Tugas TI

Nama: Sofia Nanda Arista

NIM: 200106170
Kelas: D4 Kep.Anestesiologi-6B

Anak diberikan latihan berulang-ulang sebanyak 25 kali pertemuan, pada kondisi

baseline (A) yang dilakukan sebanyak sembilan kali terlihat bahwa persentase yang diperoleh
anak masih sangat rendah, hasil tertinggi yang diperoleh anak hanya 40%. Sedangkan pada
kondisi intervensi (B) setelah anak diberikan perlakuan dengan menggunakan metode
garismatika dimana metode ini akan membantu anak nantinya dalam melakukan operasi
perkalian, intervensi dilakukan sebanyak 16 kali pertemuan maka dapat meningkatkan
kemampuan operasi perkalian yang hasil bilangannya dua angak untuk anak diskalkulia hingga
mencapai persentase 100%. (Arisandi 2014)
The association between intraoperative nociception and increased patient's morbidity is
well established. However, hemodynamic parameters, such as heart rate and blood pressure, may
result in an inadequate monitor of nociception during surgery. Over the last two decades,
different devices have been marketed to "reliably" detect intraoperative nociception. Since the
direct measure of nociception is impractical during surgery, these monitors measures nociception
surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate
variability, pupillometry, skin conductance), electroencephalographic changes, and muscular
reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to
give an overview of the most up-to-date information available in the literature on current
nociceptor monitors available in clinical practice, with particular focus on their applications in
pediatrics. (Bertolizio, Garbin et al. 2023)
The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the
governments worldwide to deal with an unprecedented health crisis. The aim of this review is to
summarize what happened to cardiac surgery worldwide during the first wave of this pandemic.
A literature search was performed to extrapolate key concepts regarding guidelines and
reorganization of cardiac surgery wards during COVID-19. Supporting literature was also
included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official
documents from national scientific societies and single- or multiple-center experiences during
the pandemics are reviewed and discussed.(Bonalumi, Giambuzzi et al. 2022)
More than identifying the “best” monitor of the NAN balance, this review of current
literature emphasizes the fact that individual characteristics of each monitoring device, and hence
the physiological understanding it provides, may be of importance when choosing a monitor for
anyone’s practice. In our view, it is of most importance that the user understands how a given
monitor is working, in order to adequately use the information it provides and eventually adapt
the administration of anesthetic drugs. When looking into the clinical designs used for
monitoring validation, absolute values seem more or less questionable in all existing devices
because of the lack of a gold standard. However, dynamic values may be of better clinical value
because they give an insight, over a short period of time, of how an individual’s ANS is reacting
to a somewhat reproducible nociceptive stimulus, e.g. electric stimulation or skin incision. (De
Jonckheere, Bonhomme et al. 2015)
Penelitian telah dilakukan terhadap 70 pasien seksio sesarea. Pasien dikelompokkan
menjadi dua kelompok, yaitu kelompok anestesi spinal dan anestesi umum, setiap kelompok
perlakuan terdiri atas 35 pasien. Berdasarkan pada hasil pengujian statistika dengan
mempergunakan uji-t, menunjukkan hasil bahwa tidak terdapat perbedaan yang bermakna pada
karakteristik subjek penelitian berdasarkan usia (p=0,159) maupun BMI (p>0,05), sehingga
homogenitas karakteristik pada kedua kelompok tersebut layak diperbandingkan. Insiden
hipotensi yang pertama kali diukur saat penurunan tekanan darah sistol lebih dari 20% dari
baseline atau tekanan darah sistol di bawah 90 mmHg, maka berdasarkan uji statistika
menggunakan chikuadrat didapatkan perbedaaan yang sangat bermakna (p<0,001) pada kejadian
hipotensi kelompok anestesia spinal bila dibandingkan dengan kelompok anestesi umum. (Flora,
Redjeki et al. 2014)
Pengetahuan pasien pre operasi dalam persiapan pembedahan di ruang rawat inap Hosana
dan Agape Rumah Sakit Baptis Kediri adalah kategori pengetahuan kurang. Dari hasil penelitian
ini diharapkan pasien pre operasi dapat meningkatkan pengetahuan terkait dengan persiapan
pembedahan serta dapat dijadikan masukan untuk mengevaluasi kembali penerapan SOP yang
dilakukan oleh perawat tentang persiapan pembedahan pada pasien.(Harahap 2015)
Prevalens ILO pascabedah abdomen pada anak masih tinggi, maka diperlukan suatu
panduan tata laksana pasien anak pra dan pascabedah. Sebagai dokter spesialis anak harus
memperhatikan dan menuliskan faktor risiko yang ada pada pasien saat membuat toleransi
operasi dan memberi penjelasan kepada orangtua pasien tentang risiko ILO pascabedah
abdomen. Perlu penelitian lebih lanjut di RSCM dan membuat sistem skor faktor risiko ILO
dengan sampel lebih besar dan dilakukan secara prospektif.(Haryanti, Pudjiadi et al. 2016)
Nociception monitoring devices using changes in autonomic nervous system activity
have been developed in numerous ways. Although there have been few studies conducted on
children, compared to the relatively higher number of studies on adults, most of the nociception
monitors in children, as in adults, appear to be more useful than the standard clinical practice that
uses hemodynamic parameters in the evaluation and treatment of intraoperative nociception
(pain) during general anesthesia. Particularly, when monitoring the surgical pleth index (SPI) in
anesthetized children, the application of a new target range of SPI values (≤ 40) to the SPI
monitoring criteria seems to be necessary for providing a more proper intraoperative analgesia.
The analgesia nociception index (ANI) shows promising results in anesthetized adults, and
recently, positive results along with cardiorespiratory coherence have been reported in pediatric
patients. Newborn infant parasympathetic evaluation (NIPE) could be useful for providing
adequate analgesia in newborns, infants, and children under 2 years of age in anesthetized or
awake states. In cases of skin conductance and pupillometry, further studies are needed.
Understanding the pros, cons, and limitations of these nociception monitoring tools will provide
more effective and safe intraoperative analgesia to pediatric patients undergoing general
anesthesia, and it may also help to plan and conduct promising research on the use of
perioperative nociception monitoring in pediatric patients in the future. (Lim 2019)
Surgery, like music, and Jazz music in particular, is more than a series oftones set in time,
and although the rules are followed, every patient presents different challenges. Surgery shares
with jazz improvisation such features as simultaneous reflection and action, simultaneous rule
creation and rule following, patterns ofmutually expected responses akin to musicians moving
through a melody together, action informed by melodies in the form of codes, continuous mixing
ofthe expected with the novel, and the feature ofa heavy reliance on intuitive grasp and
imagination. (Martellucci 2015)
Safe anesthesia is achieved using objective methods that estimate the patient's state
during different phases of surgery. A patient's state under anesthesia is characterized by three
major aspects, which are linked to the main effects produced by each of the families of anesthetic
agents administered: hypnosis, analgesia, and muscular relaxation. While quantification
techniques designed to assess muscular relaxation under neuromuscular blocking agents have a
relatively long history with a high degree of standardization and understanding (e.g., the train-of-
four), the knowledge and techniques used to the depth of hypnosis assessment suffer from a
lesser degree in both standardization and interpretation due to brain complexity. The problem of
standardization and interpretation in the analgesia and nociception assessment increases since it
involves more systems, the central nervous system, and the autonomic nervous system. This
helps to explain why there are multiple a priori valid approaches to develop nociception
monitoring froZAm different interpretations and physiological bases of noxious stimuli
processing. Thus, in this review, the current monitoring technologies clinically available for
estimating a patient's nociception under general anesthesia are described.(Martinez-Vazquez and
Jensen 2022)
Arisandi, E. (2014). "Meningkatkan Kemampuan Operasi Perkalian untuk Anak Diskalkulia Melalui
Metode Garismatika." Jurnal Penelitian Pendidikan Khusus 3(3).

