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"ABSTRAKTitle : Comparison on the effectiveness of the insersion of i-gel based onthe ear size and body weight in children 1-11 years old in CiptoMangunkusumo HospitalObjective To compare the effectiveness of i-gel insertion in children aged 1-11 years based on the ear size and body weight.Study design 104 subjects were included in the inclution criteria forrandomization.. Patients was given midazolam for premedication0,01-0,02 mg / kg as needed. Patients who has no prior venousaccess were induced with sevoflurane 8%, 50% oxygen fractioncombined with air, and patient who has venous access inductionwas done with propofol 2-2.5 mg / kg, then continue administering100% oxygen. Ear measurement by ruler measurement vertically,from the top to the bottom and horizontally from the tragus to theouter portion of the ear. Anesthesia continue by administration offentanyl 2 mcg / kg, and atracurium 0.5 mg / kg. After 3 minutesinsertion i-gel was performed. Data of seal pressure, the number ofthe insertion attemp, post-discharge complications of blood stainsand sore throat 24 hours after surgery were obtained.Results This research was followed by 104 children aged 1-11 years withgeneral anesthesia using i-gel. There were no differences indemographics between the two groups The statistical results werep> 0.05 for each variable seal pressure criteria, the number ofinsertion attempts, complications of blood stains and sore throat.Conclusion Insertion of i-gel based on the ear size has an equal effectivenesswith body weight

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ABSTRACTJudul : Perbandingan keefektifan pemasangan i-gel berdasarkan ukurandaun telinga dengan berat badan pada anak 1-11 tahun di RumahSakit Cipto Mangunkusumo JakartaTujuan Penelitian ini bertujuan untuk mengetahui perbandingankeefektifan pemasangan i-gel pada anak usia 1-11 tahun yangpemilihan ukurannya didasarkan kepada ukuran daun telingadengan ukuran berat badan.Metode 104 subjek yang masuk dalam kriteria inklusi dilakukanrandomisasi. Pasien diberikan premedikasi midazolam 0,01-0,02mg/kgBB sesuai dengan kebutuhan. Pasien yang tidak terpasangakses vena dilakukan induksi dengan gas sevofluran 8%, fraksioksigen 50 % kombinasi dengan air, pada pasien yang sudahterpasang akses vena induksi dengan propofol 2-2,5 mg/kgBB dandilajutkan dengan pemberian oksigen 100%. Pengukuran dauntelinga menggunakan penggaris secara vertikal, dari bagian teratassampai dengan terbawah dan horizontal dari tragus sampai denganbagian terluar daun telinga. Anestesi dilanjutkan dengan pemberianfentanyl 2 mcg/kgBB dan atrakurium 0,5 mg/kgBB. Setelah 3menit dilakukan insersi i-gel. Dinilai seal pressure, jumlah upayapemasangan, komplikasi noda darah pasca pelepasan dan nyeritenggorok 24 jam pasca operasi.Hasil Penelitian ini diikuti oleh 104 anak usia 1-11 tahun dengan anestesiumum menggunakan i-gel. Secara demografi tidak terdapatperbedaan diantara kedua kelompok. Hasil penelitian didapatkanp>0,05 pada masing-masing uji statistik untuk kriteria sealpressure, jumlah upaya pemasangan, komplikasi noda darah dannyeri tenggorok.Kesimpulan Pemasangan i -gel berdasarkan ukuran daun tel inga samaefekt ifnya dengan berat badan"

"Latar belakang: Aritmia jantung merupakan komplikasi yang sering terjadi pada operasi jantung. Stroke merupakan komplikasi penting dari fibrilasi atrial pascaoperasi (FAPO). Lama rawat di rumah sakit bertambah dengan adanya FAPO. Terapi medikamentosa yang sudah ada untuk penanganan FAPO belum memuaskan hasilnya. Neuromodulasi saraf vagus menggunakan Transcutaneous Vagus Nerve Stimulation (TVNS) berpotensi untuk mengurangi FAPO dan inflamasi pascaoperasi jantung sehingga layak untuk diteliti.Metodologi: Penelitian ini merupakan uji klinis acak tersamar tunggal yang dilakukan terhadap pasien dewasa yang menjalani operasi jantung pintas koroner dan katup elektif di Rumah Sakit Umum Pusat Dr. Kariadi Semarang pada bulan April-Juli 2023. Sebanyak 66 subjek yang memenuhi kriteria inklusi dibagi secara acak menjadi dua kelompok secara tersamar. Kelompok pertama mendapat perlakuan TVNS dan kelompok kedua sham TVNS. Perekaman dan pengamatan EKG kontinyu selama 3 hari pasca operasi dan kadar IL-6 diukur 24 jam praoperasi dan 72 jam pascaoperasi. Uji statistik menggunakan Chi Square dan Mann Whitney.Hasil penelitian: Pada luaran primer, tidak didapatkan perbedaan yang bermakna durasi per episode FAPO (p=0,069) dan peningkatan kadar IL-6 pascaoperasi (p=0,64) pada kelompok TVNS dan sham TVNS. Demikian juga pada luaran sekunder, tidak didapatkan perbedaan bermakna pada durasi awal tanpa terapi standar fibrilasi atrial (p=0,64), kebutuhan vasopressor inotropik (p = 0,517 dan 0,619) dan beban fibrilasi atrial (p=0,07).Kesimpulan: TVNS tidak memberikan perbedaan bermakna pada durasi per episode FAPO dan derajat inflamasi pascaoperasi bedah jantung dewasa.

