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"Skripsi ini membahas tentang tanggung jawab dan perlindungan hukum bagi perawat anestesi yang melakukan tindakan pembedahan tanpa didampingi oleh dokter spesialis anestesi. Anestesi merupakan tindakan yang sangat beresiko dan hanya dapat dilakukan oleh dokter spesialis anestesi. Namun terdapat pengecualian apabila tidak ada dokter spesialis anestesi atau berhalangan hadir, kewenangan tersebut dapat dilimpahkan dengan tetap berkoordinasi dan pemberian dosis sesuai dengan perintah dokter spesialis anestesi. Peraturan Menteri Kesehatan Nomor 18 Tahun 2016 tentang Izin Dan Penyelenggaraan Praktik Penata Anestesi mengatur bahwa pelimpahan wewenang tersebut dilakukan dengan cara mandat, karena tanggung jawabnya tetap berada pada pemberi mandat yaitu dokter spesialis anestesi. Sebagaimana kasus dalam Putusan Nomor 109/Pid.sus/2015/PN. Trt, seorang perawat melakukan tindakan anestesi dengan memberi dosis sesuai perkiraannya sendiri dan menghubungi dokter spesialis anestesi setelah tindakan anestesi dilakukan. Dengan menggunakan metode yuridis-normatif, penelitian ini bertujuan untuk menganalisis perbandingan kewenangan antara dokter spesialis anestesi dengan perawat anestesi serta tanggung jawab rumah sakit terhadap tindakan anestesi yang dilakukan tanpa didampingi dokter spesialis anestesi. Sedangkan deskriptif analisis adalah pelimpahan kewenangan yang dilakukan secara mandat dan tanggung jawab serta perlindungan hukum bagi perawat anestesi. Hasil penelitian yang diperoleh ialah segala tindakan perawat anestesi harus di bawah pengawasan dokter spesialis anestesi sebab pelimpahan wewenangnya secara mandat, mengakibatkan tidak berpindahnya tanggung jawab atas tindakan tersebut dan rumah sakit pun berkewajiban untuk mengawasi serta bertanggung jawab atas segala tindakan yang dilakukan oleh pekerja di rumah sakit tersebut.

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This thesis discusses the responsibility and legal protection of anesthetist nurses who perform surgery without being accompanied by an anesthetist.  Anesthesia is a very risky action and can only be done by anesthetists.  However, there are exceptions if there is no anesthetist or unable to attend, the authority can be delegated by continuing to coordinate and administer doses according to the anesthetist's orders.  Minister of Health Regulation No. 18 of 2016 concerning Licensing and Implementation of Anesthesia Management Practices stipulates that the delegation of authority is carried out by means of a mandate, because the responsibility remains with the mandate giver, namely the anesthetist.  As is the case in Decision Number 109 / Pid.sus / 2015 / PN.  Trt, a nurse performs anesthetic action by giving the dose according to his own estimation and contact an anesthetist after the anesthesia is performed.  By using the juridical-normative method, this study aims to determine the comparison of authority between anesthetist and anesthetist nurses and hospital responsibilities for anesthetic actions carried out without the anesthetist's specialist.  Whereas descriptive analysis is the delegation of authority which is carried out by mandate and responsibility as well as legal protection for anesthetist nurses.  The results obtained all the actions of anesthetist nurses must be under the supervision of anesthetist specialist because the delegation of authority in a mandate, resulting in no transfer of responsibility for these actions and the hospital is obliged to supervise and be responsible for all actions carried out by workers in the hospital."

"ABSTRACTTindakan anestesi merupakan tindakan yang berisiko tinggi, yang diberikan kepada pasien pada saat pasien akan menjalankan tindakan pembedahan. Dokter yang berwenang memberikan anestesi ialah dokter spesialis anestesiologi. Dalam memberikan pelayanan anestesi kepada pasien, dokter spesialis anestesiologi dibantu oleh perawat anestesi, dan berdasarkan Peraturan Menteri Kesehatan No. 31 Tahun 2013 apabila dokter spesialis anestesiologi berhalangan hadir, kewenangan dapat dilimpahkan kepada perawat anestesi secara delegasi. Namun dalam putusan nomor 109/Pid.Sus/2015/PN.Trt, perawat anestesi yang memberikan pelayanan anestesi kepada pasien tanpa adanya izin atau perintah dari dokter spesialis anestesiologi maka perawat anestesi tidak berhak melakukan tindakan anestesi. Dengan menggunakan metode yuridis-normatif, penelitian ini bertujuan mengetahui pengaturan kewenangan dan tanggung jawab hukum perawat anestesi dan dokter spesialis anestesiologi dalam tindakan pembedahan, serta deskriptif analisis pelimpahan kewenangan secara delegasi dari dokter kepada perawat dan  tanggung jawabnya di dalam putusan nomor 109/Pid.Sus/2015/PN.Trt. Hasil penelitian yang diperoleh ialah dokter spesialis anestesiologi berwenang untuk mengawasi dan mengatasi pelaksanaan pelayanan anestesi, perawat anestesi berwenang untuk melakukan pelayanan anestesi dengan berkolaborasi dengan dokter spesialis anestesiologi. Dalam pelimpahan kewenangan perawat bertanggung jawab langsung kepada dokter anestesi sebagai pelaksana. Dan dapat bertanggung jawab secara mandiri apabila bertindak diluar dari kewenangan yang dilimpahkan.

