This study aims to determine the implementation of the procurement and maintenance system of buildings at the Surakarta Health Polytechnic, the obstacles that occur in the implementation of the procurement and maintenance system of buildings at the Surakarta Health Polytechnic. This research is a qualitative research with a phenomenological approach. The technique of taking research subjects used was purposive sampling. Sources of data used are sources, events or activities, locations and documents and archives. The power gathering techniques used are interviews, archives and documentation. The validity of the data using interactive model analysis, namely data reduction, data presentation and conclusions.The results of this study indicate that the activities of implementing procurement and building maintenance services at the Surakarta Health Polytechnic include: planning, work programs, third party coordination, checking and selecting partners, so that the procurement and maintenance system of buildings runs well. Efforts made are financial proposals submitted in advance of the previous year, independent finance for each department used for minor maintenance, as well as an inventory of damage to each building with selection in building and building maintenance on the proposed priority scale.

Background & objective: Patients with COVID-19 have Acute Respiratory Distress Syndrome (ARDS) which progresses to lung edema and disorders of the liver, kidneys and heart associated with cytokine storms, which are the body's immune response to SARS-CoV-2. SARS-CoV-2 patients showed clinical neutrophilia, increased D-Dimer and increased IL-6. In addition, increased lactate dehydrogenase and increased aminotransferase are often found. This study aimed to analyze the clinical relevance of increased IL-6 and lactate in the first 24 hours of ICU-admission of COVID-19 patients in predicting mortality rate. Methodology: This study was a retrospective cohort design. The study was conducted in the Intensive Care Unit (ICU) of Dr. Moewardi Surakarta Hospital. The study was conducted by tracing the medical records of COVID-19 patients treated in the ICU of Dr. Moewardi Surakarta Hospital during the period of March 1, 2020 to March 31, 2021 that met the admission criteria. The patient's mortality assessment is seen as the patient's condition for a maximum of 30 days after discharge from the hospital. Results: Variables that meet the regression model are the lactate levels (OR = 3,143; P = 0.064) as well as the IL-6 levels (OR = 25.41; p<0.001). AUC score of 86.9% with significance of < 0.001. IL-6 levels and lactate levels in the study can be used as predictors of mortality rates with 95.7% sensitivity and 60% specificity. Lactate levels in COVID-19 cases in severe cases can be related to lung damage and tissue damage. Lactate levels have also been recognized as a marker of poor prognosis in patients with COVID-19. IL-6 as a predictor of mortality risk has been recognized and the administration of IL-6 inhibitors in COVID-19 patients may lower the risk of mortality. Conclusion: Raised IL-6 and lactate levels in this study can be a predictor of the mortality rate of COVID-19 patients within 24 hours of ICU-admission. Citation: Nugroho A, Hapsari PP, Santoso SB, Permana SA, Sitompul H. Clinical relevance of IL-6 and lactate within 24 hours of ICU-admission of COVID 19 patient in predicting mortality rate. Anaesth. pain intensive care 2022;26(5):689−694. DOI: 10.35975/apic.v26i5.2032

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea   Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

Latar Belakang: Luka bakar adalah luka yang terjadi akibat sentuhan permukaan tubuh dengan dengan benda-benda yang menghasilkan panas baik kontak secara langsung maupun tidak langsung. Hal tersebut bisa disebabkan oleh panas (api, cairan/lemak panas, maupun uap panas), radiasi, listrik, kimia. Pemberian melatonin mampu menjadi salah satu terapi pada penderita luka bakar. Dalam terapi luka bakar melatonin berperan dalam mengurangi stress oksidatif dan peradangan.Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh melatonin terhadap kadar leukosit tikus wistar model luka bakar (dalam kurun waktu dua hari).Metode: Penelitian yang dilakukan bersifat eksperimental yang dilakukan pada laboratorium dengan metode randomized control group pre test dan post test. Tikus yang digunakan pada penelitian ini berjumlah 12 yang akan dibagi menjadi 2 kelompok: K1−kelompok kontrol dan K2−kelompok perlakuan yang diinjeksi melatonin. Data akan dilakukan uji distribusinya menggunakan uji Shapiro-Wilk. Jika distribusi data normal uji hipotesis dilakukan dengan Independent T-test dan Paired T-test namun jika distribusi data tidak normal dapat dilakukan uji Mann-Whitney.Hasil: Dari hasil penelitian yang dilakukan terdapat penurunan kadar leukosit yang signifikan sebesar 6,483 x 109/L pada K2 secara signifikan yang didukung dengan uji hipotesis Paired T-test yang menunjukkan perbandingan kadar leukosit pada T1 dan T3 didapatkan nilai P = 0,01 yang berarti signifikan dan dikatakan signifikan apabila P < 0,05Kesimpulan: Terdapat pengaruh melatonin terhadap kadar leukosit tikus wistar model luka bakar (dalam kurun waktu dua hari).

