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"[ABSTRAKLatar Belakang: Parameter ektubasi yang ada saat ini masih belum akurat sehingga terjadi kesulitan penyapihan ventilasi mekanis pada pasien pneumonia. Salah satu sistem penilaian untuk diagnosis dan evaluasi pneumonia adalah skor modified clinical pulmonary infection score (MCPIS). Skor ini menilai faktor suhu tubuh, hitung jenis dan jumlah leukosit, volume dan sifat sekret trakea, oksigenasi dan rontgen toraks. Pemantauan MCPIS diharapkan dapat menjadi alat bantu untuk penilaian keberhasilan penyapihan, prediktor ekstubasi, serta gambaran prognosis pasien pneumonia di UPI.Metode: Penelitian ini merupakan studi kohort prospektif pada pasien UPI dengan diagnosis pneumonia dan penggunaan ventilasi mekanis di UPI RSUPN Cipto Mangunkusumo bulan Oktober 2014 sampai Februari 2015. Subjek dengan diagnosis pneumonia yang dirawat di UPI dengan ventilasi mekanis dinilai skor MCPIS pada awal dan setelah 72 jam perawatan. Tanggal pasien diekstubasi dicatat untuk mengetahui lama ventiasi mekanis subjek.Hasil: Sebanyak 48 subjek diikutsertakan dalam penelitian. Skor MCPIS awal (median 6) secara keseluruhan lebih tinggi dari pada skor MCPIS setelah 72 jam (median 5) dengan lama ventilasi mekanis berkisar 3-19 hari (median 7). Tidak didapatkan korelasi yang bermakna antara skor MCPIS awal dengan lama ventilasi mekanis (p=0,180; r=0,197). Terdapat korelasi yang bermakna antara skor MCPIS setelah 72 jam dengan lama ventilasi mekanis dengan kekuatan korelasi sedang dan arah korelasi positif (p=0,000; r=0,539).Simpulan: Terdapat korelasi bermakna antara skor MCPIS setelah 72 jam dengan lama ventilasi mekanis pada pasien pneumonia di UPI.

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ABSTRACTBackground: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU.Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration.Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539).Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU.;Background: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU. Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration. Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539). Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU., Background: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU. Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration. Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539). Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU.]"

"Latar belakang: Skor Mallampati dan jarak tiromental (TMD) banyak digunakan sebagai prediktor kesulitan visualisasi laring preoperatif, namun akurasi kedua penanda tersebut masih dipertanyakan. Penelitian ini mengevaluasi kemampuan memprediksi kesulitan visualisasi laring (DVL) dari prediktor preoperatif baru yaitu rasio lingkar leher (NC) terhadap jarak tiromental TMD dibandingkan dengan skor Mallampati dan jarak tiromental. Metode: Sebanyak dua ratus tujuh belas pasien yang menjalani anestesia umum untuk bedah elektif dievaluasi dengan menggunakan skor Mallampati, TMD dan rasio NC/TMD. Dan titik potong untuk masing-masing prediktor jalan nafas adalah skor Mallampati III dan IV, < 6,5 cm, ≥ 5. Pada saat dilakukan laringoskopi langsung, visualisasi laring dinilai berdasarkan klasifikasi Cormack Lehane (CL). Skor CL derajat III dan IV dianggap sulit visualisasi. Kemudian ditentukan dan dibandingkan nilai area dibawah kurva (AUC), sensitifitas, spesifisitas untuk setiap prediktor jalan nafas. Hasil: Kesulitan untuk memvisualisasi laring ditemukan pada 20 (9,7%) pasien. Area dibawah curve (AUC) rasio NC/TMD (96,2%) lebih baik dibandingkan dengan skor Mallampati (64%) dan TMD (83%). Kesimpulan: Akurasi rasio NC/TMD lebih baik dibandingkan dengan skor Mallampati dan TMD.

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Background: Mallampati score and thyromental distance (TMC) has widely use to identify potentially difficult laringoscopies preoperative, however it's predictive reliability is unclear. This research purpose are to evaluate the ability to predict difficult visualization of the larynx (DVL) from new preoperative airway predictors neck circumference ratio to thyromental distance (NC/TMD) compare to Mallampati score and thyromental distance.