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ABSTRACTAnesthesia is a high risk action which has delivered to patient while surgical procedure. A doctor who has authority to conduct anesthesia is named specialist of anesthesiology. To deliver the anesthesia services into patient, medical specialist of anesthesiology is accompanied by anesthesia nurse and refers to Minister of Health regulation Number 31 Year 2013; if medical specialist of anesthesiology is absent, his authority can be delegated to anesthesia nurse. Nevertheless, in verdict number 109/Pid.Sus/2015/PN.Trt, anesthesia nurse who delivers the services to patient without permission or command of medical specialist of anesthesiology, anesthesia nurse doesn`t have authority to deliver services. Hereby juridical-normative method, this research aims to know about the authority and accountability of anesthesia nurse and medical specialist of anesthesiology in surgical procedure, moreover descriptive-analysis is regarding the delegation of medical specialist of anesthesiology`s authority into anesthesia nurse and his accountability which stipulated in verdict number 109/Pid.Sus/2015/PN.Trt. The research outcomes are medical specialist of anesthesiology has the power to monitor and overcome anesthesia procedure and anesthesia nurse has authority to deliver anesthesia procedure by collaborating with medical specialist of anesthesiology. To delegate the authority, a nurse has to responsible directly into medical specialist of anesthesiology as executor, then he has to responsible individually outside authority which delegated by."

"[ABSTRAKHukum kesehatan merupakan cabang ilmu yang masih tergolong muda di Indonesia. Hukum kesehatan yang baru berkembang ini berbanding terbalik dengan banyaknya sorotan terhadap hukum kesehatan, khususnya kepada dokter spesialis anestesi dalam melakukan tindakan operasi. Seorang dokter spesialis anestesi melakukan peran yang sangat penting di kamar operasi, tidak hanya membuat pasien tertidur, tetapi juga harus membuat keputusan untuk melindungi dan menjaga fungsi-fungsi vital dari organ pasien sehingga dapat berjalan dengan baik. Dokter spesialis anestesi juga bertugas untuk mendiagnosa dan menangani masalah yang mungkin timbul selama operasi atau pada masa pemulihan dalam perspektif keselamatan pasien secara umum. Dalam melaksanakan tugasnya dokter spesialis anestesi harus berpedoman terhadap standar dan prosedur, karena dalam melakukan anestesi diharuskan untuk tidak melakukan kesalahan maupun kelalaian. Penulisan ini membahas tentang tinjauan tanggung jawab dokter spesialis anestesi dalam tindakan operasi. Luasnya aspek hukum yang terdapat dalam hubungan dokter dan pasien membuat penulis membatasi pembahasan penulisan ini hanya mengenai aspek hukum kesehatan.

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ABSTRACTHealth law is considered a new branch of law in Indonesia. The developing health law are inversely proportional to vast attention given to health law, especially to anesthetic specialist?s in surgical operation. Anesthetic specialist?s do important role in operation room, not only make patient sleep, but also take a decision to keep and protect the function of organ patient and also have a duty to diagnose and manage a problem that maybe will any during surgical operation or period dignification in perspective safety patient in general. Anesthetic specialist?s must orientation with standart and procedure, because when anesthesia doing, doctor?s shouldn?t do negligence or fault. The purpose of this writing is to knowing the responsibility of anesthetic specialist?s in surgical operation. The wide range of legal aspect in relationship within doctor and patient, require the writer to limit the writing of this paper only in term of health law.;Health law is considered a new branch of law in Indonesia. The developing health law are inversely proportional to vast attention given to health law, especially to anesthetic specialist’s in surgical operation. Anesthetic specialist’s do important role in operation room, not only make patient sleep, but also take a decision to keep and protect the function of organ patient and also have a duty to diagnose and manage a problem that maybe will any during surgical operation or period dignification in perspective safety patient in general. Anesthetic specialist’s must orientation with standart and procedure, because when anesthesia doing, doctor’s shouldn’t do negligence or fault. The purpose of this writing is to knowing the responsibility of anesthetic specialist’s in surgical operation. The wide range of legal aspect in relationship within doctor and patient, require the writer to limit the writing of this paper only in term of health law., Health law is considered a new branch of law in Indonesia. The developing health law are inversely proportional to vast attention given to health law, especially to anesthetic specialist’s in surgical operation. Anesthetic specialist’s do important role in operation room, not only make patient sleep, but also take a decision to keep and protect the function of organ patient and also have a duty to diagnose and manage a problem that maybe will any during surgical operation or period dignification in perspective safety patient in general. Anesthetic specialist’s must orientation with standart and procedure, because when anesthesia doing, doctor’s shouldn’t do negligence or fault. The purpose of this writing is to knowing the responsibility of anesthetic specialist’s in surgical operation. The wide range of legal aspect in relationship within doctor and patient, require the writer to limit the writing of this paper only in term of health law.]"

