Correlation between Patient’s Age and Advanced Response Time with Outcome of Cardio Pulmonary Resuscitation in Cardiac Arrest Patient

Introduction: This study is conducted to determine the correlation between patient’s age and advanced response time with the outcome of Cardio Pulmonary Resuscitation in cardiac arrest patients. Methods: This was an analytic observational cross-sectional study, evaluating correlation between patient’s age and advanced response time with the outcome of Cardio Pulmonary Resuscitation in cardiac arrest patients. This study used the primary data from Cardio Pulmonary Resuscitation sheets from February to August 2018 at Dr. Soetomo General Hospital, Surabaya. The data were analysed with Chi Square and Contingency Coefficient using SPSS version 22.0. Results: The results showed that 84.6% cardiac arrest patients who experience ROSC are over 40 years old, and 92.3% cardiac arrest patients who experience ROSC have advanced response time ≤ 5 minutes. After being tested using Chi Square, patient’s age was not statistically influencing the outcome in cardiac arrest patients (p = 0.507), but advanced response time was statistically influencing the outcome in cardiac arrest patients (p = 0.001). Conclusion: There was no statistically influence of patient’s age towards the outcome in cardiac arrest patients, but there was a significant influence of advance response time towards the outcome in cardiac arrest patients

Problem Anestesi pada HIV/AIDS

Acquired Immunodeficiency Syndrome (AIDS) pertama kali ditemukan pada tahun 1981 dan virus penyebabnya dapat diisolasi pada tahun 1983. Menurut UNAIDS, salah satu bidang dalam WHO, secara global pasien AIDS pada tahun 2017 mencapai 36,9 juta. Sedangkan di Indonesia, pada tahun 2016 ditemukan 48.000 kasus HIV baru dengan total pasien HIV mencapai 620.000. HIV merupakan anggota famili lentivirus, subtipe dari retrovirus. Virus ini bekerja sitopatik, periode laten yang panjang dan viremia persisten. Pada kondisi yang tidak, 10% akan berkembang menjadi gejala AIDS dalam 2-3 tahun infeksi, dan akhirnya berkembang dalam 10 tahun. Transmisi HIV melalui kontak seksual atau darah. Neonatus dapat tertular langsung saat kelahiran, transplasenta atau melalui ASI

Penanganan Anestesi pada Pasien Pediatri dengan Cedera Otak Traumatik Sedang, Fraktur Impresi dan Edem Serebri

Cedera otak traumatik merupakan penyebab terbanyak kecacatan dan kematian pada anak dan orang dewasa. Di Amerika Serikat, terjadi lebih dari 510.000 kasus cedera otak traumatik per tahun pada anak-anak usia 0-14 tahun;1 dengan 2.000–3.000 di antaranya meninggal setiap tahunnya. Tujuan dari penanganan cedera otak traumatik selain menangani cedera primernya, juga untuk mencegah terjadinya cedera sekunder. Seorang anak laki-laki usia 12 tahun mengalami kecelakaan lalu lintas dan didiagnosis dengan cedera otak traumatik sedang, fraktur impresi regio temporo parietal kanan dan edema serebri dengan komorbiditas anemia, rencana akan dilakukan pembedahan darurat untuk debridement, eksplorasi duramater dan rekonstruksi tulang. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan selama tujuh jam. Kondisi pasien selama pembedahan relatif stabil dan setelahnya dirawat di Ruang Observasi Intensif dengan bantuan ventilator. Setelah memastikan kondisi ekstrakranial normal, pasien kemudian disapih dari ventilator dan diekstubasi keesokan harinya. Pasien dipulangkan pada hari kedelapan setelah kejadian

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January-June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 – 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 – 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 – 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 – 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 – 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 – 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 – 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 – 5.401) were associated with higher medication complexity. Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity

Nilai Indeks Perfusi Preoperatif sebagai Prediktor Hipotensi Pasca Anestesi Spinal dengan Lidokain Hiperbarik pada Seksio Sesarea

