anestesi epidural dan umum pada laparatomy

7/24/2019 Anestesi Epidural Dan Umum Pada Laparatomy

1/44

LAPKAS

Kombinasi Anestesi

Umum dan Epidural padaPasien LaparotomyOLEH : AINA ULLAFA

STASE ANESTESIA RSIJ CEMPAKA PUTIH

FAKULTAS KEDOTERAN DAN KESEHATAN UMJ

2015


2/44

IDENTITAS PASIEN

Nama : Tn. B

Umur : 2 !a"unP#$#r%aan : n'(unanRuan) : '"a*a

'"a*a


3/44

AUTOANAMNESIS

K#+u"an u!ama :n,#r( ru!


4/44

RIWAYAT PENYAKIT SEKARAN

Pa'(#n -a!an) $# RSIJ #m&a$a &u!("ru%u$an -ar( RS PMI -#n)an $#+u"ann,#r( ru! -an 'u+(! BAB '#%a$ / "ar(

,an) +a+u ru! $#mun) !#!a&( ma'("('a $#n!u!. Pa'(#n %u)a m#n)#+u"

'#'a$ $a-an)$a-an) -an $a$(m#m#n)$a$ !a&( 'u-a" #r$uran).


5/44

RIWAYAT PENYAKIT !ULU

R(3a,a! 4ra'( '##+umn,a 674ra'( u'u' un!u !a"un 1889

P#m#$uan -ara" !(-a$ n4rma+ 7

S#'a$ na&a' 7

H(r!#n'( 7

DM 7 A'ma 7


6/44

R(3a,a! n,a$(! m#$uan -ara" !(-a$n4rma+ a'ma "(r!#n'( DM -a+am$#+uar)a -('an)$a+.

RPK

A+#r)( 4a! -#u ma$anan -('an)$a+.R(3. A+#r)(

M(num 4a! an!(&+a!#+#! 7 !(-a$ a-am(num 4a! ru!(n.

R(3.P#n)4a!an

M#r4$4$ 67 'u-a" #r"#n!( ;0 !a"un,an) +a+u M(num a+4"4+ 7 Ru!(n m(num$4&( !#" '4-a -('an)$a+ O+a"ra)a ru!(n7


7/44

PEMERIKSAAN "ISIK

KU : !am&a$ 'a$(! '#-an)

K#'a-aran : 4m&4'm#n!('TT= : TD : 1;0>90 mmH)

na-( : 90 ?>m#n(!na&a' : 20 ?>m#n(!'u"u : ;54C

BB : 0 K)ASA : / CHF -an CAD7


8/44

STATUS ENERALIS

K#&a+a : N4rm4#&"a+

Ku+(! : S(an4'(' 7

Ma!a : K4n%un)!(@a an#m(' 6>6 '$+#ra ($!#r($ >

T#+(n)a : D('"ar)# 7 H(-un) : D('"ar)# 7 na*a' u&(n) 7

Mu+u! :


9/44

T"4ra$'

In'$'( : S(m#!r(' IC !(-a$ !am&a$

Pa+&a'( : S!#m *r#m(!u' $anan $(r(

P#r$u'( : S4n4r '#+uru" +a&an) &aru

Au'$u+!a'( : Suara -a'ar @#'($u+#r 'uara!ama"an 7BJ IIImurn( murmur 7

)a++4& 7


10/44

A-4m#n

In'$'( : #mun) +#mu!

Au'$u+!a'(: B('(n) u'u' 67 n4rma+

P#r$u'( : S"(*!(n) -u++n#'' 67

Pa+&a'( : ma''a 67 $anan a3a"


11/44

E$'!r#m(!a' A!a' : a$ra+ "an)a! 6>6'(an4'('

> ($!#r($ > RCT 2 -#!($

E$'!r#m(!a' Ba3a" : a$ra+ "an)a! 6>6'(an4'(' > ($!#r($ >

RCT 2 -#!($ u-#m >


12/44

Ha'(+ La4ra!4r(umPemeri#saan $asil Satuan Nilai ru%u#an

H#ma!4+4)(

H#m4)+4(n 9.0 )r>-L 1;.21.;

Jum+a" +#u$4'(! 11.8/ r(u>+ ;.010.0

Jum+a" !r4m4'(! /5 r(u>+ 150//0

H#ma!4$r(! 2/ /052

Er(!r4'(! 2.; r(u>+ /./5.8

LED 55 Mm 0 10

MC=>=ER 99 F+ 90100

MC=>HER 28 P) 2;/MCHC>KHER ;/ )>D+ ;2;

Faa+ "#m4'!a'('

PT 8.; 117 D#!($ 8.; 11./

APTT ;.8 ;/7 D#!($ ;1.0 /.0


13/44

Ha'(+ La4ra!4r(um

Kimia #lini#

D+ 0 200

Pr4!#(n !4!a+ .2 )>D+ 9

A+um(n 2.8 )>D+ / 5.2

Ur#um -ara" 0 m)>D+ 10 50

Kr#a!(n(n -ara" 1.1 m)>D+ 1./

E+#$!r4+(!

