Anesthesia for Open Radical Retropubic Prostatectomy: A Comparison between Combined Spinal Epidural Anesthesia and Combined General Epidural Anesthesia

Background. Several anesthesiologic regimens can be used for open radical retropubic prostatectomy. The aim of this retrospective analysis was to compare the combined general epidural anesthesia and the combined spinal epidural anesthesia with regard to availability, efficacy, side effects, and perioperative time consumption in a high-volume center. Methods. A retrospective analysis was performed by querying the electronic medical records of 1207 consecutive patients from the database of our online documentation software. All patients underwent open radical retropubic prostatectomy from 01/2008 to 08/2011 and met the study criteria. Linear and multivariate regression analyses were performed to identify differences in parameters such as time consumption in the operating unit, hemodynamic parameters, volume replacement, and catecholamine therapy. Results. 698 (57.8%) patients have been undergoing open radical retropubic prostatectomy under combined spinal epidural anesthesia and 509 (42.2%) patients by combined general epidural anesthesia. Operating unit (p <0.0001) and post-anesthesia care unit stay (p <0.0001) as well as total hospital stay (p <0.0001) were significantly shorter in the combined spinal epidural anesthesia group. In addition, this group had reduced intraoperative volume need (p <0.0001) as well as lower need of catecholamines (p <0.0001). Conclusions. This retrospective study suggests that the combined spinal epidural anesthesia seems to be a suitable and efficient anesthesia technique for patients undergoing open radical retropubic prostatectomy. This specific approach reduces time in the operation unit and length of hospital stay

Adenosine By Aortic Arch Flush Fails to Augment the Brain Preservation Effect of Mild Hypothermia During Exsanguination Cardiac Arrest in Dogs -- An Exploratory Study

Most trauma cases with rapid exsanguination to cardiac arrest (CA) in the field, as well as many cases of normovolemic sudden cardiac death are ‘unresuscitable’ by standard cardiopulmonary–cerebral resuscitation (CPCR). We are presenting a dog model for exploring pharmacological strategies for the rapid induction by aortic arch flush of suspended animation (SA), i.e. preservation of cerebral viability for 15 min or longer. This can be extended by profound hypothermic circulatory arrest of at least 60 min, induced and reversed with (portable) cardiopulmonary bypass (CPB). SA is meant to buy time for transport and repair during pulselessness, to be followed by delayed resuscitation to survival without brain damage. This model with exsanguination over 5 min to CA of 15-min no-flow, is to evaluate rapid SA induction by aortic flush of normal saline solution (NSS) at room temperature (24°C) at 2-min no-flow. This previously achieved normal functional recovery, but with histologic brain damage. We hypothesized that the addition of adenosine would achieve recovery with no histologic damage, because adenosine delays energy failure and helps repair brain injury. This dog model included reversal of 15-min no-flow with closed-chest CPB, controlled ventilation to 20 h, and intensive care to 72 h. Outcome was evaluated by overall performance, neurologic deficit, and brain histologic damage. At 2 min of CA, 500 ml of NSS at 24°C was flushed (over 1 min) into the brain and heart via an aortic balloon catheter. Controls (n=5) received no drug. The adenosine group (n=5) received 2-chloro-adenosine (long acting adenosine analogue), 30 mg in the flush solution, and, after reperfusion, adenosine i.v. over 12 h (210 μg/kg per min for 3 h, 140 μg/kg per min for 9 h). The 24°C flush reduced tympanic membrane temperature (Tty) within 2 min of CA from 37.5 to ≈36.0°C in both groups. At 72 h, final overall performance category (OPC) 1 (normal) was achieved by all ten dogs of the two groups. Final neurologic deficit scores (NDS; 0–10% normal, 100% brain death) were 5±3% in the control group versus 6±5% in the adenosine group (NS). Total brain histologic damage scores (HDS) at 72 h were 74±9 (64–80) in the control group versus 68±19 (40–88) in the adenosine group (NS). In both groups, ischemic neurons were as prevalent in the basal ganglia and neocortex as in the cerebellum and hippocampus. The mild hypothermic aortic flush protocol is feasible in dogs. The adenosine strategy used does not abolish the mild histologic brain damage

Adenosine By Aortic Arch Flush Fails to Augment the Brain Preservation Effect of Mild Hypothermia During Exsanguination Cardiac Arrest in Dogs -- An Exploratory Study

