Jurnal Health Sains (JHS)
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Laporan Kasus: Modalitas CT Scan dalam Mendeteksi Renal Cell Carsinoma (RCC)
Get PDFRenal Cell Carsinoma (RCC) merupakan tumor terbanyak ketiga setelah tumor prostat dan tumor kandung kemih dengan insidensi sekitar 208.500 (2%) dari keseluruhan keganansan di dunia. Insidensi kanker ginjal di Indonesia mencapai 3/100.000 penduduk dengan perbandingan pria dan wanita 3,2:1. Dilaporkan pasien wanita, usia 52 tahun datang dengan keluhan keluhan mual, perut terasa kembung dan membesar sejak 2 tahun, terasa keras dan sulit untuk BAB. Dari pemeriksaan fisik abdomen teraba masa ukuran kurang lebih 15 cm, konsistensi padat, permukaan tegas, nyeri tekan minimal. Dari pemeriksaan laboratorium ditemukan penurunan hemoglobin sehingga terjadi anemia dan peningkatan fungsi hati yang mengarah pada gejala sindroma paraneuplastik. Pada pemeriksaan foto BOF dicurigai massa abdomen di cavum abdomen kiri dan pada pemeriksaan CT Scan abdomen menunjukkan massa berasal dari pole bawah ginjal kiri yang sudah menginvasi organ lain di luar fasia gerota dan kesan sudah menginfiltrasi ke adrenal gland kiri sesuai gambaran Renal Cell Carsinoma (RCC) kiri, T4 N1 Mx. CT scan dipilih karena mampu digunakan untuk mendeteksi, mendiagnosis dan menilai karakteristik dari massa yang ditemukan
Ementation Of Patient Safety Objectives With Nurse Caring Attitude As A Variable Mediation In Rs-X
Get PDFPatient safety is an important part of health services. Patient safety is determined by the implementation of patient safety goals. Implementation of patient safety goals plays an important role in the prevention and reduction of risks, errors and injuries that may occur during service. The application of optimal patient safety goals can be determined by the nurse's behavioral factors. Nurse behavior is influenced by several factors, namely individual factors, organizational factors, and psychological factors. Research Objectives: This study aims to analyze the relationship between the leadership style of the head of the room and the clinical career leveling of nurses on the application of patient safety goals with the caring attitude of nurses as a mediating variable. Research method: quantitative explanatory because to determine the relationship between variables based on the previous hypothesis that has been put forward by previous researchers. The sample in this study was a total sampling, that is, all the nurses were 80 people. The analysis technique uses path analysis. The results of the study: (1) the leadership style of the ward head significantly affects the caring attitude of nurses; (2) Clinical career leveling significantly influences nurses' caring attitude; (3) The leadership style of the ward head significantly influences the Implementation of Patient Safety Goals; (4) Clinical career leveling significantly affects the implementation of patient safety goals; (5) The caring attitude of nurses significantly affects the implementation of patient safety goals; (6) The leadership style of the ward head indirectly significantly affects the implementation of patient safety goals through the caring attitude of nurses; and (7) Nurse's clinical career leveling indirectly significantly influences the implementation of patient safety goals through nurses' caring attitude.Keselamatan pasien merupakan bagian penting dari pelayanan kesehatan. Keselamatan pasien ditentukan oleh pelaksanaan tujuan keselamatan pasien. Implementasi tujuan keselamatan pasien memegang peranan penting dalam pencegahan dan pengurangan risiko, kesalahan dan cedera yang mungkin terjadi selama pelayanan. Penerapan tujuan keselamatan pasien yang optimal dapat ditentukan oleh faktor perilaku perawat. Perilaku perawat dipengaruhi oleh beberapa faktor yaitu faktor individu, faktor organisasi, dan faktor psikologis. Tujuan Penelitian: Penelitian ini bertujuan untuk menganalisis hubungan antara gaya kepemimpinan kepala ruangan dengan jenjang karir klinis perawat pada penerapan tujuan keselamatan pasien dengan sikap caring perawat sebagai variabel mediasi. Metode penelitian: kuantitatif eksplanatori karena untuk mengetahui hubungan antar variabel berdasarkan hipotesis sebelumnya yang telah dikemukakan oleh peneliti sebelumnya. Sampel dalam penelitian ini adalah total