Latar Belakang: Nyeri post operasi seksio sesarea merupakan nyeri sedang berat dengan intensitas akut. Saat ini terdapat dua kombinasi obat anti nyeri yang umum digunakan untuk mengatasi nyeri post operasi seksio sesarea yaitu kombinasi parasetamol-fentanyl serta kombinasi ketorolac-fentanyl. Interaksi kedua obat tersebut dapat menurunkan ambang nyeri yang dapat kita periksa dengan skor Numerical Rating Scale (NRS). Tujuan: Untuk mengetahui adanya perbedaan efektivitas antara pemberian kombinasi parasetamol-fentanyl dengan ketorolac-fentanyl dalam mengatasi nyeri post operasi seksio sesarea.Subjek dan Metode: Penelitian eksperimental dengan pendekatan uji klinis menggunakan 30 subjek pasien hamil dengan umur 20-40 tahun dengan status fisik ASA I-II yang akan menjalani operasi seksio sesarea dengan spinal anestesi lidocain 5% hiperbarik. Grup pertama diberikan 1000mg paracetamol dan 0,3mcg/kg/jam fentanyl intravena sebagai analgesik. Grup ke 2 diberikan ketorolac 30mg dan fentanyl o,3mcg/kg/jamPada penelitian ini dilakukan analisis univariat dan bivariat. Hasil: Hasil uji beda terhadap karakteristik subyek penelitian didapatkan pada kelompok parasetamol dan fentanyl terdapat perbedaan yang signifikan pada post operasi dengan nilai p=0,005 (p<0,05), pada ketorolac dan fentanyl terdapat perbedaan yang signifikan post operasi dengan nilai p=0,023 (p<0,05) dSimpulan: Kombinasi parasetamol fentanyl lebih efektif dibandingkan dengan ketorolac fentanyl.   The Comparison of the Effectiveness of Combination Fentanyl-Paracetamol with Fentanyl–Ketorolac on Numerical Rating Scale (NRS) Post Caesarean Section Abstract Background: Postoperative cesarean section pain is moderate-to-severe pain with acute intensity. There are two common anti-pain drug combinations used to treat post-cesarean section pain, namely the parasetamol-fentanyl combination and the ketorolac-fentanyl combination. The interaction of the two drugs can lower the pain threshold which we can check with the Numerical Rating Scale (NRS) score.Objective: To determine the difference in effectiveness between the combination of parasetamol-fentanyl and ketorolac-fentanyl in dealing with post-cesarean section surgery pain.Subject and Method: This study is an experimental study with a clinical trial approach using 30 subjects of pregnant patients aged 20-40 years with ASA I-II physical status who will undergo cesarean section surgery with hyperbaric 5% lidocaine spinal anesthesia. The first group were given 1000 mg parasetamol and 0.3 mcg/kg/h fentanyl intravenous as analgesics. The second group were given ketorolac 30 mg and fentanyl 0.3 mcg/kg/h intravenously. In this study, univariate and bivariate analyzes were performed. Results: The results of different tests on the characteristics of research subjects were found in the paracetamol and fentanyl groups, there was a significant difference in the post-operation with a value of p = 0.005 (p <0.05), in ketorolac and fentanyl there was a significant difference post-surgery with a value of p = 0.023 (p <0.05) where the paracetamol and fentanyl groups with NRS scores tended to fall, and the ketorolac and fentanyl groups with NRS scores tended to increase.Conclusion: The combination of parasetamol and fentanyl was more effective than ketorolac and fentanyl.