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Abstrak :
Latar Belakang. Laringoskopi dan intubasi dilakukan untuk memfasilitasi tindakan anestesia umum. Prosedur ini mengakibatkan nyeri dan memicu pelepasan katekolamin yang dapat menimbulkan respon hemodinamik berupa hipertensi dan takikardia. Berbagai macam obat digunakan untuk menekan respon hemodinamik salah satunya lidokain namun masih tidak dapat meniadakan respon hemodinamik. MgSO4 memiliki banyak manfaat salah satunya untuk menekan hipertensi dan takikardia yang dicetuskan oleh tindakan intubasi. Penelitian ini bertujuan untuk membandingkan efektivitas MgSO4 dibandingkan lidokain dalam menekan respon hemodinamik saat intubasi. Metode. Penelitian ini merupakan penelitian uji klinis acak tersamar ganda, dengan 42 pasien yang menjalani anestesia umum dengan intubasi endotrakeal dan dibagi ke dalam 2 kelompok, yaitu MgSO4 dan lidokain. Kriteria inklusi adalah usia 18-65 tahun dengan status klinis ASA 1-2. MgSO4 25 mg/kg intravena diberikan dengan syringe pump selama 10 menit sebelum induksi dan lidokain 1,5 mg/kg diberikan secara bolus setelah pemberian atrakurium. Respon hemodinamik diukur pada saat awal, pasca induksi, saat intubasi, menit ke-1,3 dan 5 setelah intubasi. Data hemodinamik kemudian ditentukan selisihnya dari nilai pasca induksi dan dibandingkan antara kedua kelompok. Hasil. Uji General Linear Model menunjukkan MgSO4 25 mg/kg intravena tidak lebih efektif dibandingkan lidokain 1,5 mg/kg intravena dalam menekan respon hemodinamik saat intubasi dinilai dari sistolik, diastolik, MAP dan laju jantung dengan p > 0,05 pada saat intubasi dan menit ke-1,3,5 setelah intubasi dibandingkan nilai pasca induksi pada semua variabel hemodinamik antara kedua kelompok. Simpulan. MgSO4 25 mg/kg intravena tidak lebih efektif dibandingkan lidokain 1,5 mg/kg intravena dalam menekan respon hemodinamik saat intubasi. ...... Background. Laringoscopy and intubation is performed for facilitating general anesthesia procedure. This procedure induces pain and stimulate cathecolamine release which gives rise to a hemodynamic response such as hypertension and tachycardia. Many methods has been used to prevent this response such as lidocain, but still there is no method that can eliminate the hemodynamic response. MgSO4 has a lot of benefit effect including supressing hypertension and tachycardia which is induced by intubation procedure. This study aims to compare the effectiveness of MgSO4 with lidocain in supressing hemodynamic response during intubation. Methods. This study is double blind clinical study on 42 patients undergoing general anesthesia with endotracheal intubation and is divided into two groups: MgSO4 and lidocaine. Inclusion criteria were age 18-65 years old with physical status ASA 1-2. Intravenous MgSO4 25 mg/kg was given by syringe pump for 10 minutes before induction and lidocaine 1,5 mg/kg was given by bolus injection after atrakurium was administered. Hemodynamic response were recorded at baseline, post induction, intubation, 1,3,5 minutes after intubation. Hemodynamic data is determined by the difference from the post induction value and is compared between two groups. Results. General Linear Model Test shows intravenous MgSO4 25 mg/kg is not more effective than intravenous lidokain 1,5 mg/kg in supressing hemodynamic response during intubation from systolic, diatolic, MAP and heart rate variable with p > 0,05 during intubation, and 1,3,5 mintues after intubation between two groups.

Abstrak :
Renjatan merupakan sindrom klinis yang ditandai oleh "Prostration" dan gangguan perfusi jaringan. Gangguan ini akan mengakihatkan tidak terpenuhinya kebutuhan metabolisme tubuh. Penyebab renjatan pada anak adalah penadarahan, kehilangan cairan, plasma serta trauma ganda yang menyebabkan gangguan sirkulasi dan respirasi. Dampak lanjut dari renjatan ini dapat menimbulkan kematian atau gejala sisa. Mengingat dampak tersebut maka diperlukan asuhan keperawatan vang intensif, khususnya untuk anak penderita renjatan.