sampling yaitu seluruh perawat berjumlah 80 orang. Teknik analisis menggunakan analisis jalur. Hasil penelitian: (1) gaya kepemimpinan kepala ruangan berpengaruh signifikan terhadap sikap caring perawat; (2) Clinical career leveling berpengaruh signifikan terhadap sikap caring perawat; (3) Gaya kepemimpinan kepala ruangan berpengaruh signifikan terhadap Implementasi Sasaran Keselamatan Pasien; (4) Clinical career leveling berpengaruh signifikan terhadap implementasi tujuan keselamatan pasien; (5) Sikap caring perawat berpengaruh signifikan terhadap pelaksanaan tujuan keselamatan pasien; (6) Gaya kepemimpinan kepala ruangan secara tidak langsung berpengaruh signifikan terhadap pelaksanaan tujuan keselamatan pasien melalui sikap caring perawat; dan (7) Jenjang karir klinis perawat secara tidak langsung berpengaruh signifikan terhadap implementasi tujuan keselamatan pasien melalui sikap caring perawat
Faktor-Faktor Penyebab Putus Sekolah KB Injeksi 3 Bulan
Get PDF3-month injection KB is a contraceptive that is given every 3 months. Each birth control injection contains the hormones progestin and medroxyprogesterone. The importance of the 3-month injection KB for the sake of creating the welfare of mothers and children. Most of the mothers in Indonesia choose the 3-month injection KB and it is one of the favorite contraceptives because it is easy to do. However, on average, many mothers from 3 months of KB injections drop out. Drop out of family planning participants nationally reached 27%. There are several factors that can cause family planning participants to drop out, these include failure, complications, changing methods, side effects, costs and accessibility, divorced acceptors or husband dies, husband does not agree, frequency of infrequent sexual intercourse, wants to get pregnant or wants to get pregnant. having children soon and menopause. Objective To examine more deeply about the knowledge of the factors that cause dropout for 3-month injections in Indonesia. The method in this study is a scoping review. Search literature in this study using 2 databases, namely Pubmed, Ebsco and 1 search engine, namely Google Scholar published in the last 5 years (2016 – 2021), free access. The total search results were 27 articles, and 10 articles were found that met the inclusion criteria, namely the 3-month injection KB dropout factor. Results: Based on the results of the review that has been explained through the article above, it shows that there are factors that can cause the incidence of dropping out of 3-month injections, including the husband's support factor, the knowledge factor, the affordability factor for health services, and the side effect factor.KB suntik 3 bulan adalah alat kontrasepsi yang diberikan setiap 3 bulan sekali. Setiap suntikan KB ini mengandung hormon progestin dan medroxyprogesterone. Pentingnya KB suntik 3 bulan demi menciptakan kesejahteraan ibu dan anak. Sebagian besar di Indonesia ibu memilih Kb suntik 3 bulan dan menjadi salah satu alat kontrasepsi favorit karna mudah di lakukan. Akan tetapi rata rata seorang ibu dari suntik kb 3 bulan banyak yang melakukan drop out. Drop out peserta KB secara nasional mencapai 27%. Adapun beberapa faktor yang dapat menyebabkan drop out peserta KB, hal ini diantaranya disebabkan oleh kegagalan, komplikasi, merubah cara, efek samping, biaya serta aksesibilitas, akseptor bercerai atau suami meninggal, suami tidak setuju, frekuensi hubungan seksual yang jarang, ingin hamil atau ingin mempunyai anak segera dan menopause. Tujuan untuk menelaah lebih dalam tentang pengetahuan faktor-faktor penyebab dropout KB suntik 3 bulan di Indonesia. Metode dalam penelitian ini adalah scoping review. Pencarian literature dalam penelitian ini menggunakan 2 database yaitu Pubmed, Ebsco dan 1 mesin pencari yaitu Google Scholar yang terbit dalam 5 tahun terakhir (2016 – 2021), free accsess. Hasil total pencarian sebanyak 27 artikel, dan ditemukan 10 artikel yang memenuhi kriteria inklusi yaitu factor dropout kb suntik 3 bulan. Hasil : Berdasarkan hasil review yang telah di jelaskan melalui artikel di atas menunjukkan bahwa terdapat faktor yang bisa menyebabkan kejadian drop out kb suntik 3 bulan antara lain yaitu Faktor dukungan suami, faktor pengetahuan, factor keterjangkauan jarak pelayanan kesehatan , dan factor efek samping.  