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Background: Postoperative arrhythmia is a frequent complication in cardiac surgery. Stroke is an important complication of postoperative atrial fibrillation (POAF). The length of hospital stay increases with POAF. Existing medical therapy for POAF has not shown satisfactory results. Vagus nerve neuromodulation using Transcutaneous Vagus Nerve Stimulation (TVNS) has a potential effect to reduce FAPO and inflammation after cardiac surgery, so it is beneficial to study.

Methodology: This study was a single-blind randomized control trial conducted on adult patients undergoing elective coronary bypass graft and heart valve surgery at Dr. Kariadi General Hospital in April-July 2023. A total of 66 subjects who met the inclusion criteria were randomly divided into two groups in a blinded manner. The first group received TVNS treatment and the second group received sham TVNS. Continuous ECG recording and reading for 3 days after surgery and IL-6 levels were measured 24 hours preoperatively and 72 hours postoperatively. Statistical analysis using Chi-Square and Mann-Whitney test.

Results: In the primary outcome, there was no significant difference in duration per episode of POAF (p=0.069) and the increase of postoperative IL-6 levels (p=0.64) in the TVNS and sham TVNS groups. Similarly in secondary outcomes, there were no significant differences in the initial duration without standard therapy of atrial fibrillation (p=0.64), the need for inotropic vasopressors (p = 0,517 and 0,619), and the burden of atrial fibrillation (p=0.07).

Conclusion: No significant difference in the duration per episode of FAPO and the degree of inflammation after adult cardiac surgery with TVNS treatment."

"Latar belakang. Tingginya angka bedah sesar menunjukkan tingginya anestesia spinal, komplikasi yang disebabkan oleh anestesia spinal yang berhubungan dengan morbiditas ibu dan janin adalah hipotensi. Penelitian ini bertujuan untuk mengetahui apakah posisi reverse Trendelenburg (RT) dapat mencegah atau menurunkan angka kejadian hipotensi pada operasi bedah sesar yang menggunakan teknik anestesia spinal dengan bupivakain dosis 10 mg dengan fentanil 25 mcg.Metode. Penelitian ini merupakan uji klinis, acak, tidak tersamar pada pasien yang menjalani bedah sesar dengan anestesia spinal di RSIA Budi Kemuliaan pada bulan Oktober sampai November 2018. Sebanyak 108 subjek diambil setelah memenuhi kriteria inklusi. Analisis data menggunakan uji komparatif non-parametris Chi Square.Hasil. Angka kejadian hipotensi pada kelompok reverse Trendelenburg 10 derajat sebesar 15/54 (27,8%) sedangkan kelompok posisi netral sebesar 31/54 (57,4%). Posisi RT menurunkan risiko hipotensi sebesar 2.08 kali dibandingkan posisi netral (Risk ratio 0,48) dengan Interval Kepercayaan 95% berada pada rentang 0,3 – 0,8. Secara statistik dengan uji Chi square didapatkan perbedaan yang bermakna antara kelompok posisi RT dan netral dalam menyebabkan terjadinya hipotensi dengan nilai p 0,004.Simpulan. Posisi reverse Trendelenburg 10 derajat menurunkan angka kejadian hipotensi dua kali lipat dibandingkan posisi netral.

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Background. The high number of caesarean section procedure describes amount of spinal anesthesia method. Complication caused by spinal anesthesia which related to maternal and fetal comorbidities is hypotension. The main aim of this research is to study reverse Trendelenburg 10 degree position to prevent or lowering incidence of hypotension for patient undergo caesarean section with spinal anesthesia using bupivacaine 10 mg and fentanyl 25 mcg.

Method. This research is randomized but not blinded clinical trial to patient undergo caesarean section with spinal anesthesia at Budi Kemuliaan hospital during October to November 2018. Total 108 subjects were selected after fulfilling the inclusion criteria. Data were analyzed using nonparametric and comparative test with Chi Square.

Results.The incidence of hypotension in reverse Trendelenburg (RT) group is 15/54 (27.8%) while the incidence of hypotension in neutral group is 31/54 (57.4%). RT position lowering the incidence of hypotension in the amount of 2.08 times compared with neutral position (risk ratio 0.48), confidence interval 95% within 0.3-0.8. There is significant difference between groups with p 0.004."

