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"ABSTRAKLatar belakang: Postoperative Cognitive dysfunction (POCD) adalah gangguanfungsi kognitif dan komplikasi yang sering ditemukan pada pasien usia lanjut pascamenjalani anestesia umum. Selain faktor usia, pembedahan mayor, penyakitpenyerta dan riwayat konsumi obat-obatan tertentu, salah satu faktor dalampeningkatan kejadian POCD adalah tingkat pendidikan pasien. Penelitian tentangtingkat pendidikan dengan angka insiden POCD masih menunjukkan hasil yangberbeda-beda. Kondisi demografis Indonesia mengalami peningkatan populasilanjut usia disertai tingkat pendidikan yang masih rendah sehingga penelitian inibertujuan untuk mengetahui pengaruh tingkat pendidikan terhadap angka kejadianPOCD pada populasi usia lanjut.Metode. Penelitian ini merupakan uji potong lintang terhadap pasien lanjut usia ( lebih dari60 tahun) yang menjalani pembiusan umum di RSCM pada bulan Februari sampaiDesember 2018. Sebanyak 84 subyek diambil setelah memenuhi kriteria inklusi.Skor kognitif dinilai menggunakan Trail making test B dan Digit Span Backward.Analisis data menggunakan uji bivariat dengan Chi-Square dan analisis multivariatregresi logistik.Hasil. Jumlah subjek yang dianalisis pada penelitian ini 80 subjek dengan 9(11.8%) pasien dengan pendidikan rendah, 41 (52.6%) pasien dengan pendidikanmenengah dan 30 (35.6%) pasien dengan pendidikan tinggi. Angka kejadian POCDsebesar 20 (25%) dengan tingkat pendidikan rendah sebanyak 2 (22.2%), tingkatpendidikan menengah sebanyak 11 (26.8%) dan tingkat pendidikan tinggi sebanyak7 (23.3%). Pengaruh tingkat pendidikan terhadap angka kejadian POCD tidakbermakna dengan p 0.921 dan memiliki OR sebesar 1.124. Pada penelitian ini usiatidak bermakna menyebabkan POCD (p=0.064), jenis kelamin tidak bermaknamenyebabkan POCD (p=0.242), dan riwayat operasi tidak bermakna menyebabkanPOCD (p=0.196).Simpulan. Tingkat pendidikan tidak mempengaruhi angka kejadian POCD padapasien lanjut usia yang menjalani anestesia umum.

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ABSTRACTBackground: Cognitive impairment after anesthesia and surgery, also known asPostoperative Cognitive dysfunction (POCD) are most commonly found amongstthe elderly population. Factors that elevate the risk of POCD include old age, majorsurgery, pre-existing comorbidities and consumption of certain drugs. Anotherfactor known to increase the incidence of POCD is low education level.However,study about education level and the incidence of POCD still have differentresults. As Indonesias elderly population and low level education dominance areexpected to increase, this study aims to evaluate the association of educational leveland the incidence of POCD amongst the elderly population after general anesthesia.Method: This study is a cross-sectional study involving elderly patients ( 60years) who underwent general anesthesia at RSCM during February to December2018. A total of 84 subjects were selected after fulfilling the inclusion criteria.Cognitive score was assessed using Trail making test B and Digit Span Backward,while psychometric test was carried out by a validated psychologist. Data wereanalyzed using bivariate analysis test with Chi-Square and multivariate analysiswith logistic regretion.Results: Demographic studies grouped 9 (11.8%) patients with low education, 41(52.6%) patients with secondary education and 30 (35.6%) patients with highereducation. The incidence of POCD was 25% and incidence od POCD in group withlow level of education was 2 (22.2%), average level of education and POCD was11 (26.8%) and the higher level of education and POCD were 7 (23.3%). This studyfound no significant association between education level and the incidence ofPOCD (p=0.921), with an odds ratio of 1.124. Furthermore, this study found thatno significant association between age with the incidence of POCD (p=0.064) nordoes gender and incidence of POCD (p=0.242), and history of surgery withincidence of POCD (p=0.196Conclusion: Education level do not affect the incidence of POCD in elderlypatients undergoing general anesthesia."