Analisis Sebaran Spasial Kerawanan Penyakit Demam Berdarah Dengue di Kota Medan
Get PDFDengue Hemorrhagic Fever is an endemic disease in Medan City. Climate changes transition dynamic (behavior, biological cycles, species) of disease vectors and population density leads to an increased contact between vectors and humans. This study was aimed to analyze spatially distribution of dengue fever based on climatic conditions and population density in Medan City with an ecological study approach by using secondary data. Data analysis was carried out univariately, bivariately by using the Spearman and Pearson correlation test. The results showed statistically that there was a relationship between the incidence of DHF with air temperature (r = -0.374 and p = 0.001), humidity (r = -0.370 and p = 0.001), while the incidence of DHF had no relationship with rainfall (r = 0.078 and p = 0.516) and population density (r = -0.180 and p = 0.067). From the spatially results, high-risk areas for DHF are Medan Tuntungan District, Medan Johor, Medan Denai, Medan Selayang, Medan Sunggal, Medan Helvetia, Medan DeliPenyakit Demam Berdarah Dengue adalah penyakit endemis di Kota Medan. Iklim mengubah dinamika transisi vektor penyebar penyakit dan kepadatan penduduk menyebabkan peningkatan kontak antara vektor dan manusia. Penelitian ini bertujuan menganalisis secara spasial distirbusi demam berdarah dengue berdasarkan kondisi iklim dan kepadatan penduduk di Kota Medan dengan pendekatan studi ekologi dengan menggunakan data sekunder. Analisis data dilakukan secara univariat, bivariat dengan menggunakan uji korelasi Spearman dan Pearson. Hasil penelitian menunjukkan secara statistik ada hubungan kejadian DBD dengan suhu udara (r = -0,374 dan p=0,001), kelembaban (r = -0,370 dan p= 0,001), sedangkan kejadian DBD tidak memiliki hubungan dengan curah hujan (r = 0,078 dan p= 0,516) dan kepadatan penduduk (r = -0,180 dan p=0,067). Dari hasil secara spasial daerah kerawanan tinggi DBD adalah Kecamatan Medan Tuntungan, Medan Johor, Medan Denai, Medan Selayang, Medan Sunggal, Medan Helvetia, Medan Del
Pengaruh Motivasi dan Imbalan terhadap Kepatuhan Pengisian Rekam Medis
Get PDFMinimum Service Standard (SPM), the hospital in which there is information about the standard of hospital medical record service is the completeness of filling medical records 24 hours after completion of service and completeness of informed consent after obtaining clear information has a standard of 100%. This study aims to analyze the influence of understanding about medical records, attitudes, motivations, rewards and work design to the compliance of doctors in filling medical records at Insan Permata Hospital. This study uses a quantitative approach with a research sample of 30 respondents. Data analysis testing using binary logistic regression. The results of the research obtained there is the influence (simultaneous) understanding, motivation, attitude, rewards, and design of the doctor's work to the compliance of medical record filling. Partially there is an influence of motivation and rewards to the doctor's compliance in the filling of medical records. The variable that most affects compliance is motivation and is followed by rewards. It is recommended that IP Hospitals can provide training on medical records for doctors or nursesStandar Pelayanan Minimal (SPM), rumah sakit tempat terdapat informasi mengenai standar pelayanan rekam medis rumah sakit adalah kelengkapan pengisian rekam medis 24 jam setelah selesai pelayanan dan kelengkapan persetujuan informasi setelah mendapatkan informasi yang jelas memiliki standar 100%. Penelitian ini bertujuan untuk menganalisis pengaruh pemahaman tentang rekam medis, sikap, motivasi, imbalan dan desain kerja terhadap kepatuhan dokter dalam mengisi rekam medis di RS Insan Permata. Penelitian ini menggunakan pendekatan kuantitatif dengan sampel penelitian 30 responden. Pengujian analisis data menggunakan regresi logistik biner. Hasil penelitian yang diperoleh ada pengaruh (simultan) pemahaman, motivasi, sikap, imbalan, dan desain pekerjaan dokter terhadap kepatuhan pengisian rekam medis. Secara parsial ada pengaruh motivasi dan imbalan terhadap kepatuhan dokter dalam pengisian rekam medis. Variabel yang paling mempengaruhi kepatuhan adalah motivasi dan diikuti oleh imbalan. Sebaiknya pihak RS IP dapat memberikan pelatihan tentang rekam medis untuk dokter atau perawa
