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"Abses tuberkulosis spinal merupakan salah satu komplikasi serius dari infeksi tuberkulosis yang dapat menyebabkan kerusakan neurologis dan sulitnya eradikasi kuman. Tata laksana operatif dengan debridemen terbuka sering kali dipilih. Namun, teknik minimal invasif telah mulai dikembangkan, termasuk Teknik Evakuasi Abses Sistem Tertutup (EAST), meski datanya masih terbatas. Penelitian ini bertujuan untuk menilai luaran klinis dan laboratoris pada pasien yang menjalani EAST dibandingkan debridemen terbuka. Penelitian retrospektif ini melibatkan 48 pasien yang menjalani salah satu dari kedua teknik tersebut. Hasil menunjukkan bahwa EAST menghasilkan nyeri pascaoperasi lebih rendah (VAS 2 vs. 4; p<0,001) dan panjang jaringan parut lebih kecil (0 cm vs. 12 cm; p<0,001) dibandingkan debridemen terbuka. Durasi rawat inap lebih singkat secara median pada kelompok EAST, meski tidak signifikan (2 vs. 3 hari; p=0,06). Namun, angka rekurensi lebih tinggi pada teknik EAST (2 kasus vs. 0). Kedua teknik menunjukkan hasil serupa dalam kadar CRP dan Oswestry Disability Index (ODI). Hasil ini menunjukkan bahwa EAST menawarkan alternatif minimal invasif dengan hasil klinis lebih baik, tetapi memerlukan perhatian terhadap risiko rekurensi. Studi lebih lanjut diperlukan untuk memastikan temuan ini dan mengevaluasi keamanan jangka panjang teknik EAST.

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Spinal tuberculosis abscess is one of the serious complications of tuberculosis infection that can lead to neurological damage and difficulty in eradicating the pathogen. Open debridement surgery is often chosen. However, minimally invasive techniques, including closed system abscess evacuation (CSAE), have been developed, although data remains limited. This study was conducted to evaluate the clinical and laboratory outcomes of patients undergoing CSAE compared to open debridement. This study aims to compare the clinical and radiological outcomes between the Closed Abscess Evacuation System (CSAE) technique and open debridement in spinal tuberculosis abscess cases. This retrospective study involved 48 patients who underwent one of the two techniques. Results showed that CSAE yielded lower postoperative pain (VAS 2 vs. 4; p<0.001) and smaller scar length (0 cm vs. 12 cm; p<0.001) compared to open debridement. Median hospital stay was shorter in the CSAE group, although not statistically significant (2 vs. 3 days; p=0.06). However, the recurrence rate was higher with CSAE (2 cases vs. 0). Both techniques showed similar results in C-reactive protein (CRP) levels and Oswestry Disability Index (ODI). These findings suggest that CSAE offers a minimally invasive alternative with better clinical outcomes but requires attention to the risk of recurrence. Further studies are needed to validate these findings and evaluate the long-term safety of the CSAE technique."