"ABSTRAKPendahuluan Di RSCM algoritme penanganan pasien trauma belum ada. Waktu yang dibutuhkan untuk penanganan pasien trauma juga tidak pernah tercatat dengan baik. Tujuan dari studi ini adalah untuk mengetahui rerata waktu penanganan pasien trauma di ruang resusitasi RSCM. Selain itu, mortalitas akibat trauma juga dicatat.Metode Semua pasien trauma yang masuk ke ruang resusitasi RSCM pada bulan Juni-November 2012 diikutsertakan. Waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai primary survey dan tindakan diagnosis yang dibutuhkan serta waktu sampai pasien keluar dari ruang resusitasi baik ke kamar operasi maupun ke ruang rawat juga dicatat. Mortalitas yang terjadi di rumah sakit pasca trauma juga dicatat.Hasil Selama periode penelitian tercatat ada 41 pasien trauma yang masuk ke ruang resusitasi RSCM. Rerata waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai primary survey selesai dikerjakan adalah 10(5-60) menit; sampai hasil pemeriksaan laboratorium didapatkan adalah 55(5-185) menit; sampai hasil pemeriksaan rontgen didapatkan adalah 30(15-210) menit; sampai hasil pemeriksaan USG didapatkan adalah 12,5(5-30) menit; sampai hasil pemeriksaan CT-scan didapatkan adalah 75(15-360) menit. Rerata waktu yang dibutuhkan mulai dari pasien masuk ruang resusitasi sampai dikirim ke kamar operasi adalah 222,5(25-660) menit; sampai dikirim ke ruang rawat tanpa melalui operasi adalah 1440(170-1440) menit. Mortalitas yang terjadi di rumah sakit pasca trauma adalah 41,4%.Kesimpulan Rerata waktu penanganan pasien trauma di ruang resusitasi RSCM, baik untuk tindakan diagnostik maupun operasi emergensi masih lebih dari 60 menit. Mortalitas pasien pasca trauma 41,4%. Dibutuhkan penelitian lebih lanjut untuk mengevaluasi hubungan antara waktu penanganan pasien dengan mortalitas pasien.

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ABSTRACTIntroduction In Cipto Mangunkusumo Hospital trauma algorithm is not available yet. The time spent to manage trauma patients in the resuscitation room also hasn’t been recorded very well. Aim of this study is to analyze how much time needed in the resuscitation room to manage trauma patients. The mortality follow is also recorded.Methods All consecutive trauma patients who went to the resuscitation room during June to November 2012 are included. The time spent between admission to the resuscitation room until primary survey and diagnostic procedure be done also until patients exit the resuscitation room whether to the operating room or straight to the ward were recorded. In hospitality mortality were also recorded.Results During the study, there were 41 trauma patients went to the resuscitation room. Median time spent between admission until primary survey was finished was 10(5-60) minutes; until blood work results finished was 55(5-185) minutes; until x-ray results finished was 30(15-210) minutes; until USG results finished was 12,5(5-30) minutes; until CT-scan results finished was 75(15-360) minutes. Median time spent between admission until exiting to the operating room was 222,5(25-660) minutes; until exiting to the ward without operation was 1440(170-1440) minutes. In hospitality mortality was 41,4%.Conclusion The time spent in the resuscitation room to manage trauma patients both to do the diagnostic procedure and emergency operation was still more than 60 minutes. In hospital mortality was 41,4%. Further study needed to analyze the relationship between those two things."

"LATAR BELAKANG : Hipotensi akibat anestesia spinal pada pasien yang menjalani bedah caesar berbahaya bagi ibu dan janinnya. Sehingga, kombinasi anestetik lokal dosis rendah dengan opioid yaitu bupivakain 0,5% hiperbarik 5 mg dan 6 mg ditambah fentanil 25 mcg diharapkan dapat menurunkan angka kejadian hipotensi dengan kualitas analgesia yang adekuat untuk memfasilitasi bedah caesar.METODE : 394 pasien hamil aterm usia 20 ? 40 tahun yang akan menjalani bedah caesar, baik cito maupun elektif ASA I ? II,yang sesuai dengan kriteria inklusi.Randomisasi menjadi kelompok I yang mendapat bupivakain 0,5% hiperbarik 5 mg ditambah fentanil 25 mcg serta kelompok II (kontrol) yang mendapat bupivakain 0,5% hiperbarik 6 mg ditambah fentanil 25 mcg.Posisi pasien pada kedua kelompok sama yaitu posisi lateral dengan pungsi lumbal setinggi L3-4/L4-5.Total volume 1,7cc disun tikkan 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 setelah disuntikkannya obat anestetik lokal ke ruang subaraknoid.HASIL : Terdapat 3 subyek penelitian yang dikeluarkan pada kelompok I, karena dikonversi menjadi anestesia umum . Terdapat 2 subyek penelitian pada kelompok II yang mendapatkan fentanil 100 mcg intravena. Angka kejadian hipotensi pada kelompok I 9,3% dan pada kelompok II adalah 12,2%.KESIMPULAN : Tidak terdapat perbedaan yang bermakna mengenai angka kejadian hipotensi pada kedua kelompok subyek penelitian.