Most trauma cases with rapid exsanguination to cardiac arrest (CA) in the field, as well as many cases of normovolemic sudden cardiac death are ‘unresuscitable’ by standard cardiopulmonary–cerebral resuscitation (CPCR). We are presenting a dog model for exploring pharmacological strategies for the rapid induction by aortic arch flush of suspended animation (SA), i.e. preservation of cerebral viability for 15 min or longer. This can be extended by profound hypothermic circulatory arrest of at least 60 min, induced and reversed with (portable) cardiopulmonary bypass (CPB). SA is meant to buy time for transport and repair during pulselessness, to be followed by delayed resuscitation to survival without brain damage. This model with exsanguination over 5 min to CA of 15-min no-flow, is to evaluate rapid SA induction by aortic flush of normal saline solution (NSS) at room temperature (24°C) at 2-min no-flow. This previously achieved normal functional recovery, but with histologic brain damage. We hypothesized that the addition of adenosine would achieve recovery with no histologic damage, because adenosine delays energy failure and helps repair brain injury. This dog model included reversal of 15-min no-flow with closed-chest CPB, controlled ventilation to 20 h, and intensive care to 72 h. Outcome was evaluated by overall performance, neurologic deficit, and brain histologic damage. At 2 min of CA, 500 ml of NSS at 24°C was flushed (over 1 min) into the brain and heart via an aortic balloon catheter. Controls (n=5) received no drug. The adenosine group (n=5) received 2-chloro-adenosine (long acting adenosine analogue), 30 mg in the flush solution, and, after reperfusion, adenosine i.v. over 12 h (210 μg/kg per min for 3 h, 140 μg/kg per min for 9 h). The 24°C flush reduced tympanic membrane temperature (Tty) within 2 min of CA from 37.5 to ≈36.0°C in both groups. At 72 h, final overall performance category (OPC) 1 (normal) was achieved by all ten dogs of the two groups. Final neurologic deficit scores (NDS; 0–10% normal, 100% brain death) were 5±3% in the control group versus 6±5% in the adenosine group (NS). Total brain histologic damage scores (HDS) at 72 h were 74±9 (64–80) in the control group versus 68±19 (40–88) in the adenosine group (NS). In both groups, ischemic neurons were as prevalent in the basal ganglia and neocortex as in the cerebellum and hippocampus. The mild hypothermic aortic flush protocol is feasible in dogs. The adenosine strategy used does not abolish the mild histologic brain damage

PERBANDINGAN HASIL BELAJAR ANTARA SISWA YANG MENGIKUTI BIMBINGAN BELAJAR MENGGUNAKAN MODUL DAN SISWA YANG MENGIKUTI BIMBINGAN BELAJAR TIDAK MENGGUNAKAN MODUL DI KELAS V MADRASAH IBTIDAIYAH DARUSSALAM BADANG NGORO JOMBANG

Abstrak Pembelajaran dalam bimbingan belajar pastilah berbeda. Ada yang menggunakan modul ada yang tidak, dan pasti mempengaruhi hasil belajar. Tujuan penelitian ini: untuk mengetahui hasil belajar siswa yang mengikuti bimbingan belajar modul dan tidak, serta mendeskripsikan perbedaan hasil belajar siswa yang mengikuti bimbingan belajar dengan modul dan tidak. Penelitian ini kuantitatif dengan teknik analisis statistik uji-t sampel saling bebas, data diperoleh melalui observasi, wawancara, dokumentasi, angket. Hasil penenlitian menunjukkan prosentase tentang hasil belajar siswa yang mengikuti bimbingan belajar dengan modul 74% diantara (51-75%.), maka hasil belajar siswa dinyatakan baik. Dan hasil dari prosentase hasil belajar siswa yang mengikuti bimbingan belajar tanpa modul 72% diantara 51-75%, maka hasil belajar siswa dinyatakan baik. Serta tidak ada perbedaan hasil belajar siswa yang mengikuti bimbingan belajar dengan modul dan tidak. Hal ini terlihat dari signifikansi sebesar 0.282>0.05, karena lebih besar dari 0.05, maka Ho diterima dan Ha ditolak, itu menunjukkan bahwa tidak adanya perbedaan. Kata Kunci: Hasil Belajar, Bimbingan Belajar, Modu