"Instrumentasi posterior mengharuskan dipertahankannya fiksasi stabil sekrup pedikel di tulang belakang untuk mencapai fusi. Hal ini dapat menjadi sulit terutama pada kondisi tertentu, misalnya pada penurunan densitas masa tulang pedikel. Teknik insersi sekrup dengan lintasan kortikal diharapkan menambah antarmuka sekrup dan tulang dengan meningkatkan engagement antara sekrup dengan korteks tulang. Lintasan sekrup dari arah kortikal infero-superior serta kortikal supero-inferior diharapkan memiliki keunggulan kekuatan cabut (pullout strength) dibandingkan dengan lintasan konvensional dalam mengatasi masalah ini. Penelitian ini bertujuan untuk mendapatkan profil biomekanik awal lintasan kortikal dan perbedaan pull out strength lintasan konvensional (Weinstein, 1992), kortikal infero-superior (Santoni, 2009), dan kortikal supero-inferior. Metode: Sampel dari lumbal (L1-L5) babi Yorkshire (n=30) dilakukan pengukuran morfometri dan dibagi secara acak. Sampel dilakukan pengeboran dan sekrup dimasukkan ke dalam tulang dengan tiga lintasan: konvensional, kortikal infero-superior, dan kortikal supero-inferior. Arah lintasan diperiksa kembali dengan sinar-x. Dilakukan penarikan sekrup dengan arah sesuai aksis insersi sekrup dengan kecepatan translasi 5mm/menit. Hasil dicatat dengan satuan Newton (N). Hasil: Didapatkan rata-rata nilai uji tarik pada kelompok konvensional, infero-superior, dan supero-inferior masing-masing 491,72 (187.23) N, 822,16 (295.73) N, dan 644,14 (201.97) N. Lintasan kortikal infero-superior dan kortikal supero-inferior masing-masing mendapatkan nilai 67% dan 30% lebih tinggi dibandingkan dengan lintasan konvensional. Hasil uji ANOVA satu arah dan uji post-hoc Tukey menunjukkan perbedaan signifikan antara lintasan kortikal infero-superior dengan konvensional (p<0.01). Kesimpulan: Lintasan sekrup dalam tulang lumbal dapat memengaruhi nilai pullout sekrup. Keterlibatan tulang kortikal pada lintasan insersi sekrup baru ini bisa meningkatkan nilai pullout sekrup pedikel. Secara statistik pullout strength lintasan kortikal infero-superior dan kortikal supero-inferior tidak ada perbedaan. Studi ini menunjukkan nilai pullout yang lebih tinggi sebesar 30% dari lintasan yang disarankan peneliti dibandingkan dengan lintasan konvensional, walaupun tidak ada perbedaan signifikan secara statistik.

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Introduction: Posterior instrumentation is aimed to achieve spinal fusion which is helped by maintaining a stable pedicle screw insertion within the pedicle. This presents a challenge especially in conditions with low bone quality. Pedicle screw insertion with cortical bone trajectory is designed to add interface between the screw and the bone through engagement between pedicles and the cortex when compared to conventional pedicle screw insertion. Pedicle screw insertion trajectory from cortical infero-superior and the proposed cortical supero-inferior should obtain better pull out performance when compared with conventional pedicle trajectory. We aim to evaluate the pull out strength differences between conventional (Weinstein, 1992) pedicle screw trajectory, cortical infero-superior (Santoni, 2009), and a proposed cortical supero-inferior trajectory. Methods: Samples from Yorkshire porcine lumbar spine (L1-L5) (n=30) were relieved of soft tissue attachments and dried. Morphometric measurements were conducted and the samples were randomly assigned to three groups. The screws were inserted into the vertebrae by drilling with the three trajectories: conventional, cortical infero-superior, and cortical supero-inferior. The trajectory of the screws were examined using x-rays. Pull-out tests were conducted by applying uniaxial traction in line with the screw trajectory with a translational speed of 5mm/minutes. The results of the pull-out are measured in Newton (N). Results: We obtained a mean value of pullout force in conventional trajectory 491,72 (187.2) N, cortical infero-superior 822,16 (295.73) N, and cortical supero-inferior 644,14 (201.97) N. Cortical infero-superior trajectory and cortical supero-inferior trajectory attained 67% and 30% higher pullout mean respectively. Using one-way ANOVA and a post-hoc Tukey test revealed a significant difference between cortical infero-superior and conventional trajectory (p<0.01). Differing pull out strengths between cortical infero-superior and supero-inferior trajectory showed no statistical significance. Our study showed a 30% higher pull-out strength in our proposed trajectory compared with conventional trajectory although not statistically significant. Conclusion: The trajectory of the screws within the lumbar spine seemed to have an impact in pullout strength. Cortical bone engagement using the novel trajectories may increase screw pullout strength of pedicle screws."