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BACKGROUND: Hypotension due to spinal anesthesia in patients undergoing cesarean section is dangerous for both mother and fetus. So with a combination of low doses of local anesthetics 0.5% hyperbaric bupivacaine 5 mg and 6 mg plus fentanyl 25 mcg is expected to reduce the incidence of hypotension with adequate quality of analgesia to facilitate cesarean section.METHODS: 394 pregnant patients at term age 20-40 years undergo caesarean section, either cito and elective ASA I - II, in accordance with the criteria I inclusion. Randomization into groups that received 0.5% hyperbaric bupivacaine 5 mg plus fentanyl 25 mcg and group II (controls) who received 0.5% hyperbaric bupivacaine 6 mg plus fentanyl 25 mcg.Posisi patients in both groups were the same, namely the lateral position with the highest lumbar puncture L3-4/L4-5.Total injected volume is 1.7 cc with speed of injection 0.2 ml / second. Then move patient to supine position with left lateral tilt. Do blood pressure recording in minute - 3.6,9,12,15,20,30,40,50,60 after injection of local anesthetic drugs into the subarachnoid space.RESULTS: There were three subjects that excluded subjects in group I, because converted to general anesthesia. There are two subjects in group II who received fentanyl 100 mcg intravenously. The incidence of hypotension in group I and 9.3% in group II was 12.2%.CONCLUSION: There was no significant difference in the incidence of hypotension in both groups."

"ABSTRAKLatar Belakang. Nitrous oxide merupakan gas anestesia inhalasi yang seringditambahkan pada saat induksi anestesia inhalasi pada anak. Kontroversipenggunaan N2O sendiri masih ada hingga saat ini. Tujuan penelitian ini adalahuntuk mengetahui perbedaan laju induksi anestesia, respons hemodinamik, dankomplikasi yang timbul selama menggunakan N2O saat induksi inhalasi anestesiapada pasien anak.Metode. Delapan puluh orang anak usia 1-5 tahun ASA 1 dan 2 yang menjalanianestesia umum, dibagi menjadi 2 kelompok perlakuan secara acak. Kelompok Asevofluran 8 vol% ditambah oksigen, dan kelompok B sevofluran ditambahoksigen dan N2O 50%. Hasil utama yang diukur adalah laju induksi, dan hasillainnya adalah respons laju nadi, tekanan darah sistolik, diastolik, serta insidenskomplikasi desaturasi, eksitasi, laringospasme, dan breath holding..Hasil. Laju induksi kelompok B yaitu 35+8.13 detik, lebih cepat dibandingkankelompok A yaitu. 54.12+5.89 detik Respons laju nadi, tekanan darah sistolik,tekanan darah diastolik tidak berbeda bermakna di antara kedua kelompok.Insidens komplikasi desaturasi dan laringospasme tidak terjadi pada penelitian ini.Eksitasi terjadi lebih sedikit pada kelompok B yaitu 10.3% dibandingkan 26.8%pada kelompok A, namun tidak bermakna secara statistik. Breath holding terjadipada 2 orang (4.9%) di kelompok A, dan tidak terjadi di kelompok B, insidensbreath holding tidak berbeda bermakna antara kedua kelompok.Kesimpulan. Laju induksi inhalasi pada anak menggunakan sevofluran ditambahoksigen dan N2O lebih cepat dibandingkan tanpa N2O Respons hemodinamik daninsidens komplikasi tidak berbeda bermakna antara kedua kelompok.

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ABSTRACTBackground. Nitrous oxide is an anesthetic agent that are often added duringinhalation induction of anesthesia in pediatric patients. Controversy over the useof N2O is still there to this day. The purpose of this study was to determinedifferences in the induction time of anesthesia, hemodynamic response, and thecomplications that arise during the use of N2O inhalation induction of anesthesiain pediatric.Methods. Eighty children aged 1-5 years old ASA 1 and 2 who underwentgeneral anesthesia, were divided into 2 treatment groups at random. Group A was8 vol% sevoflurane plus oxygen, and group B was oxygen plus sevoflurane and50% N2O. We measured the induction time, hemodynamic response heart rate,systolic and diastolic blood pressure, and also the incidence of complicationsdesaturation, excitation, laryngospasm, and breath holding.Result. Induction time of group B was 35+8.13 seconds, faster than group A54.12 +5.89 seconds. The response of heart rate, systolic blood and diastolicblood pressure was not significantly different between the two groups.Desaturation and laryngospasm did not occur in this study. Excitation occurs lessin group B that was 10.3% compared to 26.8% in group A, but that was notstatistically significant. Breath holding occurred in 2 patients (4.9%) in group A,and did not occur in group B, breath holding incidence also did not differsignificantly between the two groups.Conclusion. Inhalation induction time in children using sevoflurane, oxygen andN2O was faster, than without N2O. Hemodynamic response and the incidence ofcomplications was not significantly different between groups."

