aim of this study is to determine the efficacy of lactated Ringer and acetated Ringer solutions in preventing hypothermia and shivering to parturitions women undergoing caesarean section using spinal analgesia.

Methods: One hundred thirty four parturitions women undergoing caesarean sections using spinal analgesia in emergency operating theatre of Cipto Mangunkusumo Hospital were included in this study. Those parturitions women were divided into two groups. One group received lactated Ringer solution and the other received acetated Ringer solution intravenously as maintenance and co-loading fluid. Tympanic membrane temperature and skin temperature were recorded every five minute within 50 minute interval.

Results: There was significant difference (p=0,003) between two groups in tympanic membrane temperature decrease. Acetated Ringer group had 0,730°C decrease in tympanic membrane temperature, while the lactated Ringer group had 1,013°C decrease. There was significant difference (p=0,005) between two groups in skin temperature. Acetated Ringer group had 0,724°C decrease in skin temperature, while the lactated Ringer group had 0,964°C decrease. Shivering incidence also show significant difference (p=0,412). Acetated Ringer group had 52,23% incidence while lactated Ringer group had 74,62%. There were no significant differences in shivering grade between two groups.

Conclusions: Acetated Ringer solution had greater efficacy in preventing hypothermia and shivering in parturitions women undergoing caesarean section using spinal analgesia."

"Dalam proses produksinya, PT. Pupuk Kujang mendirikan Central Control Building sebagai pusat pengawasan proses produksi Kujang 1B. Dengan menggunakan sistem peralatan canggih dengan nama Distribution Control System (DCS) maka diperlukan kondisi ruang kerja yang khusus, yaitu harus berada dalam suhu ruangan 18°C. Keadaan itu mengakibatkan pekerja terpajan suhu dingin selama jam kerjanya. Suhu tersebut merupakan suhu yang berada di bawah nilai suhu nyaman. Hal ini mengakibatkan pekerja merasa terganggu oleh dingin tersebut yang pada akhirnya dapat berpengaruh negatif bagi kesehatan pekerja.Penelitian ini membahas tentang gambaran pajanan suhu dingin terhadap kejadian hipotermia pada pekerja operator DCS di ruang kontrol Gedung CCB Kujang 1B PT. Pupuk Kujang Cikampek tahun 2009. Penelitian ini merupakan penelitian deskriptif kuantitatif dengan disain cross-sectional.Hasil penelitian menunjukkan bahwa suhu control room Gedung CCB Kujang 1B berada di bawah nilai ambang batas (NAB) suhu nyaman (21?30°C) berdasarkan Surat Edaran Menteri Tenaga kerja dan Transmigrasi Nomor SE.01/MEN/1978. Namun, nilai Indeks Suhu Bola Basah (ISBB) control room tersebut masih berada dalam batas yang diperkenankan menurut Keputusan Menteri Tenaga Kerja No: Kep- 51/Men/1999.Penelitian ini juga tidak menemukan adanya kasus hipotermia pada pekerja operator DCS, karena penurunan suhu tubuh yang terjadi masih berada di batas suhu normal. Berdasarkan hasil tersebut, peneliti menyarankan agar dilakukan pengendalian engineering berupa pengaturan ulang suhu control room hingga mencapai suhu nyaman yang diperkenankan (21°C) atau pemasangan pembatas yang memisahkan antara pekerja dengan sumber pendingin (air conditioner - AC) serta memperbaiki fasilitas alat pelindung diri seperti jaket, sarung tangan dan penutup kepala. Memperbanyak aktivitas fisik saat bekerja serta lebih sering menyempatkan minum dan makan juga disarankan agar panas tubuh tidak hilang.

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In the process of production, PT. Pupuk Kujang establish Central Control Building as the central control of the production process Kujang 1B. By using the system with the sophisticated equipment Distribution Control System (DCS) is required then the condition that a special work space, must be in the room temperature 18°C. Circumstances that result in workers expose to cold temperatures during work hours. That temperature is below the temperature comfortable. This resulted in the workers feel disturbed by the cold, which in turn can negatively affect the health of workers.

This study discusses illustration exposure to cold temperature incident hypothermia service workers on the DCS control room in Building CCB Kujang 1B PT. Pupuk Kujang Cikampek 2009. This research is descriptive quantitative research with cross-sectional design.

Results of research indicate that the temperature control room building CCB Kujang 1B under the threshold limit value (TLV) temperature comfortable (21-30°C) based on the Circular Letter of the Minister of Manpower and Transmigration No. SE.01/MEN/1978. However, the value of Wet Bulb Globe Temperature (WBGT) control room is still in the limit permitted by the Minister of Manpower Decree No: Kep-51/Men/1999.

This study also did not find any cases hypothermia on the DCS operator workers, because a decrease in body temperature that°Ccurred was in the normal temperature limits. Based on the results, the researchers suggested that the form of engineering control be reset control room temperature to reach a comfortable temperature allowed (21°C) or the barrier that separates between the workers, the source cooling (air conditioner) equipment and improve facilities such as selfprotective jacket, gloves and headgear. Increase physical activity at work and more often to eat and drink also suggested that body heat is not lost."