Methods: Two hundred and seventeen consecutive patients undergoing general anesthesia for elective surgery were evaluated using the Mallampati score, TMD, NC/TMD ratio and the cut-off points for the airway predictors were Mallampati score III and IV; ≤ 6,5 cm; ≥ 5. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grade III and IV were considered difficult visualization. Area under curve (AUC), sensitivity, specificity for each airway predictors were determined and compared.

Result: Difficult to visualize the larynx was found in 20 (9,7%) patients. The AUC of NC/TMD ratio (96,2%) is better tcompared to TMD (83%) and much better if compared to Mallampati score (64%).

Conclusion: NC/TMD ratio had better accuracy in predicting difficult laryngoscopy than Mallampati score and TMD."

"Latar belakang: Nyeri tenggorok pascaoperasi (POST) merupakan salah satu komplikasi yang sering muncul pada anestesia umum dengan teknik intubasi. Tujuan penelitian ini untuk membandingkan efektivitas tablet hisap amylmetacresol-dibenal dengan profilaksis deksametason intravena sebelum pemasangan pipa endotrakeal untuk mengurangi kekerapan POST.Metode: Penelitian ini adalah uji klinis prospektif yang diacak dan tersamar ganda pada 121 pasien yang menjalani operasi dalam anestesia umum menggunakan pipa endotrakeal.Pasien dibagi menjadi dua kelompok secara acak; Grup A 61 orang dan grup B 60 orang. Sebelum induksi, pasien dalam grup A diberikan tablet hisap amylmetacresol-dibenal dan suntikan NaCl 0,9% 2 ml dan grup B diberikan Deksametason 10 mg intravena dan tablet hisap plasebo. Nyeri tenggorok pascaoperasi dievaluasi dengan Numerical Rating Scale (NRS) 3 kali; setelah operasi saat Alderette skor 10, 2 jam pascaoperasi dan 24 jam pascaoperasi. Kekerapan dan derajat nyeri tenggorok pascaoperasi dicatat dan dianalisis dengan uji chi-kuadrat.Hasil. Tidak didapatkan perbedaan kekerapan nyeri tenggorok pascaoperasi bermakna pada kedua kelompok sesaat setelah operasi berakhir (18% pada kelompok A dan 16,7% pada kelompok B, p = 0,843), jam ke-2 (16,4% pada kelompok A dan 25% pada kelompok B, p = 0,242),dan jam ke-24 pascaoperasi. Derajat nyeri tenggorok pascaoperasi tidak berbeda bermakna di antara kedua kelompok.Simpulan. Tablet hisap amylmetacresol-dibenal sebelum pemasangan pipa endotrakeal memiliki efektivitas yang sama dengan profilaksis deksametason intravena dalam mengurangi kekerapan nyeri tenggorok pascaoperasi.

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Background. POST is one of the complications that often arise in the general anesthesia with intubation techniques. The purpose of this study was to compare the effectiveness of amylmetacresol - dibenal lozenges with prophylactic intravenous dexamethasone before intubation to reduce the incidence of POST.Methods. This study is a prospective randomized clinical trials and double-blind trial in 121 patients undergo surgery under general anesthesia using endotracheal tube. Patient divided into two groups at random ; Group A 61 and group B of 60 people. Before induction, patients in group A was given amylmetacresol - dibenal lozenges and injection of 2 ml of 0.9% NaCl and group B was given intravenous dexamethasone 10 mg and placebo lozenges . POST was evaluated by the Numerical Rating Scale ( NRS ) 3 times ; after surgery when Alderette score of 10 , 2 hours postoperatively and 24 hours postoperatively . The frequency and degree of POST were recorded and analyzed with Chi-Square test.Results. There were no differences in the incidence of POST significant in both groups after surgery when Alderette score of 10 ( 18 % in group A and 16.7 % in group B , p = 0.843 ) , h 2 ( 16.4 % in group A and 25 % in group B , p = 0.242 ), and the 24th hour postoperatively . The degree of POST was not significantly different between the two groups.Conclusion. Amylmetacresol - dibenal lozenges before intubation tube has the same effectiveness of prophylactic intravenous dexamethasone in reducing the incidence of POST."