Na!r(um -ara" 1/0 mE>L 1;5 1/

Ka+(um -ara" /.2 mE>L ;.5 5

K+4r(-a -ara" 100 mE>L 8/ 111Imun4'#r4+4)(

P#nan-a !um4r

CEA 0.1 n)>M+ 0.0 ;.0

H'A)


14/44

Ha'(+ La4ra!4r(um

Kimia #lini#

D+ 0 200

Pr4!#(n !4!a+ .2 )>D+ 9

A+um(n 2.8 )>D+ / 5.2

Ur#um -ara" 0 m)>D+ 10 50

Kr#a!(n(n -ara" 1.1 m)>D+ 1./E+#$!r4+(!

Na!r(um -ara" 1/0 mE>L 1;5 1/

Ka+(um -ara" /.2 mE>L ;.5 5

K+4r(-a -ara" 100 mE>L 8/ 111Imun4'#r4+4)(

P#nan-a !um4r

CEA 0.1 n)>M+ 0.0 ;.0

H'A)


15/44

K#'an:

Ma''a &a-a! &a-a 4m&a!#m#n!(n!ram#'44+(a $anan $#mun)$(nanr(a&n-(#a+ ma''

Ma'a &a-a! &a-a -(n-(n) ur@a!ur#ma%4r )a'!#r $#mun)$(nan

+#(4m,4ma )a'!#r

Su'$ &r4'!a! "(r!r4

A'(!#'

Ha'(+ CT 'an a-4m#n


16/44

K#'an:

Ma''a (n!raa-4m#n $anan a3a"-#n)an )amaran (+#u' 4'!ru$!(*&a-a a-4m#n $(r( a3a"

Pr4'!a! "(r!r4

A'(!#' m(n(ma+

Or)an +a(n !a$ !am&a$ $#+a(nan

Ha'(+ US< a-4m#n


17/44

F(na+ 4n+u'(4n:

LA -(+a!a'(

L=H $4n'#n!r($ N4rm4$(n#!($

MR '#@#r#

TR m(+- L= -(a'!4+( -,'*un!(4n

L=EDP !(n))(

Ha'(+ ECHO


18/44

4'!ru$'( u'u'm#$an($ #. !um4r

$4+4n $anan 'u'$ma+()na

D(a)n4'(

' &ra#-a"

!um4r a>r 4m#n!um 6

r*4ra'( !um4r 6r-ara"an(n!raa-4m#n

D(a)n4'(' &a'a#-a"

D(a)n4'('


19/44

&ATATAN ANESTESIA


20/44

PERSIAPAN OPERASI

Pua'a 9 %am

P#ma'an)an (n*u' r(n)#r +a$!a!

Pa'(#n -(a3a $# ruan) 4ra'( Pa'(#n -(&4'('($an !#r+#n!an) -( m#%a

4ra'(

S##+um -(+a$u$an (n-u$'( &a'(#n-(&a'an) #+#$!r4-a man'#! TD -ann)u$ur S&O2.


21/44

Anestesi

Pr#m#-($a'( :

F#n!an,+ 005 m)

M(-a4+am 1 m)

D(+a$u$an '#ara#&(-ura+ 6 umum

an#'!"#'(a

In-u$'(:

Pr4&4*4+ ;0 m)

A!raur(um ;0 m)

F#n!an,+ 02 m)

E&(-ura+:

Mara(n 025

In"a+a'(:S#@4uran

U-ara : O2 1 : 1

M#-($a'( '#+amaan#'!#'(:

E*#-r(n 10 m) ;$a+(

A!raur(um 10 m)

; $a+(On-an#n!r4n /

m)

Lama an#'!#'(: ;%am 20 m#n(!