"Latar Belakang: Blok psoas merupakan salah satu teknik anestesia untuk operasi ekstremitas bawah. Teknik blok psoas membutuhkan alat stimulator saraf atau USG untuk memfasilitasi prosedur blok tersebut. Belum semua rumah sakit atau instansi kesehatan memiliki alat tersebut. Blok paravertebral lumbal dapat dijadikan alternatif dari blok psoas karena dapat dilakukan dengan teknik blind. Penelitian ini dilakukan untuk mengetahui penyebaran zat pewarna metilen biru 1% pada injeksi 1 titik di ruang paravertebral lumbal 4. Metode: Penelitian ini dilakukan pada 16 kadaver di kamar mayat bagian forensik RSUPN-CM. Penelitian ini merupakan penelitian eksperimental dan sampel adalah kadaver segar yang memenuhi kriteria penerimaan dan tidak terkena kriteria penolakan atau pengeluaran. Penelitian dilakukan dengan menginjeksikan 30 ml zat pewarna metilen biru 1% di ruang paravertebral lumbal 4 menggunakan jarum blok pada posisi miring ke kanan. Kadaver kemudian dikembalikan ke posisi terlentang dan penyebaran zat pewarna didokumentasikan setelah otot psoas diinsisi. Analisis hasil penelitian menggunakan statistik deskriptif. Hasil: Kadaver yang diikutsertakan dalam penelitian ini adalah kadaver segar, tidak diawetkan, tinggi badan ≥ 150 cm, IMT ≤ 30 kg/m2, dan tidak dikenal. Kriteria pengeluaran adalah kadaver dengan kelainan skoliosis torakolumbal, jejas di area punggung dan pinggang, kasus kriminal, dan intoksikasi. Tidak ada kadaver yang dikeluarkan dalam penelitian ini. Penyebaran tertinggi ke arah sefalad mencapai lumbal 1 (6,25%) dengan rata-rata terbanyak pada lumbal 3 (50%). Penyebaran terendah ke arah kaudad mencapai sakral 2 (12,5%) dengan rata-rata terbanyak pada lumbal 5. Penyebaran ke arah kontralateral sebanyak 18,75%. Penyebaran paling sedikit pada 2 segmen (6,25%), paling banyak pada 5 segmen (12,5%), dan rata-rata terbanyak pada 4 segmen (43,75%). Ruang paravertebral lumbal 4 merupakan tempat utama penyebaran (100%), diikuti dengan segmen lumbal 3 (87,5%) dan lumbal 5 (87,5%). Kesimpulan: Injeksi 1 titik 30 ml zat pewarna metilen biru 1% pada blok paravertebral lumbal 4 dapat mencapai area pleksus lumbalis yang diinervasi oleh persarafan lumbal 2-4. Penelitian lebih lanjut diperlukan untuk mengetahui volume dan lokasi injeksi yang optimal dan aman untuk menghasilkan penyebaran yang lebih baik pada persarafan pleksus lumbalis.

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Background: Psoas block is one of the anesthesia techniques for lower limb surgery. Psoas block technique requires nerve stimulator or ultrasound to facilitate the procedure. Not all hospitals or health agencies have the tools. Lumbar paravertebral block can be used as an alternative to the psoas block because it can be done with a blind technique. This study was conducted to determine the spread of methylene blue dye injection 1% at one point in the fourth lumbar paravertebral space. Method: The study was conducted on 16 cadavers in the morgue forensic section RSUPN-CM. This study was an experimental study and the sample is fresh cadavers that meets acceptance criteria and not exposed to rejection or removal criteria. The study was conducted by injecting 30 ml of methylene blue dye 1% in the fourth lumbar paravertebral blocks using needle tilting to the right position. Cadaver then returned to the supine position and the spread of dye documented after psoas muscle incision. Analysis of the results of research using descriptive statistics. Results: Cadaver were included in this study were fresh cadaver, uncured, ≥ 150 cm height, BMI ≤ 30 kg/m2, and unknown cadaver. Exclusion criteria is cadaver with thoracolumbar scoliosis disorder, injury in the back and waist area, criminal cases, and intoxication. No cadaver that was removed in this study. The highest cephalad spread achieving 1st lumbar (6.25%) with the highest average in the 3rd lumbar (50%). The lowest caudad spread achieving 2nd sacral (12.5%) with the highest average in the 5th lumbar. Spread to the contralateral as much as 18.75%. The least spread is 2 segments (6.25%), the most spread is 5 segments (12.5%), and the highest average is 4 segments (43.75%). 4th lumbar paravertebral space is a prime spot spread (100%), followed by 3rd lumbar segment (87.5%) and the 5th lumbar(87.5%). Conclusion: Injection of 1 point 30 ml of methylene blue dye 1% at the 4th lumbar paravertebral block can reach the lumbar plexus area innervated by 2nd-4th lumbar innervation. Further research is needed to determine the volume and location of the optimal and safe injection to produce a better spread of the lumbar plexus innervation."