"Latar Belakang: Kegunaan laringoskop video untuk intubasi endotrakeal telah terbukti bermanfaat pada tatalaksana jalan napas normal ataupun sulit. Namun harga laringoskop video seperti McGrath MAC® yang mahal menjadi hambatan. Sebagai alternatif, dapat digunakan kamera portabel yang dipasangkan pada bilah Macintosh, dihubungkan via wifi ke telepon genggam, untuk membantu visualisasi laring seperti halnya laringoskop video. Sampai saat ini belum ada penelitian yang membandingkan waktu intubasi endotrakeal menggunakan modifikasi laringoskop Macintosh dengan laringoskop video McGrath MAC® pada populasi dewasa. Metode: Uji klinis acak tersamar tunggal terhadap 62 subjek penelitian untuk membandingkan waktu intubasi endotrakeal menggunakan modifikasi laringoskop Macintosh dengan laringoskop video McGrath MAC® pada populasi dewasa. Kriteria penolakan adalah sulit jalan napas, kehamilan, penyakit jantung iskemik akut, gagal jantung, blok jantung derajat 2 atau 3, sindrom Guillain Barre, myasthenia gravis.Hasil: Median waktu intubasi A (waktu yang diukur saat laringoskop masuk melewati gigi sampai mendapatkan visualisasi glotis) menggunakan modifikasi Macintosh 18(6-65) detik dibandingkan McGrath MAC® 21(10-70) detik (p 0.652). Median waktu intubasi B (waktu yang diukur saat mendapatkan visualisasi glotis sampai ETT masuk ke dalam trakea) 39(20-101) detik dibandingkan 50(27-102) detik (p 0,003). Median waktu intubasi total 63 (27-114) detik dibandingkan 74 (40-133) detik (p 0,032). Selain itu juga dicatat angka keberhasilan intubasi pada upaya pertama menggunakan modifikasi laringoskop Macintosh 90,3%, angka visualisasi glotis skor POGO 100 67,7% dan skor POGO 75 29%, komplikasi takikardia dan laserasi mukosa jalan napas berupa abrasi ringan pada daerah orofaring. Secara keseluruhan, para pengguna modifikasi laringoskop Macintosh menganggap alat ini baik untuk digunakan, baik dari segi kemudahan insersi alat, kemudahan penggunaan alat, dan visualisasi glotis.Simpulan: Intubasi endotrakeal menggunakan modifikasi laringoskop Macintosh membutuhkan waktu yang lebih singkat dibandingkan dengan menggunakan laringoskop video McGrath MAC® pada pasien dewasa.

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Background: The use of video laryngoscope has been proven to be beneficial for endotracheal intubation for normal and difficult airway management. But the problem with using a video laryngoscope is often the price of the tools. A widely used video laryngoscope, such as McGrath MAC® is expensive. As an alternative to help visualize the larynx like a video laryngoscope, we can use a portable camera placed in a Macintosh blade, then connected via wifi to a mobile phone. However, there is no available research that compares intubation time using modified Macintosh laryngoscope vs McGrath MAC® video laryngoscope in the adult population.

Methods: This study is a single-blinded randomized clinical trial of 62 subjects to measure the intubation time using modified Macintosh laryngoscope compared with McGrath MAC® video laryngoscope in the adult population. Exclusion criteria are difficult airway, pregnancy, acute ischemic heart disease, second or third-degree heart block, Guillain Barre syndrome, myasthenia gravis.

Results: Median intubation time A (time taken since laryngoscope passes the teeth until glottic visualization) using modified Macintosh and McGrath MAC® were 18(6-65)s and 21(10-70)s (p 0.652), consecutively. Median intubation time B (time taken since glottic visualization until tube insertion into the trachea) was 39(20-101)s and 50(27-102)s (p 0,003). Median total intubation time was 63 (27-114)s using modified Macintosh, compared with 74 (40-133)s (p 0,032) using McGrath MAC®. Besides that, we also noted the first attempt success rate in modified Macintosh was 90,3%, glottic visualization with POGO score 100 was 67,7% and POGO score 75 was 29%. The complications found in this study were tachycardia and airway mucosal laceration such as mild oropharyngeal abrasion. In conclusion, modified Macintosh users decide that this equipment is convenient, in terms of insertion easiness, usefulness, and glottis visualization.