Burnout dan Produktivitas Kerja Tenaga Keperawatan pada Masa Pandemi Covid-19 di RS Medika BSD
Get PDFThe purpose of this study was to analyze the effect of workload and social support on the work productivity of nurses during the COVID-19 pandemic, with burnout as an intervening variable at Medika BSD Hospital. This study uses quantitative methods, ex-post facto design, surveys and path analysis. The population is all nurses with a sample of 100 people. The test results show, Workload (p = 0.108); and social support (p=0.199) on productivity, both p value > alpha 0.5. While burnout on: productivity (p=0.000), workload (p=0.001); and social support (p=0.000), meaning that all three have p value 0.05. The indirect effect mediated by burnout shows the value of t count > t table (Sobel test). This study shows that burnout has a direct effect on work productivity, and there is a positive and significant influence on workload and social support on work productivity through burnout as an intervening variable. The managerial implications resulting from this research are in the form of a workload management system, rolling staff to reduce boredom, a queuing system that can reduce the density of the frequency of work arrivals, a nurse levelink system according to their competence. For social support, it is carried out through a teamwork system, increasing effective communication between staff, developing a system for developing human resources through training and capacity building to improve abilities, motivation and self-development, as well as an appreciation system for improving nurse performance. To avoid burnout conditions, mental health programs can be carried out for employees, ranging from mental examinations, self help content to counseling carried out by professionals. All of these things are solely to maintain the productivity of nurses' workTujuan penelitian ini, untuk menganalisis pengaruh beban kerja dan dukungan sosial terhadap produktivitas kerja perawat pada masa Pandemi COVID -19, dengan burnout sebagai variable intervening di RS Medika BSD. Penelitian ini menggunakan metode kuantitatif, desain ex-post facto, dengan survei serta path analysis. Populasinya adalah seluruh perawat dengan sample berjumlah 100 orang. Hasil pengujian menunjukan, Beban Kerja (p=0,108); dan dukungan sosial (p=0,199) terhadap produktivitas, keduanya p value > alpha 0,5. Sedangkan burnout terhadap: produktivitas (p=0,000), beban kerja (p=0,001); dan dukungan sosial (p=0,000), artinya ketiganya memiliki p value ≤ 0,05. Pengaruh tidak langsung yang dimediasi oleh burnout menunjukkan nilai t hitung > t tabel (uji Sobel). Penelitian ini menunjukan bahwa burnout berpengaruh langsung terhadap produktivitas kerja, serta terdapat pengaruh positif dan signifikan beban kerja dan dukungan sosial terhadap produktivitas kerja melalui burnout sebagai variable intervening. Implikasi manajerial yang dihasilkan dari penelitian ini berupa sistem pengaturan beban kerja, rolling staff untuk mengurangi kejenuhan, sistem antrian yang dapat mengurangi kepadatan frekwensi datangnya pekerjaan, sistem levelink perawat sesuai kompetensinya. Untuk dukungan sosial dilakukan melalui sistem kerja secara teamwork, peningkatan komunikasi efektif antar staf, sistem pengembangan Sumber Daya Manusia melalui pelatihan dan Capacity Building untuk meningkatkan kemampuan, motivasi dan pengembangan diri, diterapkan pula sistem apresisasi terhadap peningkatan kinerja perawat. Untuk menghindari kondisi burnout dapat dilakukan Program Kesehatan Mental pegawai, mulai dari pemeriksaan mental, self help content sampai konseling yang dilakukan oleh tenaga profesional. Semua hal tersebut semata-mata untuk tetap dapat mempertahankan produktifitas kerja perawat