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Shock ix a clinical syndrome characterized by a prostration and an alteration in tissue perfusion. This problem will laid to inadequacy of body metabolism requirements. The main causes of shock in children are bleeding, loss of fluid or plasm and multiple trauma that yield to alteration in circulation and respiration. Further negative impact of shock is squalae or death. Considering the facts above, it is really necessary to provide an intensive nursing care to children who are experiencing shock.

Abstrak :
Latar Belakang: Morbiditas dan mortalitas akibat renjatan pada anak di seluruh dunia dilaporkan masih tinggi. Pengenalan dini dan tatalaksana yang tepat penting untuk menurunkan morbiditas dan mortalitas akibat renjatan. Indikator penting untuk mendeteksi hipoksia jaringan global adalah pengukuran saturasi oksigen mixed vein (SmvO₂) dari kateter arteri pulmonal atau vena sentral namun kedua pemeriksaan ini sulit dan invasif sehingga tidak rutin dilakukan. Near infrared spectroscopy (NIRS) merupakan alternatif pemeriksaan non invasif, real time, kontinu dan praktis untuk mengukur saturasi oksigen regional sekaligus menggambarkan saturasi oksigen vena global. Tujuan: Mengetahui kenaikan nilai NIRS serebral pascarenjatan teratasi serta korelasinya dengan perubahan parameter hemodinamik non invasif.

Metoda: Penelitian potong lintang pada anak usia 1 bulan-18 tahun yang mengalami renjatan di RSUPN Cipto Mangunkusumo, RSUD Pasar Rebo dan RSUD Tarakan pada bulan Maret-Juni 2019. Terhadap subjek yang mengalami renjatan dilakukan pengukuran NIRS serebral, MAP, serta pengukuran non invasif Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) menggunakan Ultrasonic Cardiac Output Monitoring (USCOM) pada saat renjatan dan diulang ketika renjatan teratasi. Uji korelasi dilakukan untuk menilai hubungan antara perubahan nilai NIRS serebral dan parameter hemodinamik non invasif. Hasil: Dari 32 subjek yang diteliti ditemukan peningkatan nilai NIRS serebral sebesar 27,7% pascarenjatan teratasi. Parameter hemodinamik, kecuali untuk SVRI, juga mengalami peningkatan pasca renjatan namun tidak berkorelasi dengan peningkatan nilai NIRS.

Simpulan: Hasil pengukuran NIRS serebral menggambarkan perfusi dan oksigenasi ke jaringan perifer namun tidak berkorelasi dengan parameter hemodinamik non invasif pada penelitian ini. Kata kunci: Near infrared spectroscopy; parameter hemodinamik non invasif; renjatan; USCOM

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Background: Pediatric shock accounts for significant morbidity and mortality worldwide. Early recognition and timely intervention are critical for successful treatment of pediatric shock. A strong indicator of global tissue hypoxia by measuring mixed venous oxygen saturation from pulmonary artery catheter (PAC) or central vein catheter (CVC) is rarely used due to its highly invasive character. Near infrared spectroscopy (NIRS) is a noninvasive, real time, continuous and practical modality is a safe alternative for regional and global oxygen saturation measurement. Objective: To evaluate the increment of cerebral NIRS post-resuscitation in pediatric shock and its correlation with noninvasive hemodynamic measurements. Methods: This cross sectional study was conducted at Cipto Mangunkusumo Hospital, Pasar Rebo Hospital and Tarakan Hospital between March and June 2019. Children whose age ranged from1 month to 18 years admitted to Emergency Department (ED) or Pediatric Intensive Care Unit (PICU) due to shock were included. Measurement of cerebral NIRS, MAP, as well as Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) using Ultrasonic Cardiac Output Monitoring (USCOM) were performed on admission and after resuscitation when the shock has resolved and the patients were stable. Correlation between cerebral NIRS and other noninvasive hemodynamic parameters were then analysed. Results: There were 32 subjects participated in this research. Following resuscitation, cerebral NIRS measurements showed an increment of 27,7% compared to cerebral NIRS in shock state. All non invasive hemodynamic parameters, except for SVRI, were also increased after resuscitation but no correlation observed between these parameters to cerebral NIRS (p>0,005). Conclusion: Cerebral NIRS is a sensitive parameter of peripheral perfusion but showed not correlation with hemodynamic parameters in this research.