"ABSTRAKHipotermia adalah keadaan suhu inti tubuh dibawah 36 C. Kejadian Hipotermia sering muncul pada pasien post operasi. Hipotermia post operasi yang berkepanjangan dapat menyebabkan kegagalan jantung dan sistem pernapasan, dan bahkan kematian. Penelitian ini bertujuan untuk menganalisa efektifitas penggunaan warmed IV line dan selimut terhadap peningkatan suhu pada pasien hipotermia post operasi. Penelitian ini merupakan deskriptif analitik dengan metode quasi experiment yang melibatkan 34 responden. Hasil penelitian ini menunjukan ada efektifitas penggunaan warmed IV line dan selimut terhadap peningkatan suhu pada pasien hipotermia post operasi p-velue = 0,011 . Hasil penelitian ini akan menjadi salah satu rekomendasi intervensi dalam upaya peningkatan suhu pasien hipotermia post operasi.

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ABSTRACTHypothermia is a condition where the body rsquo s core temperature is below 36 oC. Hypothermia often appears in post operation patients. Prolonged post operation hypothermia can lead to heart failure and respiratory system, and even death. The purpose of this research is to analyze the effectiveness of the use of warmed IV line and blankets on increase temperature in post operation hypothermia patients. This research is an analytical descriptive with quasi experiment method that involved 34 respondents. The results of this research indicated if there was effectiveness of the use of warmed IV line and blankets on increase temperature in post operation hypothermia patients p velue 0,011 . The results of this research will be one of the recommendations of intervention in an effort to increase the temperature of post operation hypothermia patients."

"Latar Belakang: Hipotermia pascabedah seringkali terjadi pada pasien geriatri karena adanya penurunan fisiologi tubuh. Hipotermia pada pasien geriatri dapat berhubungan dengan peningkatan risiko morbiditas dan mortalitas, lama rawat inap serta komplikasi pasca pembedahan yang lebih tinggi. Lingkungan kamar bedah di Indonesia, keterampilan operator dan ketersediaan obat anestesia berbeda dengan negara lain. Penelitian ini bertujuan untuk menganalisis hubungan antara jenis anestesia, jenis operasi, dan durasi operasi terhadap hipotermia pascabedah pada pasien geriatri di RSUPN dr. Cipto Mangunkusumo.Metode: Penelitian ini menggunakan desain studi cross sectional analitik retrospektif terhadap 95 pasien geriatri yang menjalani pembedahan dengan anestesia umum dan kombinasi anestesi umum regional di RSUPN dr. Cipto Mangunkusumo pada bulan November 2018 Januari 2019. Kriteria inklusi adalah pasien dengan usia lebih dari sama dengan 60 tahun dan menjalani prosedur bedah elektif. Kriteria eksklusi adalah pasien yang rekam medisnya tidak lengkap dan menjalani pembedahan dengan durasi kurang dari satu jam.Hasil: Pada penelitian ini didapatkan prevalensi hipotermia pascabedah sebesar 63.15%. Hasil uji Fisher antara jenis anestesia dengan hipotermia pascabedah pada pasien geriatri menghasilkan nilai p sebesar 0.529. Hasil uji Chi Square antara jenis operasi dengan hipotermia pascabedah pada pasien geriatri menghasilkan nilai p sebesar 0.677. Hasil uji Chi Square antara durasi operasi dengan hipotermia pascabedah pada pasien geriatri menghasilkan nilai p sebesar 0.495.Kesimpulan: Jenis anestesia, jenis operasi, dan durasi operasi tidak memiliki hubungan yang bermakna dengan hipotermia pascabedah pada pasien geriatri.

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Background: Postoperative hypothermia occurs in geriatric patients as their physiological functions have decreased. Hypothermia in geriatric patients can be associated with an increased risk of morbidity and mortality, length of stay and higher post surgical complications. The operating room environment in Indonesia, operator skills and supply of anesthetic drugs are different from other countries. The objective of this study was to analyze the relationship between types of anesthesia, types of surgery, and duration of surgery with post surgery hypothermia in geriatric patients at RSUPN dr. Cipto Mangunkusumo.Methods: This was a retrospective analytic cross sectional study for 95 geriatric patients undergoing surgery under general anesthesia and a combination of general regional anesthesia at RSUPN dr. Cipto Mangunkusumo in November 2018 January 2019. The inclusion criteria was patients older than 60 years old and undergoing elective surgical procedures. Exclusion criteria was patients whose medical records were incomplete and undergoing surgery with a duration of less than an hour.Results: It was found that the prevalence of postoperative hypothermia was 63.5%. Fishers test results between types of anesthesia with postoperative hypothermia in geriatric patients resulted in P value of 0.529. Chi Square test results between types of surgery with postoperative hypothermia in geriatric patients resulted in P value of 0.677. Chi Square test results between the duration of surgery with postoperative hypothermia in geriatric patients resulted in P value of 0.495.Conclusion: The types of anesthesia, types of surgery, and duration of surgery did not have a significant association with postoperative hypothermia in geriatric patients."