Objectives: The purpose of this study was to assess that qSOFA validity is equal with SOFA as the predictor of mortality, both in sepsis and nonsepsis patients.Design: Diagnostic test with a retrospective design. Setting:Intensive Care Unit in Sanglah General Hospital, Bali. Indonesia. Subjects:Patients admitted to the ICU Sanglah General Hospital, from July 2015 to December 2016 (n=192), that have complete data and able to be evaluated with SOFA score. Interventions: None Measurement and Main Results:With the total population sampling techniques, 192 patients have met the criteria as the samples. The descriptive statistical analysis were performed, and the area under the ROC curve (AuROC) were used. The cutoff points will also be determined and will conclude the sensitivity and specificity of each score. From the 192 patients, the cutoff point for the SOFA and qSOFA are 11 and 2. While the AuROC from SOFA and qSOFA are 0.9307 and 0.9241, with p=0.7037 (95% confidence interval). Conclusion:In this study, we conclude that the validity of qSOFA is equal to SOFA, both in sepsis and nonsepsis. So, for the reasons of efficiency and effectiveness, qSOFA can be used to replace SOFA score in predicting mortality in ICU.

Cephalocele refers to defects in the skull and dura with extensions from intracranial to extracranial structures. Cephalocele is divided into four types which are meningoencephalocele, meningocele, atretic encephalocele, and gliocele. Encephalocele is a head's contents herniation through a defect in the skull. Meningocele is a herniation sac that contains cerebrospinal fluid and nerve elements. Meningoencephalocele is a prominent herniation of the meningeal part, nerve elements, and brain tissue in a sac that protrudes through a defect in the skull. In Southeast Asia, the incidence of meningoencephalocele is estimated to occur in 1 in 5000 live births. The occipital bone is the most common location of cephalocele. The neurological outcome of malformations that occur depends on the size of the sac formed, the nerve tissue involved, hydrocephalus, related infections, and other pathological conditions involved. Perioperative preparation must be well made by an anesthesiologist based on airway management, fluid balance, and hypothermia prevention. The main challenge of anesthesia in the management of the occipital meningoencephalocele is securing the airway. Pediatric patients have low functional reserve volume, and failure of tracheal intubation can cause hypoxemia, bradycardia, and even heart attacks. Improper positioning and limited neck extension can complicate endotracheal intubation.

Caudal block technique remains as the most popular regional anesthetic choice for the pediatric population since its first description in 1933 for pediatric urological interventions. This technique could provide exquisite analgesia during surgery, likewise in the postoperative period after infraumbilical surgeries. Caudal continues to essentially reduce systemic anesthetic and analgesic requirements, thus conceive a better postoperative outcome. Ropivacaine is a safe and effective local anesthetic agent which provides prolonged postoperative analgesia with significantly minor motor blockade following caudal block in pediatric patients undergoing infraumbilical surgeries.

AbstrakLaringoskopi dan intubasi merupakan tindakan rutin yang berisiko menyebabkan respons kardiovaskular berupa peningkatan tekanan darah dan laju denyut jantung terutama pada pasien risiko tinggi seperti kelainan jantung. Penelitian ini bertujuan mengetahui efektivitas MgSO 4 30 mg/kgBB intravena dibanding dengan fentanil 2 mcg/kgBB intravena dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi sehingga dapat menjadi obat altenatif. Penelitian ini dilakukan secara uji klinis acak terkontrol tersamar ganda terhadap 42 pasien dengan status fisik American Society of Anesthesiologist (ASA) I-II yang dilakukan operasi dengan anestesi umum intubasi trakea di RSUP Sanglah Denpasar Bali pada AgustusSeptember 2014. Subjek dibagi menjadi dua kelompok, MgSO 4 30 mg/kgBB (n=21) dan fentanil 2 mcg/kgBB (n=21) secara acak. Perubahan tekanan darah dan laju denyut jantung yang terjadi sebelum dan setelah tindakan dicatat sebagai data penelitian. Data penelitian dianalisis dengan uji repeated ANOVA, dengan p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak terdapat perbedaan bermakna antara kedua kelompok perlakuan. Simpulan, pemberian MgSO 4 30 mg/kgBB sama efektif dengan fentanil 2 mcg/kgBB dalam menekan respons kardiovaskular pada tindakan laringoskopi dan intubasi.Kata kunci: Fentanil, intubasi, laringoskopi, magnesium sulfat, respons kardiovaskular Comparison of Intravena Magnesium Sulfate 30 mg/kgBW and Intravena Fentanil 2 mcg/kgBW Effectiveness for Attenuating Cardiovascular Response in Laryngoscopy and Tracheal Intubation AbstractLaryngoscopy and intubation are routine actions which cause the risk of cardiovascular responses, including increased blood pressure and heart rate, especially in high-risk patients such as patients with heart disorders. The aim of this study was to determine the effectiveness of intravenous MgSO 4 30 mg/kgBW compared to that of intravenous fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation to assess its possibility as an alternative drug. This study was a clinical trial with randomized double-blind controlled to 42 patients with physical status of the American Society of Anesthesiologists (ASA) I-II who underwent tracheal intubation under general anesthesia in Sanglah Denpasar Hospital Bali in the period of August-September 2014. Subjects were divided into two groups, MgSO 4 30 mg/kgBW (n=21) and fentanyl 2 mcg/kgBW (n=21) groups. Changes in blood pressure and heart rate that occured before and after the action were recorded as research data. Data were analyzed with repeated ANOVA test, with p<0.05 considered significant. Statistical analysis showed that there was no significant difference between the two treatment groups. it is concluded that the administration of MgSO 4 30 mg/kgBW is as effective as fentanyl 2 mcg/kgBW in reducing cardiovascular responses to laryngoscopy and intubation.