"The increasing prevalence of obesity in many countries means that it should now be considered a pandemic. It is widely recognized that obesity increases the risk of a variety of life-threatening conditions, including heart disease, diabetes, and hypertension. Bariatric surgery is often the most effective way to treat such morbid obesity. Nevertheless, while various bariatric procedures have been proposed, to date standards have been lacking. In this book, leading experts from around the world discuss all aspects of bariatric surgery and present their own favored versions of surgical procedures with the aid of informative illustrations. Technical nuances are carefully described, and detailed attention is devoted to potential complications and how to avoid them. "

"Latar Belakang: Disfungsi saluran cerna berhubungan dengan luaran klinis yang lebih buruk pada pasien sakit kritis. Kadar albumin serum yang rendah merupakan salah satu faktor yang dapat meningkatkan risiko disfungsi saluran cerna. Hubungan kadar albumin dengan disfungsi saluran cerna masih inkonklusif karena pendekatan diagnostik disfungsi saluran cerna yang belum terstandarisasi dengan baik. Gastrointestinal dysfunction score (GIDS) instrumen dengan subjektivitas minimal dan reproduktifitas maksimal, diharapkan dapat menegakkan diagnosis disfungsi saluran cerna dengan objektivitas yang lebih baik. Penelitian ini dilakukan untuk mengetahui hubungan antara kadar albumin saat admisi dengan terjadinya disfungsi saluran cerna yang dinilai menggunakan GIDS. Metode: Penelitian ini merupakan penelitian kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di ruang rawat intensif Rumah Sakit Umum Pusat Nasional (RSUPN) dr. Cipto Mangunkusumo dan Rumah Sakit Universitas Indonesia (RSUI). Karakteristik subjek penelitian berupa usia, jenis kelamin, status gizi, penyakit komorbid, diagnosis admisi intensive care unit (ICU), waktu inisiasi pemberian nutrisi oral atau enteral, kebiasaan mengonsumsi alkohol, dan skor sequential organ failure assessment (SOFA). Dilakukan analisis bivariat untuk menilai hubungan kadar albumin saat admisi dengan disfungsi saluran cerna. Hasil: Diperoleh 64 subjek, kelompok kadar albumin rendah 32 subjek dan kelompok kadar albumin normal 32 subjek. Rerata usia subjek 50,2±15,7, laki-laki 64,1%, 26,6% subjek dengan status gizi berat badan normal berdasarkan indeks massa tubuh (IMT), 50% subjek dengan malnutrisi secara klinis,  21,9% subjek dengan diagnosis komorbid diabetes melitus dan 3,1% subjek dengan parkinson, 34,4 % subjek dengan diagnosis admisi bedah, 95,3% subjek mendapatkan nutrisi oral atau enteral ≤ 48 jam, median skor SOFA 3 (0-12). Rerata kadar albumin  subjek dengan disfungsi saluran cerna 2,7±0,6 g/dL, rerata kadar albumin  subjek tidak disfungsi saluran cerna 3,7±0,7 g/dL. 31,3% subjek mengalami disfungsi saluran cerna. Terdapat hubungan signifikan secara statistik antara kadar albumin saat admisi dengan disfungsi saluran cerna RR 9 (95%CI 2,3-35,6; p <0,001) dan skor GIDS, p<0,001. Kesimpulan: Terdapat hubungan bermakna antara kadar albumin saat admisi dengan disfungsi saluran cerna. Pemeriksaan kadar albumin saat admisi ICU idealnya dilakukan secara rutin dan diikuti dengan koreksi kadar albumin apabila ditemukan kondisi hipoalbuminemia.