Bertolizio, G., et al. (2023). "Evaluation of Nociception during Pediatric Surgery: A Topical Review." J Pers
Med 13(2).

Bonalumi, G., et al. (2022). "The day after tomorrow: cardiac surgery and coronavirus disease-2019." J
Cardiovasc Med (Hagerstown) 23(2): 75-83.

De Jonckheere, J., et al. (2015). "Physiological Signal Processing for Individualized Anti-nociception
Management During General Anesthesia: a Review." Yearb Med Inform 10(1): 95-101.

Flora, L., et al. (2014). "Perbandingan efek anestesi spinal dengan anestesi umum terhadap kejadian
hipotensi dan nilai Apgar bayi pada seksio sesarea." Jurnal Anestesi Perioperatif 2(2): 105-116.
Harahap, W. A. (2015). "Pembedahan Pada Tumor Ganas Payudara." jurnalmka.fk.unand.ac.id.

Haryanti, L., et al. (2016). "Prevalens dan faktor risiko infeksi luka operasi pasca-bedah." Sari Pediatri
15(4): 207-212.

Lim, B. G. (2019). "Nociception monitoring tools using autonomic tone changes for intraoperative
analgesic guidance in pediatric patients." Anesth Pain Med (Seoul) 14(4): 380-392.

Martellucci, J. (2015). "Surgery and jazz: the art of improvisation in the evidence-based medicine era."
Ann Surg 261(3): 440-442.

Martinez-Vazquez, P. and E. W. Jensen (2022). "Different perspectives for monitoring nociception during
general anesthesia." Korean J Anesthesiol 75(2): 112-123.