Conclusion: Endotracheal intubation using modified Macintosh laryngoscope takes a shorter time compared with McGrath MAC® video laryngoscope in the adult population"

"Latar Belakang: Secara global diperkirakan terdapat 313 juta pembedahan yang dilakukan, dengan angka kematian 30 hari pascaoperasi mencapai 4.2 juta jiwa. Penilaian kondisi pasien preoperatif diperlukan untuk memprediksi morbiditas danmortalitas pasien pascabedah, maka modalitas yang digunakan dalam menilai risiko pembedahan sebaiknya memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang rutin digunakan di RSUPN Cipto Mangunkusumo (RSUPNCM) adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih objektif, dan akurat. Studi ini menguji kesahihan skor P-POSSUM dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ICU, yang mencerminkan keparahan morbiditaspascabedah. Tujuan: Studi ini menguji kemampuan kalibrasi dan diskriminasi skor P-POSSUM dalam memprediksi lama perawatan di ICU, dan menganalisis hubungan antar variabel skor P-POSSUM dengan lama perawatan di ICU pada pasien pasabedah digestif mayor. Metode: Studi ini merupakan studi kohort retrospektif di RSUPNCM selama Januari 2017 hingga Desember 2018. Sebanyak 289 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Lama perawatan pascabedah di ICU dan skor P-POSSUM subjek dicatat sesuai dengan data rekam medis. Variabel PPOSSUM yang berpengaruh terhadap lama perawatan subjek dianalisis dengan analisis bivariat dan regresi logistik multivariat. Kesahihan skor dinilai menggunakan uji kalibrasi Hosmer-Lemeshow dan uji diskriminasi dengan melihatnilai Area Under Curve. Hasil: Hasil analisis statistik menghasilkan bahwa skor P-POSSUM memiliki kemampuan kalibrasi yang baik (uji Hosmer-Lemeshow p=0.815) dan kemampuandiskriminasi yang cukup baik (AUC 77.8%, IK 95% 0.717-0.827). Variabel PPOSSUM yang secara statistik berpengaruh signifikan (p<0.05) terhadap lama perawatan di ICU adalah kadar natrium, jumlah perdarahan, laju jantung, dan EKG.Kesimpulan: Skor P-POSSUM sahih dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ruang intensif (ICU).

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Background: It was estimated that there was 313 million surgery underwent worldwide, with the 30-days postoperative mortality rate reaching 4.2 million cases. The evaluation of preoperative patients’ conditions is encouraged to predict

postoperative morbidity and mortality, thus the modality used to assess surgery risk should be accurate and objective. RSUPN Cipto Mangunkusumo (RSUPNCM) routinely uses ASA-PS score to assess patients’ condition. Nonetheless, ASA-PS has

been regarded as subjective. Developed countries has started to replace this score with P-POSSUM score which was considered to be more accurate and objective. This study finds out the validity of P-POSSUM Score in predicting the length of

hospital stay in the ICU in patients who underwent digestive surgery, which reflects the severity of postoperative morbidity. Goals: This study investigated the calibration and discrimination ability of PPOSSUM score in predicting the length of stay in the ICU, and also explored the relationship between variables in P-POSSUM score and the length of stay in the ICU in patients who underwent digestive surgery.

Methods: This retrospective cohort study was conducted in RSUPNCM in January 2017 to December 2018 on 289 subjects who met the inclusion criteria. P-POSSUM score and the length of stay in the ICU unit were recorded, the data was taken from

medical record. Bivariate and multivariate logistic regression was used to investigate the relationship between P-POSSUM variables and the length of stay. The validity of P-POSSUM score was assessed by Hosmer-Lemeshow calibration

test and the measurement of the Area Under Curve (AUC).

Results: Statistical analysis showed that P-POSSUM had a good calibration ability (p=0.815 for Hosmer-Lemeshow test) and moderate discrimination ability (AUC 77.8%, CI 95% 0.717-0.827). Four P-POSSUM variables were found to be significantly associated with length of stay in the ICU (p<0.05), namely natrium level, total blood loss, heart rate and ECG. Conclusion: P-POSSUM score is valid in predicting the length of stay in the ICU in patients who underwent digestive surgery."