Latar Belakang: Hipotensi yang sering terjadi setelah anestesi spinal pada seksio sesarea membawa efek negatif yang kuat bagi ibu dan janin. Tujuan: Menganalisis hubungan nilai Indeks Perfusi (PI) preoperatif dengan hipotensi setelah anestesi spinal menggunakan lidokain hiperbarik pada seksio sesarea. Subjek dan Metode: Empatpuluh ibu bersalin yang memenuhi kriteria inklusi terlibat dalam penelitian observational prospektif ini. Terbagi menjadi kelompok pertama dengan PI≤3,5 dan kelompok kedua dengan PI>3,5. Efek hipotensi setelah dilakukan anestesi spinal dengan lidokain hiperbarik yang disuntikkan pada sela L3-L4 dievaluasi. Analisis statistik dilakukan dengan menggunakan Uji Pasti Fisher untuk menganalisis hubungan antara nilai PI dengan hipotensi. Plot kurva receiver operator characteristic (ROC) digunakan untuk menentukan nilai cut-off PI sebagai prediktor untuk hipotensi. Hasil: Angka kejadian hipotensi pada kelompok pertama adalah 16,7%, dan kelompok kedua adalah 89,3%. Rata-rata nilai cut-off PI awal menurut plot kurva ROC dalam penelitian ini adalah 4,1 (p=0,002) dengan sensitivitas 78,6% dan spesifisitas 80,8%. Hasil menunjukkan adanya korelasi yang signifikan antara nilai PI awal (cut-off 4,1) dengan hipotensi dalam 30 menit setelah anestesi spinal (p=0,001; odds ratio 10,5). Simpulan: Indeks perfusi (PI) preoperatif dengan nilai cut-off 4,1 valid sebagai prediktor hipotensi setelah anestesi spinal pada seksio sesarea

The Relationship of The Amount of Caspase 3 Protein Expression and Macrophage Cells to Apoptosis of Squamous Epithel Cells in Ropivacaine Additional Area Around Operating Incisions (Laboratory Experimental Study on Wistar Strain Male White Mice)

Abstract Surgery is sure to cause injury and cause pain which can interfere with wound healing if not handled adequately. In the process of wound healing, macrophages have a major role both as pro-inflammatory and anti-inflammatory agents, as well as the role of executors of cell death in regulating tissue hemostasis. Ropivacaine as a local anesthetic is believed to be able to help the wound healing process, apart from being an analgesic. Aim and Objective: This research was aimed to prove the effect of Ropivacaine on macrophages and caspase-3 which play a role in the wound healing process.Materials and Methods: This study is a quasi experimental prospective analysis with a randomized post-test-only control group design with white male Wistar rats as subjects. The samples were 24 subjects who met the inclusion and exclusion criteria which were divided into four groups, namely the treatment group on day 3 and 7 with 0.2% ropivacaine infiltration in the incision wound and the control group with 0.9% NaCl infiltration on day 3 and 7. Excisional biopsy procedures were done on third and seventh day. Examination under microscopy to assess expression caspase-3 and the amount of macrophages. Then analyzed by SPSS. Caspase-3 expression and the number of macrophage cells were lower than the control group (p<0.05).Results and Conclusion: There was a significant difference in the expression of caspase-3 protein in the control group on the 3rd day with the 3rd day treatment (p=0.007), the 7th day control group with the 7th day treatment (p=0.008), and the 7th day treatment group 3rd day with 7th day treatment (p=0.026), and the number of macrophage cells in all study groups (p=0.0001). Therefore, ropivacaine infiltration had an effect on decreasing the expression of caspase-3 protein and the number of macrophage cells on the 3rd and 7th day

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January-June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 – 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 – 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 – 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 – 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 – 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 – 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 – 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 – 5.401) were associated with higher medication complexity. Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity