EFEKTIVITAS DEKSAMETASON PRAOPERATIF SEBAGAI TERAPI PENCEGAHAN NYERI TENGGOROKAN PASCAINTUBASI ENDOTRAKEAL

Nyeri tenggorokan pascaintubasi endotrakeal (postoperative sore throat/POST) merupakan komplikasi pasca operasi yang umum terjadi pada 18% hingga 65% pasien yang menjalani anestesi umum dengan intubasi endotrakeal, biasanya terjadi pada 12-24 jam setelah operasi. Studi sebelumnya menunjukkan konflik terkait efektivitas pemberian deksametason praoperatif sebagai terapi pencegahan POST. Tinjauan sistematis ini bertujuan untuk menemukan apakah  pemberian deksametason praoperatif efektif dalam mencegah kejadian nyeri tenggorokan pascaintubasi endoktrakeal. Penelusuran dilakukan melalui database online seperti Pubmed®, Scopus®, Science Direct®, dan Cochrane®. Telaah kritis terhadap artikel ilmiah yang memenuhi kriteria inklusi dan eksklusi dilakukan berdasarkan jenis penelitian. Systematic review dinilai dengan menggunakan Centre for Evidence-Based Medicine Toronto Systematic Review (of Therapy) Critical Appraisal Worksheet. Telaah RCT menggunakan Centre for Evidence-Based Medicine Toronto Therapy Critical Appraisal Worksheet. Delapan studi yang memenuhi kriteria inklusi dan eksklusi ditelaah pada studi ini. Enam systematic review menunjukkan deksametason dapat mencegah kejadian nyeri tenggorokan pascaintubasi 24 jam setelah operasi sebesar 35%-61% dari total pasien (OR/RR 0,39-0,65). Dua RCT menunjukkan deksametason mencegah kejadian nyeri tenggorokan pasca intubasi 24 jam setelah operasi secara signifikan (P 0,02-0,039). Deksametason preoperatif dapat mencegah nyeri tenggorokan pascaintubasi endotrakeal pada pasien setelah menjalani anestesi umum dan memiliki implikasi ekonomi yang baik, kenyamanan pasien serta penyembuhan yang lebih cepat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Oxygenation and Hemodynamic Changes in Traumatic Brain Injury: A Literature Review

Traumatic brain injury (TBI) is a major public health problem and the main cause of death and disability worldwide. TBI can causing primary and secondary injury. Primary brain injury occurs within a moment after a collision and worsen by acute systemic damage such as hypoxia, bleeding, and neurotoxic pathway activation. Under normal conditions, brain has several mechanisms for regulating pressure and volume to prevent ischemia. The purpose of these mechanisms is to maintain a continuous cerebral blood flow (CBF) and adequate oxygen supply

Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors

Over half of soft tissue tumor surgeries require intraoperative Packed Red Cell (PRC) transfusion. Transfusion should be sufficient, as inadequacy will increase risk of tissue ischemia, morbidity and mortality. On the other hand, liberal transfusion is related to infection, tumor recurrence, and immunosuppression. Therefore, good PRC planning measures in preoperative period are essential. Several factors that can be identified in the preoperative period, have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. These factors are ASA score, preoperative hemoglobin (Hb) value, malignancy, size, and location of tumor. By acknowledging influencing factors, a system for predicting blood requirement can be established to promote patient safety and avoid waste. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion.A retrospective cohort was analyzed on 84 records of orthopaedic soft tissue tumor surgery during 2014-2018. In all subjects, the aforementioned factors, amount of intraoperative bleeding and intraoperative PRC transfusion was recorded. Data was analyzed by linear regression to see the relationship of factors to the amount of bleeding and by logistic regression to assess the probability of receiving intraoperative PRC transfusions. A multivariate analysis identified tumor size as an independent determining factor of bleeding. In further analysis, it was found that tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.

Delirium Pasca Operasi sebagai Prediktor Mortalitas pada Geriatri yang Menjalani Operasi Non-Kardiak: Tinjauan Sistematis