"Latar Belakang. Bedah jantung terbuka mengakibatkan nyeri dan respons stres pascabedah yang dapat memberikan dampak buruk bagi pasien. Blok transversus thoracis plane merupakan blok interfascial dalam di area parasternal untuk mengatasi nyeri sternotomi. Penelitian ini bertujuan untuk membandingkan efektivitas penambahan blok transversus thoracis muscle plane bilateral dalam mengurangi nyeri dan respons stres pascabedah jantung terbuka terhadap kontrol. Metode. Penelitian ini adalah uji klinis terkontrol acak tersamar ganda. Tiga puluh empat subjek yang memenuhi syarat yang menjalani operasi jantung elektif antara September 2020 dan Agustus 2001 secara acak dimasukkan ke kelompok blok TTP atau kontrol. Penelitian membandingkan beda rerata konsumsi morfin 24 jam pascabedah, waktu pertama dosis morfin pascabedah, waktu ekstubasi, konsentrasi plasma IL-6 dan kortisol pada 24 jam dan 48 jam pascabedah. Penelitian juga ingin mengetahui konsumsi fentanil intraoperatif, waktu pertama opioid rescue intraoperatif, komplikasi, efek samping opioid, dan lama rawat inap. Hasil. Konsumsi morfin 24 jam pertama pascabedah lebih tinggi secara bermakna (p<0,001) pada kelompok kontrol dibandingkan kelompok blok TTP. Waktu pertama pemberian morfin pascabedah lebih lama secara bermakna (p<0,001) pada kelompok blok TTP dibandingkan kelompok kontrol. Waktu ekstubasi tidak berbeda bermakna antara kelompok blok TTP dan kelompok kontrol. Konsentrasi plasma IL-6 dan kortisol tidak berbeda bermakna antara kelompok blok TTP dan kelompok kontrol pada 24 jam dan 48 jam pascabedah. Kesimpulan. Penambahan blok transversus thoracis muscle plane bilateral tidak terbukti lebih efektif dalam mengurangi nyeri dan respons stres pascabedah jantung terbuka dibandingkan dengan kontrol.

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Background. Open-heart surgery is a major surgery that causes postoperative pain and surgical stress response, contributing further to postoperative complications and morbidity. Transversus thoracis muscle plane block is a deep interfascial block in the parasternal area to treat sternotomy pain. This study aimed to compare the effectiveness of bilateral transversus thoracis muscle plane blocks in reducing pain and stress response after open-heart surgery versus control. Methods. This is a prospective, double-blind, randomized control trial. Thirty-four eligible subjects who underwent elective cardiac surgery between September 2020 and August 2001 were randomly assigned to the TTPB or control group. The primary outcomes were the different means of 24-hour postoperative morphine consumption, time of first postoperative morphine dose, extubation, postoperative plasma levels of IL-6 and cortisol at 24 hours and 48 hours after surgery. The secondary outcomes were intraoperative fentanil consumption, time of first intraoperative opioid rescue, complication, opioid side effects, and length of stay. Results. The 24-hour postoperative morphine consumption was significantly higher (p<0.001) in the control group than in the TTPB group. The time of first postoperative morphine dose was significantly longer (p<0.001) in the TTPB group than in the control group. Extubation time was not statistically different between the TTP block group and the control group. Plasma levels of IL-6 and cortisol were not statistically different between the TTP block group and the control group at 24 hours and 48 hours after surgery. Conclusion. The bilateral transversus thoracis muscle plane blocks were not shown to be more effective in reducing pain and stress response after open-heart surgery compared to controls."

"Latar belakang. Emergence agitation (EA) merupakan gangguan perilaku sementara yang sering terjadi pascaanestesia inhalasi dan berpotensi membahayakan pasien. Pemberian propofol 1-3 mg/kg di akhir anestesia inhalasi mencegah EA tetapi memperpanjang waktu pindah ke ruang pulih. Penelitian ini bertujuan mengetahui efektivitas propofol dosis 0,5 mg/kg di akhir anestesia untuk menurunkan kejadian EA pasien anak yang menjalani anestesia umum inhalasi. Propofol dinilai efektif jika dapat menurunkan kejadian EA tanpa memperpanjang waktu pindah.Metode. Penelitian uji klinik acak tersamar ganda terhadap anak usia 1-5 tahun yang menjalani anestesia umum inhalasi di RSCM pada bulan Mei – Agustus 2018. Sebanyak 108 subjek didapatkan dengan metode konsekutif yang dirandomisasi menjadi dua kelompok. Kelompok propofol (n=54) mendapat propofol 0,5 mg/kg di akhir anestesia, sedangkan kontrol (n=54) tidak mendapat propofol. Kejadian EA, waktu pindah, hipotensi, desaturasi dan mual-muntah pascaoperasi dicatat. EA dinilai dengan skala Aono dan Pediatric Anesthesia Emergence Delirium (PAED). Analisis data menggunakan uji chi-square dan t tidak berpasangan.Hasil. Kejadian EA pada kelompok propofol sebesar 25,9% sedangkan kontrol 51,9% (RR = 0,500; IK 95% 0,298-0,840; p=0,006). Rerata waktu pindah kelompok propofol lebih lama (9,51 ± 3,93 menit) dibandingkan kontrol (7,80 ± 3,57 menit) (selisih rerata 1,71 menit; IK 95% 0,28-3,14; p=0,020). Hipotensi didapatkan pada satu pasien (1,9%) pada kelompok propofol sedangkan pada kontrol tidak ada. Mual-muntah terjadi pada lima pasien (9,3%) pada kelompok propofol dan delapan pasien (14,8%) pada kontrol. Tidak ada desaturasi pada kedua kelompok.Simpulan. Pemberian propofol dosis 0,5 mg/kg di akhir anestesia secara statistik tidak efektif namun secara klinis efektif menurunkan kejadian EA pasien anak yang menjalani anestesia umum inhalasi.