"Skripsi ini menganalisis tanggung jawab dokter dan rumah sakit dalam Putusan Pengadilan Nomor 1324/Pdt.G/2021/PN Tng. Skripsi ini disusun dengan metode penelitian doktrinal dengan tipe penelitian deskriptif-preskriptif, menelaah melalui perspektif hukum tentang tanggung jawab dokter dan rumah sakit dalam Putusan Pengadilan Nomor 1324/Pdt.G/2021/PN Tng. Skripsi ini secara komprehensif membedah bagaimana seharusnya tanggung jawab hukum dokter selaku pelaku tindakan medis dan rumah sakit sebagai tempat pelayanan kesehatan apabila terjadi kegagalan tindakan medis. Dalam kasus ini, dokter dan rumah sakit merupakan dua subjek hukum utama yang bertanggung jawab dalam kegagalan tindakan anestesi yang dialami oleh Penggugat. Penggugat mengalami kelumpuhan permanen setelah dilaksanakannya tindakan anestesi oleh dokter spesialis anestesi. Dalam kasus ini, dokter telah melakukan perbuatan melawan hukum dalam memintakan informed consent kepada Penggugat, tetapi tindakan dokter dalam tindakan anestesi dan anamnesis bukan merupakan perbuatan melawan hukum karena telah sesuai dengan pedoman. Lebih lanjut, rumah sakit dalam kasus ini telah melakukan perbuatan melawan hukum dengan tidak memberikan isi rekam medis kepada Penggugat dan lalai dalam menjaga kualitas peralatan medis yang digunakan. Oleh karena itu, disarankan kepada dokter dan rumah sakit sebagai untuk dapat memahami hak, kewajiban, serta tanggung jawab yang dimiliki demi memaksimalkan pelayanan kesehatan dan meminimalisasi risiko.

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This thesis analyzes the responsibilities of doctors and hospitals in Court Decision Number 1324/Pdt.G/2021/PN Tng. The thesis employs a doctrinal research method with a descriptive-prescriptive type of research, examining the legal perspectives on the responsibilities of doctors and hospitals in the said court decision. This thesis comprehensively dissects how the legal responsibilities of doctors as medical practitioners and hospitals as healthcare service providers should be addressed in the event of medical procedure failures. In this case, both the doctor and the hospital are the primary legal subjects responsible for the failure of the anesthesia procedure experienced by the Plaintiff. The Plaintiff suffered permanent paralysis following an anesthesia procedure performed by an anesthesiologist. In this case, the doctor committed an unlawful act by failing to obtain informed consent from the Plaintiff; however, the doctor's actions during the anesthesia and anamnesis procedures were not unlawful as they adhered to established guidelines. Furthermore, the hospital committed an unlawful act by failing to provide the Plaintiff with the medical records and by neglecting the maintenance of the medical equipment used. Therefore, it is recommended that doctors and hospitals understand their rights, obligations, and responsibilities to maximize healthcare services and minimize risks."