"PendahuluanUntuk menentukan apakah diperlukan fusi tulang belakang disamping dekompresi untuk kasus stenosis spinal lumbar (SSL) akan bergantung kepada stabilitas segmen tulang belakang yang terkena. Stabilitas tulang belakang didefinisikan sebagai kemampuan tulang belakang untuk mempertahankan kemampuan geraknya dengan serta mencegah terjadinya nyeri, defisit neurologis, dan angulasi yang tidak normal. Namun, sampai saat ini, belum ada konsensus yang jelas tentang definisi ketidakstabilan untuk menentukan apakah diperlukan fusi pada kasus SSL. Dalam penelitian ini, kami mengembangkan sistem penilaian baru, yang disebut dengan Indonesia Score of Spinal Instability (ISSI), untuk membantu menentukan adanya ketidakstabilan pada tulang belakang dan mengevaluasi kebutuhan fusi pada LSS.Metodologi Penelitian ini terdiri dari tiga tahap, tahap pertama adalah tinjauan sistematis untuk menemukan prediktor ketidakstabilan tulang belakang pada SSL, tahap kedua adalah pengembangan sistem penilaian untuk ketidakstabilan tulang belakang - Indonesia Score of Spinal Instability (ISSI) melalui pendapat ahli dan teknik Delphi yang dimodifikasi, dan tahap ketiga adalah studi validitas dan reliabilitas sistem penilaian yang baru dikembangkan. Tinjauan sistematis dilakukan dengan menggunakan pedoman dari Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pendapat ahli dan teknik Delphi yang dimodifikasi dilakukan oleh ahli bedah tulang belakang berpengalaman di Indonesia yang telah terpilih, tahap ini dilakukan dua kali untuk menilai apakah ada perbedaan antara putaran pertama dan kedua. Tahap kedua akan menghasilkan ISSI yang baru. Pengujian validitas dan reliabilitas dilakukan di rumah sakit institusional kami, yang melibatkan ahli bedah Ortopedi dan Ahli Radiologi yang bersertifikasi dan dibandingkan dengan penilaian radiologis dari White & Panjabi.HasilSebanyak 54 studi dimasukkan dalam tinjauan sistematis, dan prediktor ketidakstabilan pada stenosis tulang belakang dibagi menjadi klinis (adanya nyeri punggung sebagai gejala primer atau sekunder), radiografi polos statis (adanya vacuum phenomenon, kolaps diskus intervertebralis, sklerosis subkondral, dan traction spur), radiografi polos dinamik (translasi dan angulasi dinamik), dan temuan pencitraan resonansi magnetik/ (magnetic resonance imaging, MRI) yang terdiri dari efusi sendi faset, degenerasi otot multifidus, degenerasi endplate, dan degenerasi diskus. Melalui pendapat para ahli dan teknik Delphi yang dimodifikasi, penilaian ISSI dikembangkan dan terdiri dari komponen klinis (nyeri punggung), komponen radiografi dinamik (translasi horizontal dan angulasi), dan komponen MRI (efusi sendi faset), masing- masing komponen tersebut akan diberi nilai, dan total nilai adalah 0 hingga 14. Penilaian akhir akan mengklasifikasikan pasien ke dalam tiga kelompok: kelompok stabil (nilai 0 hingga 4) di mana fusi tidak diperlukan, kelompok berpotensi tidak stabil (nilai 5 hingga 8) di mana keputusan fusi didasarkan pada penilaian klinis dokter bedah, dan kelompok tidak stabil (nilai 9 hingga 14) di mana fusi diperlukan. Tahap akhir penelitian menyimpulkan bahwa ISSI ini memiliki validitas dan reliabilitas yang baik.Diskusi dan KesimpulanISSI yang baru dikembangkan adalah sistem penilaian ketidakstabilan tulang belakang pada kasus SLL degeneratif yang sahih (valid) dan dapat diandalkan (reliabel), yang dapat membantu mengidentifikasi adanya ketidakstabilan pada SSL degenratif. ISSI diharapkan dapat digunakan sebagai pedoman untuk memutuskan apakah fusi tulang belakang diperlukan.