Delirium postoperatif merupakan suatu bentuk delirium yang sering tidak disadari serta dapat meningkatkan morbiditas dan mortalitas. Studi yang telah dilakukan sebelumnya menunjukkan masih terdapat konflik terkait hubungan delirium pascaoperasi sebagai prediktor mortalitas, terutama pada pasien geriatri. Oleh karena itu, tinjauan sistematis ini bertujuan mengetahui hubungan delirium pascaoperasi sebagai prediktor mortalitas pada pasien geriatri yang menjalani anestesi pada pembedahan non-kardiak. Penelusuran dilakukan melalui database online seperti Medline®, ClinicalKey®, Science Direct®, EBSCO®, ProQuest®, dan Cochrane®. Telaah kritis terhadap artikel ilmiah yang memenuhi kriteria inklusi dan tidak termasuk eksklusi dilakukan berdasarkan Center of Evidence-Based Medicine, University of Oxford for prognosis study.Berdasarkan hasil penelusuran diperoleh tiga studi yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Hasil telaah kitis terhadap ketiga studi tersebut menunjukkan tidak terdapat cukup bukti kuat yang mendukung delirium pascaoperasi merupakan prediktor independen terhadap mortalitas pada pasien geriatri. Delirium pascaoperasi bukan merupakan prediktor independen, namun meningkatkan risiko mortalitas bersama faktor lain seperti frailty, usia, jenis operasi, urgensi operasi, dan komorbid, hingga terdapat studi yang cukup kuat untuk mendukung delirium pascaoperasi bukan sebagai prediktor mortalitas. Klinisi tetap harus berupaya mencegah kondisi delirium pascaoperasi agar tidak menjadi mediator yang meningkatkan risiko mortalitas. Postoperative Delirium as Mortality Predictor in Geriatrics Undergoing Non-Cardiac Surgery: A Systematic ReviewPostoperative delirium is a form of delirium that often goes unrecognized and can increase morbidity and mortality. However, there are still conflicts in previous studies regarding the relationship between postoperative delirium as a predictor of mortality, especially in geriatric patients. Therefore, this systematic review aimed to determine the relationship to postoperative delirium as a predictor of mortality in geriatric patients undergoing anesthesia for non-cardiac surgery. Searches were conducted through online databases such as Medline®, Clinical Key®, Science Direct®, EBSCO®, ProQuest®, and Cochrane®. A critical review of scientific articles that met the inclusion and exclusion criteria was carried out by the Center for Evidence-Based Medicine, University of Oxford, for prognostic studies. The search resulted in three studies that met the inclusion criteria. A clinical review of these three studies has shown insufficient evidence to support that postoperative delirium is an independent predictor of death in geriatric patients. Postoperative delirium is not an independent predictor but increases the risk of death and other factors such as frailty, age, type of surgery, urgency of surgery, and co-morbidities. Until there are sufficiently robust studies to support postoperative delirium rather than as a predictor of mortality, clinicians should continue to strive to prevent postoperative delirium from becoming a mediator that increases the risk of death.  Latar belakang: Delirium postoperatif merupakan suatu bentuk delirium yang sering tidak disadari serta dapat meningkatkan morbiditas dan mortalitas. Studi yang telah dilakukan sebelumnya menunjukkan masih terdapat konflik terkait hubungan delirium postoperatif sebagai prediktor mortalitas, terutama pada pasien geriatri. Oleh karena itu, tinjauan sistematis ini bertujuan untuk mengetahui hubungan delirium postoperatif sebagai prediktor mortalitas pada pasien geriatri yang menjalani anestesi pada pembedahan non-kardiak.Metode: Penelusuran dilakukan melalui database online seperti Medline®, ClinicalKey®, Science Direct®, EBSCO®, ProQuest®, dan Cochrane®. Telaah kritis terhadap artikel ilmiah yang memenuhi kriteria inklusi dan eksklusi dilakukan berdasarkan Center of Evidence-Based Medicine, University of Oxford for prognosis study.Hasil: Berdasarkan hasil penelusuran diperoleh tiga studi yang memenuhi kriteria inklusi dan eksklusi. Hasil telaah kitis terhadap ketiga studi tersebut menunjukkan tidak terdapat cukup bukti yang kuat yang mendukung delirium postoperatif merupakan prediktor independen terhadap mortalitas pada pasien geriatri.Kesimpulan: Delirium postoperatif bukan merupakan prediktor independen, namun meningkatkan risiko mortalitas bersama faktor lain seperti frailty, usia, jenis operasi, urgensi operasi, dan komorbid. Hingga terdapat studi yang cukup kuat untuk mendukung delirium postoperatif bukan sebagai prediktor mortalitas, klinisi tetap harus berupaya mencegah kondisi delirium postoperatif agar tidak menjadi mediator yang meningkatkan risiko mortalitas

Efek Penggunaan Propofol terhadap Kejadian Disfungsi Kognitif Pasca Operasi pada Pasien Lanjut Usia: Sebuah Telaah Sistematik