Pengetahuan Sikap dan Perilaku Anak Remaja Usia 15-18 Tahun terhadap Penggunaan Sunscreen di SMK Kesehatan Yannas Husada Bangkalan
Get PDFUV rays can have a negative impact on human skin if exposed for too long (BPOM, 2009). The lack of knowledge and the low level of use of sunscreen in adolescents so that better and more optimal education is needed. Therefore, to get an overview of this, research is needed on Knowledge of Attitudes and Behaviors of Adolescents Aged 15-18 Years Against the Use of Sunscreen at the Yannas Husada Health Vocational School in the Bangkalan area. Data was collected by distributing questionnaires to 63 respondents. The data obtained were then performed with univariate analysis using IBM SPSS software and chi square test. The results of the univariate analysis showed that as many as (4.8%) of respondents had a good level of knowledge, (47.6%) had a fairly good knowledge and (47.6%) had a poor knowledge of the use of sunscreen. Then as many as (3.17%) respondents have a good attitude, (50.79%) have a fairly good attitude and (46.03%) have a bad attitude towards the use of sunscreen. Then (0%) respondents have good behavior, (30.2%) have quite good behavior and (69.8%) have bad behavior towards the use of sunscreen. The chi square test shows that all variables have a value of more than 0.05 so there is no relationship between them. Teenagers or students of Yannas Husada Health Vocational School have a fairly good level of knowledge, attitude and behavior towards the use of sunscreenSinar UV dapat memberikan dampak buruk bagi kulit manusia apabila terpapar terlalu lama (BPOM, 2009). Minimnya pengetahuan dan rendahnya tingkat penggunaan sunscreen pada remaja sehingga dibutuhkan edukasi yang lebih baik dan lebih maksimal. Oleh karena itu, untuk mendapatkan gambaran mengenai hal tersebut dibutuhkan penelitian tentang Pengetahuan Sikap Dan Perilaku Anak Remaja Usia 15-18 Tahun Terhadap Penggunaan Sunscreen Di SMK Kesehatan Yannas Husada di daerah Bangkalan. Pengumpulan data dilakukan dengan menyebarkan kuesioner kepada responden sejumlah 63 orang. Data yang diperoleh kemudian dilakukan analisis univariat menggunakan perangkat lunak IBM SPSS dan uji chi square. Hasil analisis univariat menunjukkan sebanyak (4,8%) responden memiliki tingkat pengetahuan yang baik, (47,6%) memiliki pengetahuan yang cukup baik dan (47,6%) memiliki pengetahuan yang kurang baik terhadap penggunaan sunscreen. Kemudian sebanyak (3,17%) responden memiliki sikap yang baik, (50,79%) memiliki sikap yang cukup baik dan (46,03%) memiliki sikap yang kurang baik terhadap penggunaan sunscreen. Lalu (0%) responden memiliki perilaku yang baik, (30,2%) memiliki perilaku yang cukup baik dan (69,8%) memiliki perilaku yang kurang baik terhadap penggunaan sunscreen. Uji chi square menunjukkan seluruh variabel memiliki nilai lebih dari 0,05 sehingga tidak ada hubungan diantara hal tersebut. Anak remaja atau siswa-siswi SMK Kesehatan Yannas Husada memiliki tingkat pengetahuan, sikap dan perilaku yang cukup baik terhadap penggunaan sunscree
Comparative Study Kinerja dengan Balanced Scorecard Puskesmas Terakreditasi & Terimplementasi ISO 9001: 2008 di Puskesmas Cilandak Timur & Pejaten Barat III