"[ABSTRAKLatar Belakang. Manajemen jalan nafas merupakan salah satu tahap yang paling penting dalam bidang anestesiologi. Salah satu jenis Alat bantu jalan nafas yang telah dipergunakan secara luas adalah Laringeal Mask Airway (LMA/Sungkup Laring). Pada pemasangan sungkup laring tanpa menggunakan pelumpuh otot membutuhkan kedalaman anestesi yang cukup, Tes klinis yang mudah, akurat dan aplikatif diperlukan untuk menghindari terjadinya komplikasi. Penelitian ini bertujuan untuk membandingkan trapezius squeezing test dan jaw thrust sebagai indikator kedalaman anestesi pada pemasangan sungkup laring dengan propofol sebagai agen induksiMetode. Sebanyak 128 pasien di randomisasi ke dalam 2 kelompok yaitu jaw thrust dan trapezius squeezing test. Seluruh pasien mendapatkan premedikasi dengan midazolam 0.05 mg/kgBB dan Fentanyl 1 mcg/kgBB. Induksi menggunakan propofol titrasi. Manuver jaw thrust dan trapezius squeezing test dilakukan setiap 15 detik. Saat respon motorik hilang dilakukan pemasangan sungkup laring. Dicatat keberhasilan pemasangan, dosis propofol, tekanan darah, laju jantung, dan insiden apneu.Hasil. Keberhasilan pada kelompok jaw thrust 93.8%, sedangkan trapezius squeezing test yang 90.6%. Penggunaan rerata propofol pada kelompok jaw thrust yaitu sebesar 120.34 mg, sedangkan pada kelompok trapezius squeezing test yaitu sebesar 111,86 mg. Insiden apneu yang pada kelompok jaw thrust terjadi pada 10 (15.6%) pasien, sedangkan pada kelompok trapezius squeezing test sebesar 11 (17.2%) pasien. Tidak terdapat perubahan hemodinamik yang berarti pada kelompok jaw thrust sedangkan sedangkan pada kelompok trapezius squeezing test terdapat perubahan hemodinamik yang berarti di menit ke 3 dan ke 4Kesimpulan. Trapezius squeezing test tidak lebih baik daripada jaw thrust sebagai indikator klinis dalam menilai kedalaman anestesia pada insersi sungkup laring.

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ABSTRACTBackground. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.;Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion., Background. Airway management is one of the most important phase in anesthesiology. One of airway device that have been used generally is Laryngeal Mask Airway (LMA). Laryngeal mask insertion without muscle relaxant requires a level of depth anesthesia. An easy, accurate, an applicable clinical indicator were required to avoid complication. This study was determine the comparison trapezius squeezing test and jaw thrust as indicator of depth of anesthesia in laryngeal mask insertion with propofol as induction agent.Methods. 128 patient have been randomize in to 2 group that are jaw thrust and trapezius squeezing test. All patients were received premedication with midazolam 0.05 mg/kg and fentanyl 1 μg/kg. Induction were done by propofol titration. Jaw thrust and trapezius squeezing test maneuver were done in every 15 second. When motoric respond negative the laryngeal mask were inserted. The successful of laryngeal mask insertion was recorded, propofol consumption, blood pressure, heart rate, and incidence of apnea were also documented.Result. Laryngeal mask successfully inserted in 93.8% patients in jaw thrust group, and 90.6% in trapezius squeezing test group. Mean of propofol consumption in jaw thrust group is 120.34 mgs, and in trapezius squeezing test is 11.86 mgs. Incident of apnea in jaw thrust group happened in 10 patients (15.6%), and in trapezius squeezing test group happened in 11 patient (17.2%). Hemodynamic in jaw thrust group relatively stable but in trapezius squeezing test there is significant hemodynamic changing in minute third and fourth.Conclusion. Trapezius squeezing test is not better than jaw thrust as clinical indicators of depth of anesthesia for laryngeal mask insertion.]"

"Latar belakang. Komplikasi paru pascaoperasi merupakan salah satu penyebab penting morbiditas dan mortalitas pascaoperasi yang berkaitan dengan anestesia dan pembedahan. Pengaturan ventilasi mekanis berpengaruh terhadap munculnya komplikasi paru pascaoperasi. Penelitian ini bertujuan meneliti pengaruh volume tidal 6 mL/kg dan 10 mL/kg dengan menggunakan PEEP 6 cmH2O terhadap penanda fungsi paru yaitu PaO2/FiO2.Metode. Penelitian ini bersifat uji klinis acak senter tunggal terhadap pasien yang menjalani operasi abdominal mayor elektif di Rumah Sakit Cipto Mangunkusumo pada bulan November 2014 sampai April 2015. Sebanyak 52 subyek diambil dengan metode consecutive sampling. Subyek diacak dalam 2 kelompok yaitu kelompok yang medapat volume tidal 6 mL/kg dengan PEEP 6 cmH2O dan volume tidal 10 mL/kg dengan PEEP 6 cmH2O. Keluaran primer adalah pemeriksaan fungsi paru menggunakan rasio PaO2/FiO2. Keluaran sekunder adalah komplikasi paru (pneumonia, atelektasis, ARDS, gagal napas), komplikasi ekstraparu (SIRS, sepsis, sepsis berat), dan mortalitas dalam 28 hari pascaoperatif.Hasil. Kedua grup memiliki karakteristik dasar dan intraoperatif yang sama. Tidak ditemukan perbedaan yang bermakna rasio PaO2/FiO2 antara kelompok VT-6 mL/kg dengan VT-10 mL/kg, baik pada awal operasi (p=0,14), akhir operasi (p=0,44), hari pertama pascaoperasi (p=0,23), dan hari kedua pascaoperasi (p=0,39). Tidak ada perbedaan bermakna keluaran sekunder berupa kompikasi paru sampai hari ke-7 pascaoperasi, ekstraparu sampai hari ke-7 pascaoperasi, dan mortalitas dalam 28 hari pascaoperasi antara kedua kelompok.Simpulan. Volume tidal-6 sampai volume tidal-10 dengan PEEP6 cmH2O aman untuk dipakai pada pasien yang menjalani operasi abdominal mayor.