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Background. Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm. Propofol 1-3 mg/kg administration at the end of inhalational anesthesia prevents EA but prolongs transfer time to recovery room. This study evaluated the effectivity of propofol 0,5 mg/kg at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia. Propofol was considered effective if could reduce the incidence of EA without prolonging transfer time.Method. This was a double-blind randomized clinical trial on children aged 1-5 years old underwent general inhalational anesthesia in Cipto Mangunkusumo Hospital. One hundred eight subjects were included using consecutive sampling method and randomized into two groups. Propofol group (n=54) was given propofol 0,5 mg/kg at the end of anesthesia while control group (n=54) was not. Incidence of EA, transfer time, postoperative hypotension, desaturation and nausea-vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium (PAED) scale were used to assess EA. Statistical tests used were chi square and unpaired t test.Result. Incidence of EA in propofol group was 25,9% while in control group was 51,9% (RR = 0,500; 95% CI 0,298-0,840; p=0,006). Mean transfer time in propofol group was longer (9,51 ± 3,93 minute) than control group (7,80 ± 3,57 minute) (mean difference 1,71 minute; 95% CI 0,28-3,14; p=0,020). Hypotension was found in one patient (1,9%) in propofol group while in control group there was none. Nausea-vomiting was found in five patients (9,3%) in propofol group and eight patients (14,8%) in control. There was no desaturation in both groups.Conclusion. Administration of propofol 0,5 mg/kg at the end of anesthesia statistically ineffective but clinically effective in reducing the incidence of EA in children undergoing general inhalational anesthesia."

"Latar belakang. Ukuran sungkup laring yang tidak sesuai menyebabkan ventilasi yang tidak efektif dan komplikasi seperti peradangan sampai kerusakan pada saraf sehingga diperlukan metode untuk menentukan ukuran yang sesuai.Metode. Penelitian merupakan uji klinis acak tersamar tunggal dengan concealment dan 130 subjek dibagi menjadi 2 kelompok (berat badan dan lebar lidah). Lebar lidah dinilai dengan subjek menjulurkan lidah namun tidak ditegangkan lalu lebar lidah disesuaikan dengan penggaris papan segi empat yang dibuat sesuai dengan ukuran sungkup laring dengan inflasi minimal no. 2,5 sampai 5. Keefektifan pemasangan sungkup laring dinilai bila semua kriteria terpenuhi yaitu: 1) tekanan kebocoran orofaringeal/seal pressure ≥20 cmH₂O, 2) tekanan maksimal inspirasi (Ppeak_insp) ≤20 cmH₂O, 3) tidak terlihat sebagian kaf dalam rongga oral dan 4) perbedaan tidal volume inspirasi dan ekspirasi <5%  tercapai.Hasil. Secara statistik tidak menunjukkan perbedaan bermakna antara dua kelompok untuk masing-masing komponen penilaian keefektifan pemasangan sungkup laring kecuali untuk variabel OLP (p <0,05). Terdapat lebih banyak komplikasi berupa noda darah dan nyeri tenggorok pada kelompok BB dibanding kelompok LL dengan tingkat keberhasilan dan waktu lebih cepat pada pemasangan sungkup laring di kelompok BB dibandingkan kelompok LL.Simpulan. Penentuan ukuran sungkup laring pada ras Melayu menggunakan metode lebar lidah tidak lebih efektif dengan metode berat badan namun kejadian komplikasi lebih rendah.

