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Introduction: Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk deep vein thrombosis, fast recovery, and reduced cost of care. Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period, has the potential to be more effective than a similar analgesic treatment initiated after surgery. As a part of multimodal analgesia, the use of NSAIDs should always be considered for acute postoperative pain management. NSAIDs can be used preoperatively as a part of the preemptive regimen and for postoperative pain control to increase the efficacy of opioids and reduce its side effects. Material and Method: This research was experimental research with a case-control design of the study. The samples separated into two groups, the first group got ketoprofen suppository before the induction, and the second group didn't get the ketoprofen suppository The intensity of pain measured with the Numeric Rating Scale (NRS) or Wong-Baker Faces Pain Scale was the variable studied at different postoperative times (30 min, 60 min, 120 min, 2-6 hours, 6-12 hours). The total amount of rescue analgesics (fentanyl) and side effects were other variables of this study. Result and Discussion: The result is ketoprofen suppository as preemptive analgesia administrations can reduce postoperative pain. Numeric Rating Scale was significantly lower in the ketoprofen group compared to the control group (p < 0,05) at 30 min, 60 min, 230 min, 2-6 hours, 6-12 hours. The number of postoperative analgesics needed in the recovery room was significant differences among both groups (p < 0,05). Conclusion: Preemptive analgesia in patients who underwent an operation with general anesthesia with ketoprofen suppository was effectively in blocking noxious stimuli and central sensitization, with subsequent prevention of acute postoperative pain. ABSTRAKPendahuluan: Manajemen nyeri postoperatif yang efektif akan dapat meningkatkan kepuasan dan kenyamanan pasien, mobilisasi dini, komplikasi pulmoner dan kardiovaskuler yang rendah, menurunkan resiko deep vein thrombosits, pemulihan lebih cepat dan menurunkan biaya perawatan. Preemptive analgesia yang diberikan sebelum prosedur pembedahan untuk mencegah nyeri diawal periode postoperatif lebih efektif dibandingkan dengan terapi analgesik yang sama diberikan di akhir pembedahan. Konsep multimodal analgesia diajukan dan direkomendasikan bila memungkinkan. Sebagai bagian dari multimodal analgesia, penggunaan NSAID dapat dipertimbangkan sebagai bagian dari manajemen nyeri akut postoperatif. NSAID sapat digunakan sebagai regimen preemptive dan mengendalikan nyeri postoperatif untuk menurunkan penggunaan opioid dan mengurangi resiko. Bahan dan Metode: Penelitian ini merupakan penelitian eksperimental dengan desain studi case control. Sample dibedakan menjadi dua kelompok, kelompok pertama mendapat ketoprofen suppositoria sebelum induksi dan kelompok kedua tidak ...

Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and  were treated in ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT. Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein. Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events to be detected early and prevented.

Highlight: Sepsis and septic shock cause morbidity and mortality in pediatric patients. The accuracy of pediatric sequential organ failure assessment and anion gap (pSOFA+AG) was compared with AG and pediatric logistic organ dysfunction-2 (AG+PELOD-2). The mortality assessment of pediatric septic patients showed that pSOFA was more sensitive than PELOD-2, while pSOFA+AG was not more sensitive than PELOD-2.   Abstract: Sepsis and septic shock are some of the causes of morbidity and mortality (50-60%) in pediatric patients treated in intensive care rooms. This study aimed to compare the accuracy of pediatric Sequential Organ Failure Assessment (pSOFA) score combined with anion gap (AG) score to Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in the assessment of mortality in pediatric septic patients at the Resuscitation Room of Dr. Soetomo Geeneral Academic Hospital, Surabaya, Indonesia. This was a retrospective observational cohort study using pediatric sepsis diagnosis guidelines based on the 2016 Pediatric Sepsis Consensus and medical records between January-December 2018. All data of patients aged 1 month to 16 years with suspected infection at the Resuscitation Room were collected based on predisposing infections, signs of infection, and warning signs. Organ dysfunction was assessed by calculating the pSOFA+AG scores, PELOD-2 scores, and corrected anion gap (cAG) in the first 24 hours. Sepsis mortality was assessed by comparing the results of the pSOFA, pSOFA+AG, and PELOD-2. The results showed 94.9% sensitivity and 70.0% specificity (p<0.0001) in the pSOFA, 89.9% sensitivity and 71.3% specificity (p<0.0001) in the PELOD-2, 79.7% sensitivity and 65% specificity (p<0.0001) in the AG, 79.7% sensitivity and 73.8% specificity (p<0.0001) in the cAG, and 79.3% sensitivity (p<0.0001) in the pSOFA+AG. In conclusion, pSOFA was more sensitive than PELOD-2, while the use of pSOFA+AG was not more sensitive than PELOD-2 in assessing the mortality of pediatric septic patients.

Post anesthesia agitation is common problem in pediatric post anesthesia care unit. The incidences range from 10 to 80%. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, and uncooperative typically thrashing, crying, moaning or incoherent. This study was done to determine the incidence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This descriptive and analytic study was performed on 105 pediatric patient aged 1-12 years that underwent general anesthesia for various elective diagnostic and surgeries at Dr. Soetomo Hospital between January and February 2016. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium (PAED) scale. The factors that linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software with logistic regression. p - values less than 0.05 were considered as significant. Forty two (40%) children had Emergence Agitation. Preoperative anxiety (p = 0.006) and Pain (p=0.035) were associated with higher rates of post anesthetic emergence agitation. This study identified preoperative anxiety and pain as risk factors, which are associated with emergence agitation in children. To minimize the incidence of post anesthetic emergence agitation, these risk factors should be considered in the routine care by anesthetist.

Anatomi jalan napas pediatri menyebabkan pemilihan ukuran pipa endotrakeal (ETT) menjadi tantangan tersendiri. Pipa endotrakeal (ETT) yang terlalu kecil/besar meningkatkan risiko komplikasi. Prediksi ukuran ETT berdasar atas usia merupakan metode yang paling sering digunakan namun ternyata tidak selalu tepat pada aplikasinya. Parameter lain seperti diameter subglotis atau diameter kelingking tangan dapat menjadi alternatif untuk memprediksi ukuran ETT pediatri. Tujuan penelitian ini menganalisis dan membandingkan akurasi prediksi ukuran ETT tanpa cuff berdasar berbagai variabel pada pasien pediatri di RSUD Dr Soetomo Surabaya mulai Februari hingga April 2020. Subjek penelitian ini pasien usia 2-9 tahun, PS ASA 1-2 yang akan dilakukan operasi elektif. Saat preoperatif, usia, berat, dan panjang badan dicatat. Saat intraoperatif, diameter kelingking tangan dan diameter subglotis menggunakan USG diukur dan dicatat. ETT yang digunakan adalah ETT tanpa cuff berdasar atas diameter subglotis. ETT dianggap tepat apabila memberikan audible air leak pada tekanan 10-25 cmH2O. Bila ETT terlalu kecil/besar maka dilakukan reintubasi. Tiaptiap parameter dilakukan uji korelasi, agreement test, serta predictive performance menggunakan MAPE, dan RMSE. Dari 48 pasien, didapatkan hasil bahwa prediksi ukuran ETT tanpa cuff berdasar atas diameter subglotis memiliki akurasi yang paling baik hingga 91,67% (r=0,973, koefisien kappa 0,892; p<0,001, MAPE 0,803%, dan RMSE 0,144). Simpulan, prediksi berdasar atas diameter subglotis merupakan metode yang akurat untuk memprediksi ukuran ETT tanpa cuff pediatri.

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