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Background. Postoperative pulmonary complications are one of the important causes of postoperative morbidity and mortality associated with anesthesia and surgery. Mechanical ventilation settings influence the emergence of postoperative pulmonary complications. The aim of this study is to investigate the influence of tidal volume 6 mL/kgBW and 10 mL/kgBW with PEEP 6cmH2O to pulmonary function which is measured by the ratio of PaO2 / FiO2.Methods. This study is a single center randomized clinical trial on patients undergoing elective major abdominal surgery at Cipto Mangunkusumo Hospital in November 2014 to April 2015. A total of 52 subjects were taken with consecutive sampling method. The subjects were randomized into two groups: the group receiving tidal volume 6 mL/kgBW with PEEP 6 cmH2O and the group receiving tidal volume of 10 mL/kgBW with PEEP 6 cmH2O. The primary output is the assessment of pulmonary function using the ratio of PaO2/FiO2. Secondary outputs are pulmonary complications (pneumonia, atelectasis, ARDS, respiratory failure), extrapulmonary complications (SIRS, sepsis, severe sepsis), and mortality within 28 days postoperative.Results. The two intervention groups had similar characteristics at baseline. There are no significant PaO2 / FiO2 ratio differences between the VT - 6 mL/kgBB with VT - 10 mL/kgBB, at the start of the operation (p=0,14), the end of surgery (p=0.44), the first postoperative day (p=0,23), and the second postoperative day (p=0,39) . There is no significant difference in the secondary outcomes in form of pulmonary complications until postoperative day 7, extrapulmonary complications until postoperative day 7, and in 28-days postoperative mortality between the two groups.Conclusions : Tidal volume of 6 to 10 mL/kg with PEEP 6 cmH2O are safe for use in patients undergoing major abdominal surgery."

"[ABSTRAKLatar Belakang: Kraniotomi elektif memiliki insidens komplikasi paru pascaoperasi (25%) dan mortalitas (10%) yang tinggi. Pemakaian volume tidal rendah sebagai bagian dari teknik proteksi paru diketahui menurunkan komplikasi paru pascaoperasi. Penelitian ini berusaha mengetahui efek volume tidal 6 mL/kg dan 10 mL/kg terhadap rasio PaO2/FiO2 pascaoperasi pada kraniotomi elektif.Metoda: Uji klinis acak ini dilakukan di satu rumah sakit pendidikan di Indonesia. Lima puluh dua pasien kraniotomi elektif (usia 18-60 tahun, durasi bedah >4 jam, paru normal) dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik perioperatif dengan volume tidal 6 mL/kg (VT-6) atau 10 mL/kg (VT-10). Hipotesis penelitian ini adalah rasio PaO2/FiO2 kelompok VT-6 lebih tinggi dibandingkan VT-10. Analisis gas darah dilakukan pada 1 jam pascainduksi, akhir operasi, 24 jam pascainduksi dan 48 jam pascainduksi. Komplikasi paru (atelektasis, pneumonia, ARDS, gagal napas) dan komplikasi ekstraparu (SIRS, sepsis, sepsis berat) diobservasi sampai hari ke-7 dan mortalitas pada hari ke-28.Hasil: Rasio PaO2/FiO2 kelompok VT-6 dan VT-10 secara berurutan adalah: pada 1 jam pascainduksi adalah 413,7 ± 113,4 mmHg dan 401,5 ± 106,3 mmHg (p = 0,69); pada akhir operasi, 466,6 ± 94,6 mmHg dan 471,1 ± 89,0 mmHg (p = 0,86); pada 24 jam pascainduksi, 418,8 ± 108,8 mmHg dan 448,5 ± 119,6 mmHg (p = 0,35); pada 48 jam pascainduksi, 414,9 ± 88,1 mmHg dan 402,5 ± 100,7 mmHg (p = 0,63). Pneumonia ditemukan pada 1 pasien (3,8%) di kelompok VT-6 dan pada 2 pasien (7,6%) di kelompok VT-10. SIRS ditemukan pada 1 pasien (3,8%) di kelompok VT-6 dan pada 2 pasien (7,6%) di kelompok VT-10. Tidak ditemukan komplikasi paru/ekstraparu lain dan mortalitas dalam penelitian ini.Simpulan: Ventilasi mekanik perioperatif dengan volume tidal 6 mL/kg tidak menghasilkan rasio PaO2/FiO2 yang lebih tinggi pada 1 jam pascainduksi, akhir operasi, 24 jam pascainduksi, dan 48 jam pascainduksi dibandingkan volume tidal 10 mL/kg pada pasien kraniotomi elektif dengan paru sehat. Insidens komplikasi paru/ekstraparu pascaoperasi dan mortalitas serupa di antara kedua kelompok.