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Introduction

Whether spinal fusion is performed in addition to a decompression for lumbar spinal stenosis (LSS) depends on the stability of the involved spinal segments. Spinal stability is defined as the ability of the spine to maintain its degree of motion while simultaneously preventing pain, neurologic deficits, and abnormal angulation. However, until currently, there is no clear consensus regarding the definition of instability to perform fusion in the cases of LSS. We developed a new scoring system, the Indonesia Score of Spinal Instability (ISSI), to identify spinal instability and to evaluate the need of spinal fusion in LSS.

Materials and Methods

This study consisted of three stages, the first stage was the systematic review to find predictors of spinal instability in LSS, the second stage was the development of scoring system for spinal instability – the Indonesia Score of Spinal Instability (ISSI) through expert opinion and modified Delphi technique, and the third stage was validity and reliability studies of the new developed scoring system. The systematic review was performed through Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guideline. Expert opinion and modified Delphi technique were performed by experience spine surgeons in Indonesia who had been elected, this stage was performed twice to assess whether there was difference between first and second rounds. The second stage would yield the new developing ISSI. Validity and reliability testing were performed in our institutional hospitals, which included the board-certified Orthopaedic surgeon and Radiologist and was compared with the radiological checklist from White & Panjabi.

Results

A total of 54 studies were included in the systematic reviews, and the predictors of instability in spinal stenosis were divided into clinical (presence of back pain as primary or secondary symptoms), static plain radiograph (presence of vacuum phenomenon, intervertebral disk collapse, subchondral sclerosis, and traction spurs), dynamic plain radiograph (horizontal translation and angulation), and magnetic resonance imaging/ MRI findings (facet joint effusion, fatty degeneration of multifidus, endplate degeneration, and disk degeneration). Through expert opinion and modified Delphi technique, ISSI score was developed and consisted of the clinical component (back pain), dynamic radiograph component (horizontal translation and angulation), and MRI component (facet joint effusion), each of the component would be scored, and the total scoring would be from 0 to 14. The final scoring would classify patients into three groups: stable group (score of 0 to 4) in which the fusion is not needed, potentially unstable group (score of 5 to 8) in which the decision of fusion is based on surgeon’s clinical judgment, and unstable group (score of 9 to 14) in which the fusion is needed. Final stage of study concluded that this ISSI had good reliability and validity

Discussion and Conclusion

The new developed ISSI was a valid and reliable scoring system that could help to identify the presence of instability in LSS and the need of fusion. This ISSI can be used as a guideline to decide whether spinal fusion would be needed."

"LATAR BELAKANG : Kombinasi anestetik lokal dosis rendah dengan opioid yaitu bupivakain 0,5% hiperbarik 7,5 mg dan 5 mg ditambah fentanil 25 mcg diharapkan keefektifannya untuk memfasilitasi bedah Caesar, yaitu dengan cara menurunkan angka kejadian hipotensi dan kualitas analgesia serta blok motorik yang adekuat. METODE : 112 pasien hamil usia 18-40 tahun yang akan menjalani bedah Caesar baik cito maupun elektif ASA I-III yang sesuai dengan kriteria inklusi. Randomisasi menjadi 2 kelompok; kelompok I mendapatkan bupivakain 0,5% hiperbarik 7,5 mg ditambah fentanil 25 mcg dan kelompok II mendapatkan bupivakain 0,5% hiperbarik 5 mg ditambah fentanil 25 mcg. Posisi pasien kedua kelompok yaitu posisi duduk dengan pungsi lumbal setinggi L3-4/L4-5.Total volume 2 cc disuntikkan dengan kecepatan 0,2 cc/detik.Kemudian telentang dengan posisi left lateral tilt. Dilakukan pencatatan tekanan darah pada menit ke-3, 6, 9, 12, 15, 20, 30, 40, 50, 60 atau sampai bayi lahir setelah disuntikkannya obat anestetik lokal ke ruang subaraknoid. Dilakukan pencatatan tercapai blok motorik dan sensorik sampai operasi selesai. HASIL : Keefektifan pada kelompok I 89,3 % dan kelompok II 76,8 %. KESIMPULAN : Tidak terdapat perbedaan yang bermakna mengenai keefektifan pada kedua kelompok subyek penelitian.