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Background. Unsuitable laryngeal mask size selection causes ineffective ventilation and complications such as inflammation until neuropraxia, thus method to determine optimal size selection is needed.Methods. This was a randomized single blinded clinical study with concealment and 130 subjects were divided into 2 groups (body weight and tongue width). Subjects were asked to open their mouth and protrude the tongue in the relaxed manner and corresponded to rulers that were made from the width of laryngeal mask minimally inflated from size 2,5 to 5. The effectiveness of laryngeal mask insertion if all of the four criteria were met ie.1) oropharyngeal leak pressure/seal pressure ≥20 cmH₂O, 2) peak inspiratory pressure (Ppeak_insp) ≤20 cmH₂O, 3) no presence of cuff in the mouth and 4) difference between inspiratory (VTi) and expiratory tidal volume (VTe) <5%.Results. All parameters were not statistically significant except the OLP (P <0,05). Meanwhile, subjects in BB group manifest more complications in the laryngeal mask than the LL group with faster speed and higher chance of <2x successful insertion than the LL group.Conclusion. Laryngeal mask insertion among Malay race using size selected based on tongue width was not more effective than based on body weight."

"ABSTRAKIntubasi endotrakeal merupakan upaya menjaga jalan nafas dan memberikan ventilasi. Intubasi endotrakeal menggunakan pipa endotrakeal yang memiliki balon dan dapat dikembangkan dengan tekanan yang direkomendasikan adalah 20-30 cmH2O. Terdapat berbagai faktor yang dapat mempengaruhi tekanan balon pipa endotrakeal, salah satunya rotasi kepala dan perubahan posisi tubuh. Penelitian ini bertujuan untuk mengetahui perbedaan tekanan balon pipa endotrakeal terhadap perubahan posisi rotasi kepala 15o, 45o, 60o, serta perubahan posisi lateral dekubitus. Penelitian dilakukan pada pasien yang menjalani anestesia umum dan terintubasi di RSUPN Dr. Cipto Mangunkusumo. Tekanan awal balon ditetapkan sebesar 25 cmH2O lalu dilakukan perubahan posisi dari supinasi ke lateral dekubitus, rotasi kepala 15°, 45°, dan 60° lalu dilakukan penilaian oleh penilai yang berbeda. Hasil penelitian menunjukkan terdapat perbedaan bermakna antara tekanan balon pipa endotrakeal pada posisi supinasi dengan posisi rotasi kepala 15o, 45o, 60odan lateral dekubitusdengan nilai uji Friedman p<0,001 serta uji post-hocdengan nilai uji Wilcoxon masing-masing p<0,001. Walaupun terdapat perbedaan bermakna secara statistik, namun hanya posisi lateral dekubitus yang memiliki perbedaan bermakna secara klinis. Kesimpulan penelitian ini adalah terdapat perbedaan bermakna secara statistik pada perubahan posisi rotasi kepala 15o, 45o, 60odan lateral dekubitusdan hanya posisi lateral dekubitus yang memiliki perbedaan tekanan bermakna secara klinis.

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ABSTRACTEndotracheal intubation is an effort to maintain airway and deliver ventilation. It uses endotracheal tube which has inflatable cuff with recommended pressure of 20-30 cmH2O. There are various factors affecting the endotracheal tube cuff pressure, including head rotation and change of body position. This study aims to investigate the effect of 15o, 45o, 60ohead rotation and lateral decubitus body position to endotracheal tube cuff pressure. This study was conducted to intubated patients undergoing general anesthesia in RSUPN Dr. Cipto Mangunkusumo. Initial cuff pressure was set to 25 cmH2O; then body position was altered from supine to lateral decubitus; head rotated to 15°, 45°, 60°. Cuff pressure was measured by different observers. Results show significant difference in endotracheal tube cuff pressure between supine, head rotations, and lateral decubitus positions, with p<0,001 and subsequent post-hoc analysis yielding to p<0,001. Even though statistically significant, only lateral decubitus position yields to clinically significant pressure difference."