Abstrak :
ABSTRAK
Latar Belakang. Optimalisasi hemodinamik perioperatif berkorelasi dengan peningkatan hasil terapi pascaoperasi. Alat pantau pulse contour analysis telah digunakan rutin pada operasi transplantasi ginjal di RSCM. Teknologi ini mahal dan harus dilakukan pemasangan akses kateter arteri. Terdapat alat ukur lain dengan kelebihan tidak invasif.Tujuan. Mengetahui kesesuaian hasil pengukuran hemodinamik antara teknik bio-impedance analysis dan pulse contour analysis pada pasien resipien transplantasi ginjal.Metode. Penelitian observasional statistik potong lintang terhadap 35 pasien resipien transplantasi ginjal di RSCM dan RSCM Kencana Jakarta periode Oktober 2017-Febuari 2018. Parameter hemodinamik pasien diukur menggunakan kedua alat uji yaitu ICONTM dan EV1000TM, pencatatan dilakukan pascainduksi, pascainsisi dan pascapelepasan klem arteri renalis. Analisis data menggunakan uji kesesuaian Bland-Altman dan korelasi.Hasil. Rerata perbedaan nilai indeks curah jantung dan indeks isi sekuncup antara kedua alat adalah 1,3 l/mnt/m2 dan 22,1 ml/denyut/m2 lebih tinggi pada EV1000TM. Rerata perbedaan hasil indeks tahanan vaskular sistemik dan stroke volume variation antara kedua alat adalah 973,3 dynes-detik-m2/cm5 dan 4,8 lebih rendah pada EV1000TM.Simpulan. Tidak terdapat kesesuaian hasil pengukuran curah jantung, tahanan vaskular sistemik dan stroke volume variation antara teknik bio-impedance analysis dengan teknik pulse contour analysis pada pasien resipien transplantasi ginjal. Background. Hemodynamic optimization perioperative has strong correlation with improvement of post-operative outcome. Pulse contour analysis uses regularly for monitoring in renal transplantation surgery at RSCM hospital. This technology is expensive and need access to artery vascular. There is other monitoring device with excess non-invasive use. Purpose. Comparing hemodynamic measurement results between bio-impedance analysis and pulse contour analysis in renal transplant recipients.Method. Cross sectional observasional study to 35 renal transplantation recipient patients at RSCM and RSCM Kirana hospitals Jakarta during October 2017-February 2018. Each patient was measured with both devices ICONTM and EV1000TM. Data collected after induction, after incision and after renal artery release. All the data analyzed with Bland-Altmant agreement and corellation.Result. Mean difference of cardiac output index and stroke volume index are 1,3 l/mnt/m2 and 22,1 ml/denyut/m2 higher in EV1000TM. Mean difference of systemic vascular resistance index and stroke volume variation are 973,3 dynes-detik-m2/cm5 and 4,8 lower in EV1000TM. Conclusion. There is no agreement in measurement of cardiac output, systemic vascular resistance and stroke volume variation between bio-impedance analysis and pulse contour analysis in renal transplantation recipient patients.

Abstrak :
Abstrak
Brain relaxation and prevention from cerebral edema are essential in craniectomy. Osmotherapy with 20% mannitol are generally used to withdraw fluid from the brain parenchyma, however may cause hemodynamic fluctuation, due to increase diuresis. On the other hand 0.5 M hypertonic sodium lactate (HSL) appeared as an alternative of osmotherapy. This study aimed to observe the effect of hypertonic sodium lactate (HSL) on brain relaxation, blood glucose level and hemodynamic variables in craniectomy due to moderate brain injury. Methods: A randomized controlled study of 42 cases with moderate brain injury, aged 18 - 65 years, ASA 1 - 3, between September-November 2012, was carried out. The patients were divided into group M (n = 21) that received 2.5 mL/kg 20% mannitol and group HSL that received 2.5 mL/kg 0.5M HSL. Mean arterial pressures (MAP), central venous pressures (CVP) and urine output were measured after induction, and at 15, 30, 45, 60 min after infusion. Brain relaxation was assessed at a four-point scale after opening the duramater. Blood glucose levels were measured before induction and at 60 min after the infusion. Appropriate statistical tests were used for comparison. Unpaired t-test was used to compare hemodynamic and blood glucose level, and chi-square was used to compare brain relaxation. Results: MAP at 60 minute was significantly higher in HSL group than M group (81.66 ± 7.85 vs 74.33 ± 6.18 mmHg; p = 0.002). There was no difference in brain relaxation (p = 0.988). A significant increase in blood glucose level was observed in group HSL (17.95 ± 11.46 mg/dL; p = 0.001). Conclusion: Half-molar HSL was as effective as 20% mannitol in producing brain relaxation, with better hemodynamic stability and gave significant increase in blood glucose level.