"ABSTRAKDalam penyelenggaraan upaya kesehatan khususnya di rumah sakit, tentunyamelibatkan hubungan dokter dan perawat. Dokter atau tenaga medis tidak dapatbekerja tanpa bantuan perawat di suatu ?rumah sakit. Sebaliknya, perawat tanpaadanya instruksi dokter, tidak berwenang untuk bertindak secara mandiri kecualidalam bidang tertentu yang sifatnya umum dan memang termasuk bidang asuhanperawat (nursing care). Hal tersebut juga berlaku pada tindakan yang dilakukanoleh dokter anestesi dan perawat anestesi. Permasalahan terkait pemberian danperlindungan hukum bagi perawat dapat dilihat pada tindakan anestesi. Perawatanestesi tidak dapat semaunya melakukan tindakan pembiusan kepada pasien.Undang-Undang No. 29 Tahun 2004 tentang Praktik Kedokteran memuat sanksipidana dan denda kepada siapapun yang menjalankan praktik kedokteran yangmenimbulkan kesan bagi masyarakat seolah-olah merupakan dokter yangmemiliki Surat Tanda Registrasi (STR). Selain itu, tuntutan masyarakat akanpemberian pelayanan kesehatan yang berkualitas, efektif dan efisien jugadibutuhkan. Ketentuan ini tentunya menimbulkan polemik mengingat nasibperawat anestesi yang berpraktik di daerah terpencil seperti Kabupaten PadangPanjang di Provinsi Sumatera Barat. Dimana pada daerah tersebut hanyaterdapat beberapa tenaga medis yang dapat memenuhi kebutuhan masyarakatKabupaten Padang Panjang, Sumatera Barat.

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ABSTRACTIn the implementation of healthcare especially in hospitals, naturally there will bean involvement in between doctors and nurses. Doctors or what we could called asparamedics will not be able to work without the help of the nurses in the?hospitals?. Vice versa, the nurses without the Doctors supervision will not be ableto act independently unless it is in a general action and part in the field of nursingcare. This also applies to the action taken by the anesthesiologist. The problemrelated to the issue and a legal care towards the nurses can be shown duringanesthesia. Anesthesist are not allowed giving anesthesia to the patients by theirown will. In the Act No. 29 Year 2004 about Medical practice, it states a criminalsanction and fines to anyone who undertake an illegal medical action, which willlater generate an impression as if it is a legal doctor who has an authorizedregistration letter and have the authority to take measure. Moreover, the demandfor giving a good quality, effective and efficient healthcare to the society is alsoneeded. This provision will certainly polemical considering the fate of theanesthesist that have their practice in a remote area like in Kabupaten PadangPanjang in the province of West Sumatera, where in that area there are only a fewof paramedics which could fulfill the needs of the people."

"Latar Belakang Refleks okulokardiak (OCR) dapat menyebabkan penurunan denyut jantung signifikan dan peningkatan risiko mual muntah pascabedah. Kejadian refleks okulokardiak dilaporkan berkisar antara 14% hingga 90% yang dipengaruhi oleh agen anestesi, premedikasi, dan proses saat operasi.2 Terdapat banyak faktor yang memengaruhi kejadian refleks okulokardiak. Penelitian ini bertujuan mengetahui faktor yang memengaruhi refleks okulokardiak pada pembedahan mata di RSUPN Dr. Cipto Mangunkusumo yang merupakan rumah sakit rujukan dengan karakteristik pasien yang bervariasiMetode Penelitian ini adalah penelitian analitik dengan desain potong lintang, menggunakan data pasien pembedahan mata dengan anestesi umum di RSUPN Dr. Cipto Mangunkusumo periode Mei 2023 - Februari 2024. Analisis perbedaan kelompok dengan OCR dan tanpa OCR dilakukan dengan uji Mann Whitney dan chi-square. Analisis multivariat dengan regresi logistik metode backward dilakukan pada variabel yang dianggap memiliki pengaruh yang signifikan dengan refleks okulokardiak. Hasil Dari 178 data pasien yang terkumpul dilakukan eksklusi sehingga terdapat 165 pasien yang dianalisis. Faktor usia anak (0-18 tahun) memiliki OR=0,143 (p=0,015), strabismus memiliki OR 14,843 (p=0,000), konsentrasi agen anestesi inhalasi (sevoflurane dan desflurane) < 1 MAC memiliki OR 5,070 (p=0,004) berpengaruh secara signifikan dengan kejadian OCR. Namun, dosis opioid tidak terbukti signifikan berpengaruh dengan kejadian OCR (p=0,840) Kesimpulan Penelitian ini menunjukkan adanya pengaruh yang signifikan antara usia, jenis bedah, dan konsentrasi agen anestesi inhalasi terhadap kejadian refleks okulokardiak pada anestesi pembedahan mata di RSUPN Dr. Cipto Mangunkusumo.

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Introduction

The oculocardiac reflex (OCR) can cause a significant decrease in heart rate and increase the risk of postoperative nausea and vomiting. Many factors influence the occurrence of OCR. The incidence of OCR ranges from 14% to 90%, depending on the anesthetic agents, premedication, and surgical procedure. This study aims to identify the factors influencing OCR during eye surgery anesthesia at RSUPN Dr. Cipto Mangunkusumo, a referral hospital with a diverse patient population.