"Teknik anestesia yang adekuat menghasilkan analgesia pascabedah yang cukup dan menurunkan respon stres pasien. Hal ini dapat menurunkan morbiditas dan mortalitas yang berhubungan dengan gangguan imunologis, seperti infeksi, penyembuhan luka berkepanjangan, dan sepsis. Studi ini bertujuan untuk membandingkan derajat nyeri pascabedah, kadar interleukin-6 (IL-6) dan C-reactive protein (CRP) sebagai marker respon stress, dan durasi pemakaian kateter urin antara epidural kontinu dan blok Quadratus Lumborum (QL) sebagai teknik analgesia pascabedah pada donor ginjal. Enam puluh dua pasien dibagi secara acak menjadi dua kelompok sama rata: epidural kontinu dan blok QL. Grup blok QL mendapatkan bupivakain 0,25% sebanyak 20 ml dan grup epidural mendapatkan bupivakain 0,25% 6 ml/jam kontinu melalui kateter. Menjelang ekstubasi, grup blok QL mendapatkan blok QL bilateral dengan dosis yang sama sedangkan grup epidural mendapatkan bupivakain 0,125% 6 ml/jam kontinu melalui kateter. Sampel darah diambil untuk membandingkan kadar IL-6 dan CRP setelah intubasi (preoperatif), segera setelah operasi, 24 jam serta 48 jam setelah operasi. Nyeri pascabedah diukur menggunakan numerical rating scale (NRS) di ruang pulih dan 24 jam pascabedah. Kebutuhan morfin dan durasi pemakaian kateter juga dicatat pascabedah. Efek samping yang muncul selama 24 jam dicatat. Data dianalisis menggunakan uji t tidak berpasangan atau uji Mann-Whitney. Tidak ada perbedaan yang ditemukan antarkelompok pada derajat nyeri pasca bedah, kadar plasma IL-6 setelah operasi atau 24 jam setelah operasi (p= 0,785 dan p=0,361, secara berurutan) meskipun rerata kadar IL-6 24 jam setelah operasi lebih rendah pada grup blok QL dibandingkan kelompok epidural kontinu. Durasi pemakaian kateter urin pada blok QL lebih singkat daripada epidural. Kadar CRP tidak berbeda signifikan antara kedua kelompok baik setelah operasi maupun 48 jam setelah operasi (p=0,805 dan p=0,636, secara berurutan). Durasi pemakaian kateter urin pada blok QL lebih singkat daripada epidural. Kedua teknik epidural kontinu dan blok QL menunjukkan analgesia pascabedah yang sebanding pada pasien donor ginjal yang menjalani laparoskopi nefrektomi.

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An adequate anesthesia technique generates appropriate postoperative analgesic properties and decreases the patient’s stress response. This will lead to decreased morbidity and mortality associated with immunology disturbances, such as infection, prolonged wound healing, and sepsis. The aim of this study was to compare postoperative pain level, interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, as the markers of the stress response, and duration of catheter usage between continuous epidural and quadratus lumborum (QL) block as postoperative analgesia techniques among living kidney donors. Sixty-two patients were randomly divided into two equal groups: continuous epidural and QL block. A group received bilateral QL block with 20 mL of bupivacaine 0.25% and the other received 6 mL/hour of bupivacaine 0.25% continuously via an epidural catheter. Prior to extubation, the QL block group received bilateral QL block with the same dose and the continuous epidural group was administered with 6 mL/hour of bupivacaine 0.125%. Blood samples were drawn to compare IL-6 and CRP concentrations after intubation (preoperatively), directly after surgery, 24 hours postoperatively, and 48 hours postoperatively. Postoperative pain was measured with the numerical rating scale (NRS). Morphine requirement and duration of catheter usage were also measured porsoperatively. Side effects within 24 hours postoperatively were noted. Data were analyzed with independent t-test or Mann-Whitney test. No difference was observed between the groups in the postoperative pain level, plasma concentration of IL-6 either after surgery or 24 hours postoperatively (p= 0.785 and p=0.361, respectively) although the mean IL-6 concentration 24 hours postoperatively was lower in the QL block group than in the continuous epidural group. CRP concentration was not significantly different between the groups either after surgery or 48 hours postoperatively (p=0.805 and p=0.636, respectively). The duration of catheter usage is significantly shorter in QL Block. Both continuous epidural and QL block techniques showed comparable postoperative analgesic properties among living kidney donors undergoing laparoscopic nephrectomy."