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BACKGROUND : the combination of low doses local anesthetics with opioid is 0,5 % hyperbaric bupivacaine 7,5 and 5 mg plus fentanyl 25 mcg is expected to facilitate the effectiveness cesarean that is by way of reducing the incidence of hypotension and the quality of analgesia and motor block adequate.

METHOD : 112 pregnant patients aged 18-40 years who underwent emergency surgery or elective cesarean both ASA I-III corresponding inclusion criteria. Randomization into 2 groups: group 1 receive hyperbaric bupivacaine 0,5 % 7,5 mg plus fentanyl 25 mcg and group 2 get hyperbaric bupivacaine 0,5 % 5 mg plus fentanyl 25 mcg. The position of the two groups are seated position with lumbar puncture as high as L3-4/L4-5. The total volume of 2 ml injected with a speed of 0,2 ml/sec. then supine with left lateral tilt position. Did recording of blood pressure in minute-3, 6, 9, 12, 15, 20, 30, 40, 50, 60 or until the baby was born after injection of local anesthetics into subarachnoid space. Did recording of motor and sensory block achieved until the operation was complete.

RESULT : The effectiveness of the group I was 89,3 % and group II was 76,8 %.

CONCLUSION : There were no significant differences between the two groups regarding the effectiveness of the study subjects."

"[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: 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 kriteria penolakan 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.

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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."

"Sistem urinari hewan dapat dibagi menjadi 2 bagian yaitu sistem urinari bagian atas dan sistem urinari bagian bawah. Ginjal yang merupakan bagian dari sistem urinari memiliki 2 fungsi penting, yaitu filtrasi dan reabsorpsi. Dalam mendiagnosis penyakit yang diderita hewan pada sistem urinarinya terdapat beberapa kendala. Pada penelitian ini, dikembangkan model untuk mendiagnosis gangguan sistem urinari pada anjing dan kucing dengan menggunakan algoritma VFI 5 berdasarkan gejala klinis (terdapat 37 feature) dan pemeriksaan laboratorium (39 feature). Percobaan dilakukan baik pada feature gejala klinis dan juga pada feature pemeriksaan laboratorium. Hasil pengamatan yang dilakukan menunjukkan bahwa akurasi rata-rata sebesar 77,38% untuk percobaan dengan feature gejala klinis, dan 86,31% untuk percobaan dengan feature pemeriksaan laboratorium. Peningkatan ini mengindikasikan bahwa dalam mendiagnosis penyakit dalam sistem urinari, pemeriksaan laboratorium masih sangat dibutuhkan dalam menentukan hasil diagnosis suatu penyakit."

"Latar belakang. Kombinasi anestesi spinal bupivakain dan fentanil dengan penambahan klonidin dosis tinggi diketahui dapat memperpanjang durasi blok sensorik dan motorik, namun prevalensi timbulnya efek samping cukup tinggi. Dalam studi ini, kami menggunakan klonidin dosis rendah secara intratekal (30 mcg) sebagai adjuvan  bupivakain dan fentanil. Tujuan. Penelitian dilakukan untuk membandingkan efektifitas serta efek samping pada kombinasi anestesi spinal bupivakain fentanil dengan dan tanpa klonidin 30 mcg. Metode. Penelitian studi potong lintang yang dilakukan pada 70 pasien seksio sesarea terbagi kedalam dua kelompok masing-masing 35 pasien yang mendapatkan kombinasi anestesi spinal dengan penambahan klonidin 30 mcg dan tanpa klonidin 30 mcg. Penelitian ini mengevaluasi kualitas blok sensorik dan motorik. Efek samping yang terjadi diamati selama 24 jam paska tindakan seksio sesarea meliputi pruritus, mual muntah, nyeri tungkai, nyeri punggung dan mata merah. Hasil Penelitian. Median durasi blok sensorik kelompok kombinasi anestesi bupivakain fentanil dengan klonidin 30 mcg dibandingkan tanpa klonidin 30 mcg (330 menit vs 220 menit), Median durasi blok motorik (193 menit vs 188 menit). Efek samping tertinggi adalah mual muntah terdapat pada kelompok kombinasi tanpa klonidin 30 mcg (42.85%). Perbedaan bermakna (p-value < 0.05) terdapat pada durasi blok sensorik, blok motorik dan efek samping mual muntah. Kesimpulan. Penambahan klonidin 30 mcg pada kombinasi anestesi spinal bupivakain fentanil dapat memperpanjang durasi blok sensorik dan motorik serta meminimalisir efek samping dibandingkan dengan tanpa klonidin 30 mcg.