Method

This was an analytical study with a cross-sectional design, using data from patients undergoing eye surgery under general anesthesia at Dr. Cipto Mangunkusumo National Central General Hospital from May 2023 to February 2024. The association was analyzed using the Mann-Whitney test and chi-square test. Multivariate analysis with the backward logistic regression method was performed on variables considered to have a significant relationship with the oculocardiac reflex.

Results

178 patient records collected and 165 patients of it were analyzed after exclusions. Younger age (0-18 years) was significantly associated with OCR (OR=0.143, p=0.015), as well as strabismus surgery (OR=14.843, p=0.000) and concentration of inhalation anesthetic (sevoflurane and desflurane) ≤ 1 MAC (OR=5.070, p=0.004). However, opioid dosage did not show a significant association with OCR (p=0.840). Conclusion This study shows a significant influence between age, type of surgery, and concentration of inhalation anesthetic with the incidence of OCR in eye surgeries anesthesia at RSUPN Dr. Cipto Mangunkusumo."

"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."

"Skripsi ini membahas mengenai perlindungan hukum bagi dokter dalam melakukan tindakan cito seksio sesarea. Permasalahan yang akan diteliti mengenai prosedur dan tanggung jawab dokter dalam melaksanakan cito seksio sesarea dan menganalisis putusan No.90/PID.B/2011/PN.MDO, putusan No.365 K/Pid/2012 dan Putusan 79PK/PID/2013.Tujuan dari penelitian ialah memahami prosedur dan tanggung jawab dokter dalam melaksanakan tindakan cito seksio sesarea, dan menganilisis putusan. Penelitian ini merupakan penelitian yuridis normatif dengan pendekatan perundang-undangan dan pendekatan kasus.Berdasarkan hasil penelitian, dapat disimpulkan bahwa dokter yang sesuai dengan Standard Operating Procedure, dalam melaksanakan profesinya maka berhak memperoleh perlindungan hukum berdasarkan UU No. 36 Tahun 2009 Tentang Kesehatan dan UU No. 29 Tahun 2004 Tentang Praktik Kedokteran.

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This thesis discusses the legal protection for doctors in performing cito Seksio Caesarea. Issues that will be examined on the procedure and the doctor's responsibility in implementing cito cesarean section and analyze the decision 90/Pid.B/2011/PN.MDO, 365 K/Pid/2012 and 79PK/PID/2013.The purpose of the research is to understand the procedure and the doctor's responsibility in implementing the action cito cesarean section, and analyze the decision. This research is a normative juridical approach to legislation and case approach.Based on the results, it can be concluded that the doctor is in accordance with Standard Operating Procedure, in carrying out his profession, the right to obtain legal protection under Law No. 36 of 2009 on Health and Law No. 29 of 2004 on Medical Practices."

"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."

"ABSTRACTPerawat merupakan salah satu tenaga kesehatan di Indonesia yang memiliki kewenangan melakukan tindakan keperawatan. Praktiknya, masih ada perawat yang melampaui kewenangannya dan melakukan tindakan pembedahan. Salah satu kasusnya ada pada Putusan Putusan Pengadilan Negeri Gresik dengan Nomor 204/Pid.B/2008/PN.Gs. Pada putusan tersebut seorang perawat dipidana karena melakukan tindakan pembedahan berupa sirkumsisi kepada seorang anak yang berujung pada kecacatan anak tersebut. Metode penelitian ini berupa deskriptif analitis yang bertujuan untuk memberikan suatu gambaran umum dan terperinci tentang kewenangan perawat dalam melakukan tindakan pembedahan berupa sirkumsisi. Hasil dari penelitian ini menunjukkan bahwa perawat tidak boleh melakukan tindakan pembedahan kecuali ada pelimpahan kewenangan dari dokter kepada perawat. Akan lebih baik apabila ada pendidikan khusus dan juga aturan yang mengatur bagi perawat untuk melakukan tindakan pembedahan.

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ABSTRACTAbstract Nurse is one of the health workers in Indonesia who have the authority to perform nursing actions. In practice, there are nurses who go beyond their authority and perform surgery. One of the cases is on Decision of Gresik District Court Number 204 Pid.B 2008 PN.Gs. In that decision a nurse is convicted crime because of performing surgery in the form of circumcision to a child who leads to the child 39 s disability. This research method is analytical descriptive which aims to give a general description and detail about the authority of nurses in performing surgery in the form of circumcision. The results of this study indicate that the nurse should not perform surgery unless there is a delegation of authority from the doctor to the nurse. It would be better if there is a special education and also rules that regulate for nurses to perform surgery. "