22/44

TERAPI &AIRAN

BB: 0 $)

K#u!u"an a(ran :

Ma(n!#nan# : /0 6 20 6/0 100 >%am

D#'(! &ua'a : 9 %am ?100 900

S!r#'' 4ra'( #'ar7 :9 ? 0 $) /90 >%am

J#n(' an#'!#'( : B#'ar

R#'($4 an#'!#'( : B#ra! P#r-ara"an : ;500

T4!a+ $#u!u"an a(ran -ura'(4ra'( ; %am 20 m#n(!7 ;120

Jam 1 : 100 6 /00 6 /90 890

Jam 2 ; : 100 6 200 6 /90 90

Jam / : 100 6 /90 590

Ca(ran ,an) -(#r($an : RL 500

RA 500

PC ;91

NaC+ 100


23/44

PERSIAPAN OPERASI

I=FD $a#n ;B 1500 >2/ %am

Ana+)#'($ #&(-ura+>12 %am7 mara(n0125 25 6 m4rn 2 m) 2 6NaC+ 55

An!(#m#!($ 4n-an#n!r4n ; ? / m)


24/44

PEMANTAUAN di RR

M4n(!4r(n) !an-a @(!a+>15 m#n(!'am&a( '!a(+ &(n-a" HCU

B#r( O2;L>m#n(! na'a+ $anu+

B(+a a+-r#!!# '$4r 9 4+#" &(n-a"ruan)an


25/44

N(+a( &u+(" -ar( an#'!#'(

Nilai ' ( )

K#'a-aran Sa-ar 4r(#n!a'(a($

Da&a!-(an)un$an

Ta$ -a&a!-(an)un$an

arna M#ra" mu-a

!an&a O 'a!82

Pua! $#"(!aman

r+u O a)ar 'a! 80

S(an4'(' -#n)an

'a! O 80

A$!(@(!a' / #$'!r#m(!a'-a&a! #r)#ra$

2 #$'!r#m(!a'-a&a! #r)#ra$

T(-a$ a-a#$'!r#m(!a' ,an)#r)#ra$

R#'&(ra'( Da&a! na&a'-a+amBa!u$

Na&a' -an)$a+S#'a$ na&a'

A&nu a!au4'!ru$'(

Kar-(4@a'$u+#r T#$anan -ara"#rua" 20

B#rua" 20;0 B#rua" 50


26/44

N(+a( A+-r#!!# S4r#

K#'a-aran 2

arna2

A$!(@(!a' 2 R#'&(ra'( 2

Kar-(4@a'$u+ar 2


27/44

TINJAUAN PUSTAKA


28/44

Anestesi Umum

An#'!#'( Umum a-a+a" !(n-a$an m#n(a-a$anra'a n,#r(>'a$(! '#ara '#n!ra+ -('#r!a( "(+an)n,a$#'a-aran -an -a&a! &u+(" $#ma+( r#@#r'(#+7.K4m&4n#n an#'!#'( ,an) (-#a+ !#r-(r( : "(&n4!($

ana+)#'(a r#+a$'a'( 4!4!.

Ana'!#'(umum

An#'!#!($

(n"a+a'(An#'!#!($(n!ra@#n

a

#!#r In-u$'( -an &u+(" -ar(


29/44


30/44

n nKardio+as#ularTe#anan dara, TB

La%u nadi TB TB a!au TB

Ta,anan +as-ular TB TB

&ura, %antun. TB

TB TB a!au

Respirasi/olum tidal

La%u napas

Pa&O' Istira,at TB

1&,allen.e2

Serebral

Aliran dara,

Te#anan Intra#ranial

La%u metabolism

1Sei3ure2

4lo#adePelumpu, otot non

depolarisasi

in%alAliran dara,

La%u 5ltrasi

.lomerulus

Output urin

$epar

Aliran dara, Metabolisme 0.00/ 1520 25 0.2 0.1 2;


31/44

Anestesi Re.ional

An#'!#'( r#)(4na+ a-a+a" "ama!an (m&u+' n,#r( 'ua!ua)(an !uu" '#m#n!ara &a-a (m&u+' 'ara* '#n'4r($

'#"(n))a (m&u+' n,#r( -ar( 'a!u a)(an !uu" -(+4$(r un!u$'#m#n!ara r#@#r'(#+7. Fun)'( m4!4r($ -a&a! !#rn)aru"

'#a)(an a!au '#+uru"n,a. T#!a&( &a'(#n !#!a& 'a-ar

Ana'!#'(r#)(4na+

B+4$

'#n!ra+

B+4$

r(*#r


32/44

Anestesi Epidural

An#'!#'(a a!au ana+)#'(a #&(-ura+ (a+a" +4$a-# 'ara*-#n)an m#n#m&a!$an 4a! -( ruan) #&(-ura+ r(-ura+