Latar Belakang dan Tujuan: Disfungsi kognitif pascaoperasi/Postoperative Cognitive Dysfunction (POCD) umum terjadi pada pasien usia lanjut setelah operasi. Propofol merupakan salah satu agen anestesi yang sering digunakan, namun keterkaitannya dengan kejadian POCD. Telaah sistematik ini bertujuan mengetahui efek anestesi propofol terhadap POCD pada pasien lanjut usia. Subjek dan Metode: Penelusuran literatur melalui database PubMed, Cochrane, dan ScienceDirect untuk mengidentifikasi semua uji acak yang membandingkan tingkat kejadian POCD pada pasien lanjut usia ≥ 55 tahun yang menerima agen anestesi propofol dengan agen anestesi lainnya dan dipublikasikan dalam Bahasa Inggris. Artikel sekunder yang bukan merupakan jurnal dan artikel penelitian akan dieksklusi. Cochrane Risk of Bias digunakan untuk menilai potensi bias. Hasil: Kami mengidentifikasi 3 uji acak dengan total 478 pasien yang menjalani pembedahan. 478 pasien yang menjalani operasi non-kardiak. 212 subjek mendapatkan intervensi propofol, 266 mendapat intervensi agen anestesi lain seperti dexmedetomidine, midazolam, atau sevoflurane. Mayoritas membahas perbandingan propofol dan agen anestesi lain terhadap kejadian POCD pada bedah non-kardiak Simpulan: Propofol dan agen anestesi lain seperti dexmedetomidine, midazolam, dan sevoflurane tidak menunjukkan perbedaan yang signifikan terhadap insidensi POCD pada pasien lanjut usia. Namun, propofol terbukti memiliki insidensi POCD jangka pendek yang lebih rendah dibandingkan dengan agen anestesi lain.

Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial

Abstract Background and objectives The erector spinae plane block (ESPB) and classical thoracolumbar interfascial plane (TLIP) block can reduce postoperative pain in lumbar surgery. In this study, we compared the efficacy of ESPB and classical TLIP block in providing perioperative analgesia in patients undergoing lumbar posterior decompression and stabilization by comparing postoperative pain, opioid consumption, and IL-6 and IL-10 serum concentrations between ESPB and classical TLIP block. Method This was a prospective, double-blinded, randomized controlled trial in tertiary referral hospitals. Forty patients were randomized into two equal groups, each receiving either ESPB or classical TLIP block. The primary outcome was the difference in IL-6 and IL-10 serum concentrations at baseline and 6 h after lumbar posterior decompression and stabilization. The secondary outcome was total opioid consumption and pain score 24 h post-operatively. Result There were no significant differences between the ESPB and classical TLIP block groups in pain score, IL-6 and IL-10 concentration change, and total opioid consumption post-operatively. There was a significant difference in the time until the first dose of morphine was needed between the ESPB and classical TLIP block groups (300 min vs. 547.5 min; p = 0.002). Conclusion ESPB and classical TLIP block performance during lumbar surgery have comparable pain scores, IL-6 and IL-10 concentration differences pre- and post-operation, and total opioid consumption post-operatively. However, classical TLIP block provides a prolonged duration of analgesia. Trial registration ClinicalTrials.gov NCT04951024

Penggunaan Lidokain Intravena untuk Adjuvan Obat Analgesik pada Operasi Bedah Saraf

Nyeri merupakan suatu perasaan atau pengalaman yang bersifat subjektif yang melibatkan sensoris, emosional, dan tingkah laku yang tidak menyenangkan yang disebabkan oleh kerusakan jaringan. Manajemen nyeri pascaoperasi dinilai esensial karena akan memberikan hasil luaran yang baik pada pasien serta meningkatkan kualitas hidup pascaoperasi. Opioid merupakan obat analgesik intravena yang paling sering digunakan sebagai terapi nyeri perioperatif, namun memiliki efek samping yang kurang menyenangkan. Pengembangan dalam penggunaan obat analgesik yang lebih efektif diperlukan, salah satu adalah lidokain intravena yang memiliki efek samping yang lebih kecil dibandingkan opioid. Beberapa studi menunjukkan bahwa penggunaan lidokain sebagai obat analgesik intraoperatif memiliki efek samping minimal dan pemulihan lebih cepat. Penelitian lain juga menunjukkan penggunaan lidokain sebagai analgesik pada operasi bedah saraf memiliki efek yang cukup baik. Maka dari itu, tinjauan pustaka ini akan membahas mengenai penggunaan lidokain sebagai terapi adjuvan obat analgesik, khususnya pada operasi bedah saraf.   The Use of Intravenous Lidocaine as Adjuvant Analgesia in Neurosurgery Abstract Pain is a subjective feeling or experience involving sensory, emotional, and unpleasant behavior caused by tissue damage. Postoperative management is considered essential because it will provide excellent results for patients and improve postoperative quality of life. Opioids are intravenous analgesic drugs that are most often used as perioperative pain therapy but have unpleasant side effects. Developments in using more effective analgesic drugs are needed, one of which is intravenous lidocaine which has fewer side effects than opioids. Several studies have shown that lidocaine as an intraoperative analgesic drug has minimal side effects and faster recovery. Other studies have also shown lidocaine as an analgesic in neurosurgery surgery to have a fairly good effect. Therefore, this literature will discuss lidocaine as an adjuvant therapy, especially in neurosurgery operations