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Background. The combination of the spinal anesthesia bupivacaine and fentanyl with the addition of high doses of clonidine are known to prolong the duration of sensory and motor blocks, but the prevalence of side effects is high. In this study, we used an intrathecally low dose of clonidine (30 mcg) as an adjuvant to bupivacaine and fentanyl.

Aim. This study was conducted to compare the effectiveness and side effects of the combination spinal anesthesia bupivacaine fentanyl with and without clonidine 30 mcg.

Method. Cross-sectional study conducted on 70 patients with cesarean section divided into two groups of 35 patients each who received a combination of spinal anesthesia with the addition of clonidine 30 mcg and without clonidine 30 mcg. This study evaluates the quality of the sensory and motor blocks. Side effects observed for 24 hours after cesarean section included pruritus, nausea, vomiting, leg pain, back pain and red eyes.

Result. Median sensory block duration in the combination group of the anesthetic bupivacaine fentanyl with clonidine 30 mcg compared without clonidine 30 mcg (330 min vs 220 min), Median motor block duration (193 min vs 188 min). The highest side effect was nausea and vomiting in the combination group without clonidine 30 mcg (42.85%). Significant differences (p-value <0.05) were found in the duration of sensory blocks, motor blocks and side effects of nausea and vomiting.

Conclusion. The addition of clonidine 30 mcg to the combination of spinal anesthesia bupivacaine fentanyl can prolong the duration of sensory and motor blocks and minimize side effects compared to 30 mcg without clonidine."

"Ada beberapa komplikasi respon fisiologis yang muncul setelah pemberian anestesi spinal diantaranya : retensi urine . Dimana klien tidak dapat berkemih selama 6 - 8 jam paska operasi Maka hal ini peneliti ingin melihat sejauh mana ketidakmampuan berkemih pada klien paska operasi. Penelitian deskriptif sederhana yang dilakukan oleh peneliti terhadap 20 responden paska operasi dengan anestesi spinal pada 24 jam pertama di ruang rawat dewasa RS Siloam Gleneagles pada bulan Juni - Juli 2001, membuktikan bahwa terdapat 17 responden (85 %) yang mempunyai nilai rentang antara 21 - 30 adalah merasa ingin berkemih tetapi tidak mampu. Hal ini menunjukkan adanya kebenaran konsep menurut Perry dan Potter (1993)yang mengatakan bahwa klien tidak dapat berkemih selama 8 jam paska operasi dan merasakan kandung kemih penuh atau distensi, sehingga pasien merasa tidak nyaman, menurut Lewis, Heitkemper, dan Dirksen (1999) mengatalcan bahwa anestesi dapat menekan sistem syaraf termasuk refleks berkemih. Dan menurut Miller (2000) mengatakan retensi urine terjadi karena anestesi spinal menghambat syarah neuroaksial. Metode pengumpulan data dilakukan sesuai prosedur dimana setelah menyerahkan surat ijin, peneliti mendatangi respnnden paska operasi dergi anestesi spinal pada 24 jam pertama untuk rnemberikan kuesioner. Hasil penelitian ini menyimpulkan bahwa klien dengan paska anestesi spinal menunjukkan respon ketidakmampuan berkemih pada 24 jam pertama."