Background:Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia.Methods:A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications.Results:A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3).Conclusion:One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.

BackgroundPostoperative cognitive dysfunction (POCD) is commonly observed following cardiac surgery. The utilization of cardiopulmonary bypass (CPB) is associated with many possible mechanisms to cause POCD. However, there is no evidence confirming that CPB alone is the cause of POCD.ObjectivesThe current study aimed at evaluating several factors suspected to cause POCD following cardiac surgery in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.MethodsThe current prospective cohort study was conducted on 54 patients who were candidates for cardiac surgery. The assessment of memory, attention, and executive functions was performed by neuropsychological tests, before and after the surgery. Cognitive decline was defined as a 20% decrease in cognitive function in at least one of the tests. Inclusion criteria were adults spokeing Bahasa Indonesia fluently, literate, and giving consent to participate in the study. The analyzed risk factors included age, diabetes, educational level, duration of aortic cross clamp, and duration of cardio-pulmonary bypass.ResultsPOCD occured in 40.7% of subjects that underwent cardiac surgery using cardiopulmonary bypass. Age was the only influential factor through bivariate test and logistic regression analysis (P = 0.001). The current study conducted a logistic regression test on age variable; the obtained result indicated an increasing trend of POCD in accordance with age group.ConclusionsDurations of CPB, cross clamp, diabetes, and educational level were not the main risks of POCD. Old age was a significant predictor to POCD.

Background:The practice of anesthesia requires good awareness, parallel decision-making and fine motor skills. The duration of working hours of anesthesiology residents is often more than 12 hours.Objectives:This study aimed to measure cognitive and psychomotor functions of anesthesiology residents after 12 working hours.Patients and Methods:This was an observational study on anesthesiology residents who underwent 12 working hours. Each subject, who fulfilled inclusion and exclusion criteria, had their cognitive and psychomotor functions tested at 0 and 12 hours. The cognitive function was measured by “Cognitive Stimulation” test, while the psychomotor function was measured by the grooved pegboard. Statistical analysis was conducted to compare the results between 0 and 12 hours.Results:Cognitive Stimulation” test revealed statistically significant decrease at sequential image frequency stimulation (P = 0.035). Other stimulation tests did not show any statistically significant result. Grooved pegboard test showed statistically significant decrease in psychomotor function from 0 to 12 hours (P = 0.037).Conclusions:There was a decrease in cognitive function, including attention, visual memory, naming, and executive function, as well as psychomotor function among residents of Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, who underwent 12 working hours.

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Emotional stress, such as seen in preanesthetic anxiety, often occurs in parents and children who will undergo surgery and anesthesia. Preanesthetic anxiety is a subjective feeling associated with increased autonomic nervous system activity. Preanesthetic anxiety experienced by parents can be passed onto their children and have a negative impact on a child such as the occurrence of post anesthesia behaviour disorders. In Indonesia, data about preanesthetic maternal anxiety is still unavailable. The purpose of this study is to determine the proportion of preanesthetic maternal anxiety and the contributing factors. After obtaining ethical approval from Health Research Ethics Committee of FKUI-RSCM, 144 mothers of children aged 0 – 12 years at preoperative clinic Dr. Cipto Mangunkusumo Hospital who were scheduled to undergo anesthesia, were interviewed using an anxiety disorders interview guide MINI (Mini International Neuropsychiatric Interview) ICD-10. The anxiety scores were assessed using the VAS (Visual Analogue Scale). Results were analyzed using multivariate logistic regression. A total of 70 mothers (48,6%) had anxiety disorders with VAS score ranging between 3- 8 mm. Preanesthetic maternal anxiety is influenced by the child’s age (p = 0.001), history of previous anesthesia on the child (p = 0.004), and number of children (p = 0.041). Mothers with infants are 7.9 times more likely to experience higher anxiety (adjusted OR = 7.982), but because of the wide range of confidence interval (95% CI = 2.599 to 24.512) other factors may also influence the preanesthetic maternal anxiety. Preanesthetic maternal anxiety has fairly high proportion in numbers. This problem needs to be addressed to prevent a negative impact on children post anesthesia.

Latar Belakang : Intubasi endotrakeal dan laringoskopi direk merupakan standar baku emas dalam tatalaksana jalan nafas baik pada keadaan gawat darurat ataupun tidak. Peningkatan tanggapan kardiovaskular karena rangsangan simpatis merupakan komplikasi tersering saat intubasi. Tanggapan kardiovaskular ini dapat berbahaya bagi pasien-pasien yang berisiko, terutama yang memiliki masalah gangguan jantung. Metode pemilihan bilah merupakan salah satu teknik non farmakologi yang digunakan untuk mengurangi tanggapan kardiovaskular yang timbul akibat intubasi. Penelitian ini bertujuan untuk membandingkan tanggapan kardiovaskular dan kemudahan intubasi antara laringoskop McCoy dan Macintosh. Metode : Uji klinis acak tersamar tunggal, dengan 78 pasien yang akan menjalani anestesia umum dengan intubasi endotrakeal dan dibagi ke dalam 2 kelompok, yaitu McCoy dan Macintosh. Kriteria inklusi adalah 18-65 tahun dengan status fisik ASA 1 dan ASA 2 tanpa penyulit jalan nafas. Midazolam 0,05mg/kgBB dan fentanyl 2mcg/kgBB diberikan 2 sebagai agen koinduksi. Induksi anestesia menggunakan propofol 2mg/kgBB, dilanjutkan dengan pemberian rocuronium 0,6mg/kgBB setelah dipastikan hilangnya refleks bulu mata. Tanggapan kardiovaskular yang diukur (tekanan sistolik, diastolik, tekanan arteri rerata, dan laju denyut nadi). Intubasi dikatakan mudah bila dilakukan dalam waktu kuang dari 10 menit dan tidak lebih dari 3 kali percobaan. Hasil : Pada menit pertama pasca intubasi, tekanan darah sistolik, diastolik, dan lau denyut nadi kelompok McCoy lebih tinggi dibandingkan Macintosh, dengan perbedaan tekanan sistolik -2,38 (-9,93-5,16), tekanan diastolik -1,07(-7,313-5,15 95%IK), laju denyut nadi 2,79(-2,69 – 8,28). Pada menit ke-3 pasca intubasi, tekanan sistolik, diastolik, tekanan arteri rerata, dan laju denyut nadi kelompok McCoy tetap lebih tinggi dibandingkan dengan Macintosh, dengan perbedaan tekanan sistolik -1,23 (-8,51-6,05), tekanan diastolik -0,97(-6,69-4,75), tekanan arteri rerata -0,65(-6,27-4,97), dan laju denyut nadi 0,89(-3,99-5,78). Kesimpulan : Intubasi dengan laringoskop McCoy tidak mampu menekan tanggapan kardiovaskular yang timbul akibat rangsang nyeri dan stimulasi simpatis.

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