Get PDFThis research was to conduct a comparative study of working performance with balanced scorecard in accredited and ISO certified health center. Used descriptive mix method with cross-sectional approach by purposive sampling method. The financial perspective of the two health centers have the same regulation, namely that finance is directly managed by sub-district (higher) health center. The mix income was obtained from general income and national health insurance capitation. The claims directly goes into the account of the sub-district health center, while general income is at general insert fee of Rp.2000. The perspective of health center customers related to accredited health center is 80% satisfied, 100% retention, ISO certified health center is 80% satisfied, 60% retention. Internal business perspective of accredited health center: children's playground and planning of special calling list for blind patients, ASI corner, ISO certified health centers have stimulation of toddler development and TB cadres. The perspective of learning growth in ISO certified health center is better than accredited health center. Suggested for health center to improve the working performance by proposing additional staff. For academics, it is hoped to add more literature related to health policy in Indonesia. For the next researcher, adding unexisted factorsPenelitian ini melakukan Comparative Study Kinerja dengan Balanced Scorecard di puskesmas terakreditasi dan terimplementasi ISO. Menggunakan metode mix method deskriptif dengan pendekatan cross sectional dengan teknik purposive sampling. Perspektif keuangan kedua puskesmas kelurahan memiliki regulasi yang sama yaitu keuangan langsung dikelola oleh puskesmas kecamatan. Bauran pendapatan didapatkan dari pendapatan umum dan kapitasi jaminan kesehatan nasional (JKN), klaim langsung masuk kedalam rekening puskesmas kecamatan, sedangkan pendapatan umum di tarif Rp.2000. Perspektif pelanggan puskesmas terkareditasi 80% puas, 100% retensi, puskesmas terimplementasi ISO 80% puas, 60% retensi. Perspektif bisnis internal puskesmas terakreditasi : tempat bermain anak dan perencanaan daftar panggil khusus untuk pasien tuna runggu, pojok ASI, puskesmas terimplementasi ISO memiliki stimulasi perkembangan balita dan kader TB. Perspektif pertumbuhan pembelajaran puskesmas terimplementasi ISO lebih baik dibandingkan puskesmas terakreditasi. Bagi Puskesmas, diharapkan untuk meningkatkan kinerja dengan mengajukan penambahan tenaga. Bagi Akademisi, diharapkan agar bisa menambahkan literature terkait kebijakan kesehatan di Indonesia. Bagi peneliti selanjutnya, pada penelitian selanjutnya dapat menambahkan faktor-faktor yang belum ad
New Bioinsecticides From Combination Extract of Leaf and Flower of Breadfruit (Artocarpus Altilis) On Mortality of Aedes Aegypti Larvae
Get PDFThe main vector for the spread of dengue fever is the female mosquito Aedes aegypti. In Indonesia, chemical larvicides are commonly used to control Aedes aegypti larvae. Bioinsecticides made from plants are one option for environmentally friendly larvae control. Leaves and flower of breadfruit Artocarpus altilis contains toxic compound that can function as larvicides. This experimental study used combination of leaf and flower of breadfruit expect that the combination of the two extracs was synergistic and it was more effective in killing Aedes aegypti larvae. The third instar Aedes aegypti larvae was used and divided into control group and test group with concentrations 1000, 2750, 4500, and 6250 ppm and replicated in 3 times with observations every 6, 9, and 24 hours. To identify the significant difference, the mortality data was analyzed using ANOVA and Duncan's test. In probit analysis, LC50 value of breadfruit leaf extract was 1871 ppm with LT50 was 4.2 hours. LC50 value of breadfruit flower extract was 2531 ppm with LT50 was 10.8 hours. LC50 value of the combination of breadfruit leaf and flower extract was 903 ppm with LT50 was 3.7 