Background: Balanced anesthesia is a technique of general anesthesia based on the concept that administration of mixture agent inhalation and intravenous or combinations anesthesia technique for desired advantages effect anesthesia. Opioid as one component of balanced anesthesia proven can reduce perioperative pain and anxiety, decrease somatic and autonomic responses to airway manipulation, improve hemodynamic stability during noxious stimulation due to surgery, lower requirements for inhaled anesthetics, and provide immediate postoperative analgesia. The goal of

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INTRODUCTION:Deep vein thrombosis is formation of thrombus which often attacks deep veins, especially lower extremities. VTE itself has an incidence rate 1 per 1000 people and mortality rate around 60,000-100,000 per year. 1,2 Patients with critical illness also have risk factors, in context of ICU care. Some studies write incidence of patients experiencing DVT in general ICU care around 8% to 40% . 3 Therefore, this study aims to determine relationship between 72 hours ICU patient using mechanical ventilation and incidence of DVT. METHOD: This study is a prospective cohort analytic study to see relationship between 72 hours ICU treatment using mechanical ventilation with incidence of DVT in ICU patients at H. Adam Malik General Hospital Medan during August-September 2019. Inclusion criteria were patients aged 18-65 years and patients who using mechanical ventilation after 72 hours treatment at ICU. RESULT: Study was followed by 39 samples treated at ICU Haji Adam Malik Hospital Medan. It was found that proportion of male sample was 22 people (56.4%), most age group was 48-62 years as many as 15 people (38.5%), all samples did not experience DVT on first day care, found 10 sample (25.6%) who had DVT on the 72-hour treatment (p <0.001). Then results of analysis between a two variables have a significant relationship, (p value <0.05; CI: 95%). DISCUSSION: In this study, number of men tends to be more than women. There are no definitive theories regarding sex population associated with ICU care. The results of study of the 72-hour DVT incidence were also further strengthened by the results of analysis relationship between two variables of the DVT incidence and the ICU treatment for 72 hours. CONCLUSION: There is an association between 72 hours ICU care using mechanical ventilation with incidence of DVT in this study. (p value: 0,001, pvalue <0,005).

BACKGROUND: Shivering is an increased muscular activity that can caused by spinal anaesthesia. Dexamethasone is a steroid drug that can lower the incidence of post anaesthetic shivering by decreasing the dermal temperature and core temperature gradient. This study aimed to compare the effect of dexamethasone and pethidine in lowering the incidence of shivering in caesarean section patients under spinal anaesthesia.METHOD: This was a post-test control group clinical trial study conducted in Central Surgical Unit at RSUP H Adam Malik Medan and University of North Sumatera Hospital for 3 months. A total of 81 samples were divided into 3 groups (pethidine; dexamethasone; normal saline, NS). Randomized triple blind method was used. The variables were tested using chi square (p<0,05).RESULT: Shivering was found in all study groups (pethidine 25,9%; dexamethasone 37%; NS 59,3%). The percentages of grade 0 shivering were 74,1%, 63%, and 40,7% in pethidine, dexamethasone, and NS group respectively (p value 0,011). There was no incidence of grade 4 shivering in pethidine group.CONCLUSION: The effects of pethidine, dexamethasone, and NS in lowering the incidence of post anaesthesia shivering in caesarean section patients under spinal anaesthesia were statistically significant (p value 0,04). There was a significant difference in shivering incidence based on shivering assessment scale among all study groups (p value 0,011).