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Background: Gastrointestinal dysfunction is associated with worse clinical outcomes in critically ill patients. Low serum albumin levels are one factor that can increase the risk of gastrointestinal dysfunction. The relationship between albumin levels and gastrointestinal dysfunction is still inconclusive because the diagnostic approach to gastrointestinal dysfunction is not yet well standardized. Gastrointestinal dysfunction score (GIDS) is an instrument with minimal subjectivity and maximum reproducibility, which is expected to provide a diagnosis of gastrointestinal dysfunction with better objectivity. This research was conducted to determine the relationship between albumin levels at admission and the occurrence of gastrointestinal dysfunction as assessed using GIDS. Methods: This study is a prospective cohort study of subjects aged ≥18 years who were treated in the intensive care unit at RSUPN dr. Cipto Mangunkusumo and RSUI. Characteristics of research subjects included age, gender, nutritional status, comorbid diseases, ICU admission diagnosis, time of initiation of oral or enteral nutrition, alcohol consumption habits, and SOFA score. Bivariate analysis was carried out to assess the relationship between albumin levels at admission and gastrointestinal dysfunction. Results: There were 64 subjects, 32 subjects in the low albumin level group and 32 subjects in the normal albumin level group. Mean age of subjects 50.2 ± 15.7, 64.1% male, 26.6% subjects with normal weight nutritional status based on BMI, 50% subjects with clinical malnutrition, 21.9% subjects with comorbid diagnosis of diabetes mellitus and 3.1%  subjects with Parkinson's, 34.4%  subjects with surgical admission diagnosis, 95.3% subjects received oral or enteral nutrition ≤ 48 hours, median SOFA score 3 ( 0-12). The mean albumin level of subjects with gastrointestinal dysfunction was 2.7 ± 0.6 g/dL, the mean albumin level of subjects without gastrointestinal dysfunction was 3.7 ± 0.7 g/dL. 31.3% of subjects experienced gastrointestinal dysfunction. There was a statistically significant relationship between albumin levels at admission and gastrointestinal dysfunction RR 9 (95%CI 2.3-35.6; p <0.001) and GIDS score, p<0.001. Conclusion: There is a significant relationship between albumin levels at admission and gastrointestinal dysfunction. Albumin levels examination during ICU admission should ideally be carried out routinely and followed by correction of albumin levels if hypoalbuminemia is found."

"Pasien yang menjalani prosedur pembedahan secara elektif dilakukan pembiusan umum dan tindakan intubasi serta menggunakan ventalisi mekanik. Ketika pasien dinilai sudah baik dan mampu dalam bernafas secara spontan, pengunaan ETT harus segera  di lepaskan. Menyegerakan ekstubasi pada pasien dengan pasca pembedahan merupakan hal yang penting dilakukan agar tidak terjadi komplikasi yang cukup besar. Durasi intubasi yang lebih lama  insiden komplikasi akan lebih tinggi, termasuk kejadian pneumonia terkait ventilator (VAP), dan peningkatan kematian. Penelitian ini bertujuan untuk mengetahui gambaran indikator  keberhasilan ekstubasi bedasarkan karakteristik fisik dan psikologis pada pasien post operasi di ruang perawatan intensif. Penelitain ini menggunakan desain deskriptif murni dengan pendekatan retospektif melalui data sekunder pada 96 responden. Pengambilan sampel dilakukan dengan teknik stratifed random sampling. Instrumen yang digunakan adalah lembar cheklist penilaian ekstubasi. Hasil penelitian didapatkan bahwa 100% pasien post operasi dilakukan ekstubasi dengan status kesadaran compos mentis atau nilai GCS > 10, hemodinamik stabil dengan nilai mean teakanan darah sistolik 120,7mmhg, nilai AGD denagn nilai mean PO2 120, PCo2 39.99 dan SaO2 98.36%, memiliki nilai hemtokrit normal denagn nilai mean Hct 38,98%, telah dilakukan spontaneous breathing trial dan kooperatif. 96% pasien memiliki refleks batuk yang kuat sebelum dialakukan ekstubasi.

Kata kunci : Ekstubasi, pasca pembedahan, penilaian ekstubasi

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Patients undergoing elective surgical procedures are subjected to general anesthesia and intubation procedures and use mechanical ventalization. When the patient is judged to be good and able to breathe spontaneously, the use of ETT must be released immediately. Moving extubation in patients with post-surgery is important to do so that there are no major complications.  A longer incidence of intubation will be higher, including the incidence of ventilator-related pneumonia (VAP), and increased mortality.   This study aims to determine the description of indicators of extubation success based on physical and psychological characteristics in postoperative patients in intensive care rooms.  This research used a purely descriptive design with a retospective approach through secondary data on 96 respondents. Sampling was carried out using a stratifed random sampling technique. The instrument used is an extubation assessment cheklist sheet. The results of the study found that 100% of postoperative patients were extubated with compos mentis awareness status or GCS value > 10, stable hemodynamics with a mean value of systolic blood teakanan 120.7mmhg, AGD  value with mean PO2 value 120, PCo2 39.99 and SaO2 98.36%, had a normal hemtokrit value with a mean Hct value of 38.98%, spontaneous breathing trial and cooperative. 96% of patients have a strong cough reflex before  he performed extubation."