hours. Based on these studies, it may be indicated that breadfruit leaves and flowers was more effective in killing Aedes aegypti larvae than single extractsThe main vector for the spread of dengue fever is the female mosquito Aedes aegypti. In Indonesia, chemical larvicides are commonly used to control Aedes aegypti larvae. Bioinsecticides made from plants are one option for environmentally friendly larvae control. Leaves and flower of breadfruit Artocarpus altilis contains toxic compound that can function as larvicides. This experimental study used combination of leaf and flower of breadfruit expect that the combination of the two extracs was synergistic and it was more effective in killing Aedes aegypti larvae. The third instar Aedes aegypti larvae was used and divided into control group and test group with concentrations 1000, 2750, 4500, and 6250 ppm and replicated in 3 times with observations every 6, 9, and 24 hours. To identify the significant difference, the mortality data was analyzed using ANOVA and Duncan's test. In probit analysis, LC50 value of breadfruit leaf extract was 1871 ppm with LT50 was 4.2 hours. LC50 value of breadfruit flower extract was 2531 ppm with LT50 was 10.8 hours. LC50 value of the combination of breadfruit leaf and flower extract was 903 ppm with LT50 was 3.7 hours. Based on these studies, it may be indicated that breadfruit leaves and flowers was more effective in killing Aedes aegypti larvae than single extract
Spinal Anesthesia Failure In Patients With Total Abdominal Hysterectomy With Anemia and Its Management: Case Report
Get PDFA 46-year-old woman with a diagnosis of uterine myoma and anemia who will undergo an elective total abdominal hysterectomy by an obstetrician and gynecologist. The patient has received PRC transfusion, fasted for 8 hours and is hemodynamically stable. Preoperative vital signs showed blood pressure: 130/80 mmHg, pulse: 64 times/minute, respiration: 20 times/minute, and 97% oxygen saturation without supplemental oxygen. Spinal anesthesia technique was performed with the patient lateral decubitus position at L3-4, CSF (+), blood (-), Bupivacaine 0.5% hyperbaric 15 mg and then the patient was positioned back in the supine position. A pin prick test was performed to find that there were no sensory and motor blocks, spinal anesthesia was performed again in a sitting position, at L3-4, CSF (+), blood (-), Bupivacaine 0.5% hyperbaric 15 mg and returned to position. supine. Evaluated by pin prick test and still no sensory and motor block. The block failed and was converted to general anesthesia with ETT. The duration of the operation is 2 hours, during observation in the recovery room the patient can be treated in the room.A 46-year-old woman with a diagnosis of uterine myoma and anemia who will undergo an elective total abdominal hysterectomy by an obstetrician and gynecologist. The patient has received PRC transfusion, fasted for 8 hours and is hemodynamically stable. Preoperative vital signs showed blood pressure: 130/80 mmHg, pulse: 64 times/minute, respiration: 20 times/minute, and 97% oxygen saturation without supplemental oxygen. Spinal anesthesia technique was performed with the patient lateral decubitus position at L3-4, CSF (+), blood (-), Bupivacaine 0.5% hyperbaric 15 mg and then the patient was positioned back in the supine position. A pin prick test was performed to find that there were no sensory and motor blocks, spinal anesthesia was performed again in a sitting position, at L3-4, CSF (+), blood (-), Bupivacaine 0.5% hyperbaric 15 mg and returned to position. supine. Evaluated by pin prick test and still no sensory and motor block. The block failed and was converted to general anesthesia with ETT. The duration of the operation is 2 hours, during observation in the recovery room the patient can be treated in the room