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ABSTRACTBACKGROUND: Elective craniotomy is associated with high incidence of postoperative pulmonary complications/PPC (25%) and mortality (10%). Low tidal volume as part of lung protective strategy is known to decrease PPC. We determined to study the effect of low tidal volume solely to postoperative PaO2/FiO2 ratio (PF ratio) in elective craniotomy.METHODS: This was a randomised control trial in one university hospital in Indonesia. Fifty two patients underwent elective craniotomy (age 18-60 years, duration of surgery >4 hours, normal lung) were ventilated with tidal volume 6 mL/kg (VT-6) or 10 mL/kg (VT-10) perioperatively. We hypothesized that postoperative PaO2/FiO2 ratio in VT-6 is higher than VT-10. Blood gas analysis were measured at 1 hour postinduction, at end of surgery, at 24 hours postinduction and 48 hours postinduction. Postoperative pulmonary complications (atelectasis, pneumonia, ARDS, respiratory failure) were observed on day 7 and mortality on day 28.RESULTS: PaO2/FiO2 ratio of VT-6 and VT-10 respectively: at 1 hour postinduction, 413.7 ± 113.4 mmHg and 401.5 ± 106.3 mmHg (p = 0.69); at end of surgery, 466.6 ± 94.6 mmHg and 471.1 ± 89.0 mmHg (p = 0.86); at 24 hours postinduction, 418.8 ± 108.8 and 448.5 ± 119.6 mmHg (p = 0.35); at 48 hours postinduction, 414.9 ± 88.1 mmHg and 402.5 ± 100.7 mmHg (p = 0.63). Pneumonia were found in 1 (3.8%) patient in group VT-6 and 2 (7.6%) patients in group VT-10. SIRS were found in 1 (3.8%) in group VT-6 and 2 (7.6%) in group VT-10. No other pulmonary/extrapulmonary complications and mortality were found in this study.CONCLUSION: Perioperative mechanical ventilation with lower tidal volume (6 mL/kg) does not result in higher postoperative PaO2/FiO2 ratio compared to higher tidal volume (10 mL/kg) in healthy lung patients undergone elective craniotomy. Incidence of postoperative pulmonary/extrapulmonary complications and mortality were similar between both groups. , BACKGROUND: Elective craniotomy is associated with high incidence of postoperative pulmonary complications/PPC (25%) and mortality (10%). Low tidal volume as part of lung protective strategy is known to decrease PPC. We determined to study the effect of low tidal volume solely to postoperative PaO2/FiO2 ratio (PF ratio) in elective craniotomy.METHODS: This was a randomised control trial in one university hospital in Indonesia. Fifty two patients underwent elective craniotomy (age 18-60 years, duration of surgery >4 hours, normal lung) were ventilated with tidal volume 6 mL/kg (VT-6) or 10 mL/kg (VT-10) perioperatively. We hypothesized that postoperative PaO2/FiO2 ratio in VT-6 is higher than VT-10. Blood gas analysis were measured at 1 hour postinduction, at end of surgery, at 24 hours postinduction and 48 hours postinduction. Postoperative pulmonary complications (atelectasis, pneumonia, ARDS, respiratory failure) were observed on day 7 and mortality on day 28.RESULTS: PaO2/FiO2 ratio of VT-6 and VT-10 respectively: at 1 hour postinduction, 413.7 ± 113.4 mmHg and 401.5 ± 106.3 mmHg (p = 0.69); at end of surgery, 466.6 ± 94.6 mmHg and 471.1 ± 89.0 mmHg (p = 0.86); at 24 hours postinduction, 418.8 ± 108.8 and 448.5 ± 119.6 mmHg (p = 0.35); at 48 hours postinduction, 414.9 ± 88.1 mmHg and 402.5 ± 100.7 mmHg (p = 0.63). Pneumonia were found in 1 (3.8%) patient in group VT-6 and 2 (7.6%) patients in group VT-10. SIRS were found in 1 (3.8%) in group VT-6 and 2 (7.6%) in group VT-10. No other pulmonary/extrapulmonary complications and mortality were found in this study.CONCLUSION: Perioperative mechanical ventilation with lower tidal volume (6 mL/kg) does not result in higher postoperative PaO2/FiO2 ratio compared to higher tidal volume (10 mL/kg) in healthy lung patients undergone elective craniotomy. Incidence of postoperative pulmonary/extrapulmonary complications and mortality were similar between both groups. ]"