Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patient's age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by gas insufflation or laparoscopic penetration and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.

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Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Lowdose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psychomimetic like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.

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Introduction: Shivering and hypothermia after general anesthesia is a common complication in the recovery room. Heating methods and certain drugs are widely used, but may not be effective. The purpose of this study was to evaluate the effectiveness of using infusion warmer in maintaining normal core temperature and prevent shivering after general anesthesia. Material and Methods: The study was a non-blind randomized control trial study. Research conducted at the Sanglah General Hospital in October 2016. Fifty-eight people met the inclusion and exclusion criteria. They were divided into two groups of 29 patients, Group A (with infusion warmer) and Group B (without infusion warmer). Multiple parameters were recorded: vital signs, hemodynamic, Aldrette's score, body temperature, and shivering at after induction as well as at 5, 15, 30, 60 post surgery, and at recovery room. The data obtained were analyzed with SPSS software with a significance level of p <0.005, with a relative risk <1 as significantly preventive. Results: Hypothermia incidents at 5, 15, 30, and 60 minutes after arrival at recovery room (RR) were significantly different between groups (each p value <0.001). Shivering incidents at 5, 15, 30, and 60 minutes after arrival at recovery room (RR) were significantly different between groups (p value <0.018, <0.004, <0.001, and <0.001 respectively). Conclusions: The use of infusion warmer may help in reducing the incidence of hypothermia and shivering after general anesthesia.

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Background: Intravascular volume status is an important parameter in monitoring the patients treated at intensive care unit (ICU), so accuracy and strict monitoring of fluid volume is one factor that influence patient's health status. Amongst others, two ways to monitor body fluid volume status is central venous pressure (CVP) and collapsibility index of inferior vena cava (IVC) diameter. The purpose of this study is to determine the correlation between CVP with the IVC collapsibility index in patients treated in ICU Sanglah Hospital in Denpasar. Method: Seventy patients treated at Sanglah Hospital ICU with already inserted CVC for appropriate indication, were measured for CVP, then followed by examination the diameter of IVC with ultrasound to measure the maximum and minimum collapsibility index. Spearman's correlation coefficients was used to assess the correlation between CVP and collapsibility index of the IVC. Results: In 70 patients, we found a very strong negative correlation between CVP and IVC's collapsibility index (Spearman's rho = -0.854; p <0.001). Conclusion: This study found that there is a very strong negative correlation between CVP and collapsibility index of IVC. This finding indicates that the collapsibility index of the IVC may substitute CVP in determining the status of the intravascular volume.

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Epilepsy is a neurological disorder characterized by recurrent epileptic seizures. Non-convulsive status epilepticus (NCSE) is defined as a persistent change in mental status as opposed to the previous conditions, lasted at least 30 minutes long, associated with continuous spike wave epileptiform EEG changes. Clinical manifestation of NCSE can present as confusion, personality changes, psychosis, and coma. Indeed NCSE prognosis is dependent on the underlying etiology of persistent EEG changes. Preferred medication is focus on improving its fundamental pathological changes, such as metabolic disorders, infection, drugs toxicity, and immediate pharmacological treatment. Intravenous benzodiazepine is recommended as the first drug of choice for NCSE and early recognition of treatment response can help to establish the diagnosis. This patient has a good outcome which was influenced with short ictal period from the first episode upon arrival on reffered hospital, good initial response and management on emergency department, a conduct and thorough ICU monitoring, as well as the effective treatment response.

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