#$'!ra-ura+7. Ruan) (n( #ra-a -( an!ara +()am#n!uma@um -an -uram#!#r. Ba)(an a!a' #ra!a'an -#n)an

*4ram#n ma)num -(-a'ar !#n)$4ra$ -an -( a3a"-#n)an '#+a&u! 'a$r4$4$'()#a+. K#-a+aman ruan) (n(ra!ara!a 5 mm -an -( a)(an &4'!#r(4r $#-a+aman

ma$'(ma+ &a-a -a#ra" +uma+


33/44

Indi#asi Anestesi Epidural

P#m#-a"an -an nan))u+an)an n,#r( &a'a#-a"

Ta!a+a$'ana n,#r( 'aa! r'a+(nan

P#nurunan !#$anan -ara" 'aa! m#-a"an'u&a,a !(-a$ an,a$ r-ara"an

Tama"an &a-a an#'!"#'(a umum r(n)an$ar#na n,a$(! !#r!#n!u &a'(#n.


34/44

Prosedur intra6abdominal

&r4'#-ur m#-a"an umum mun)$(n'#'ua( -#n)an +4$ n#ura?(a+ '#n!ra+ '#a)a(an#'!#'( &r(m#r !#rma'u$ ra($an "#rn(a

(n)u(na+ a&n-#!4m, r#'#$'( 4+4n +43an!#r(4r -an 4+#!4m, '()m4(-.

K4m(na'( n#ura?(a+ -an an#'!#'( umummun)$(n '#'ua( un!u$ &r4'#-ur (n!ra

a-4m(na+ +a(n !#rma'u$ ra-(a+)a'!r#!4m, @#r!(a+ an-#- )a'!r4&+a'!,m#-a"an a-4m#n a!a' m#-a"an

#'4&"a)#a+ -an m#-a"an "#&a!(.


35/44

E&(-ura+

An#'!#'(a

Ana+)#'(a

K#un!un)an an#'!#'(

n#ura?(a+ !#rma'u$m#nurun$an r#'&4n'!r#'' &'($4+4)(

m#nurun$an &a'(#nm#n-a&a!$an @4+a!(+#

(n"a+a'( m#nurun$ann))unaan mu'+#

r#+a?an -anm#nurun$an

$#u!u"an 4&(4(-

K#un!un)an ana+)#'(a#&(-ura+ -(an-(n)$an

-#n)an ana+)#'(a 4&(4(-'('!#m($ !#rma'u$m#nurun$an -ura'(&4'!4ra'( (+#u'

m#nurun$an (n'(-#n'(mua+ mun!a" -an

$4m&+($a'( &u+m4nar,&4'!4ra'( m#n(n)$a!$an$4n!r4+ n,#r( &4'!4ra'(

-an m#n(n)$a!$an $ua+(!a'


36/44

Prosedur intra6abdominal

K4m(na'( n#ura?(a+ -an an#'!#'(umum !#r$a(! -#n)an n,#r( ,an)

#r$uran) '#-a'( ,an) #r$uran) -an

n(n)$a!an *un)'( &'($4m4!4r '#)#ra'#!#+a" r(4-# &4'!4ra'(. Ana+)#'(a

#&(-ura+ un!u$ m#-a"an 4+4n

mun)$(n a$an m#mra&a!m#+an%u!$an $#)(a!an '#"ar("ar( -anm#n(n)$a!$an $ua+(!a' "(-u& '#!#+a"

-(ra3a! -( ruma" 'a$(!.


37/44

!urasi ileus

M#$an('m# &4'!4ra'( (+#u' !#rma'u$nan)anan -ar( u'u' $#!(-a$'#(man)an#+#$!r4+(! -an m#r(an 4&(4(-. Ana+)#'(a#&(-ura+ -#n)an an#'!#!($ +4a+ mun)$(n

m#na($$an a$!(@(!a' u'u' '#ara +an)'un) +4$'(m&a!(' !"4ra4+uma+ -#n)an +4$(n) n#r@u'n4(#&!(@# a#r#n! m#man!u a$!(@a'( '('!#m

n#r@u' '(m&a!(' -an '#ara !(-a$ +an)'un)

$4n!r4+ n,#r( -an m#mun)$(n$an un!u$m#mr#&a! m4(+('a'(. B+4$ #&(-ura+ !"4ra$a+

+#(" #*#$!(* -ar(&a-a +4$ +uma+ -a+amm#n)uran)( -ura'( (+#u'.


38/44

Anal.esia postoperasi

O&(4(- #&(-ura+ #$#r%a '(n#r)(' -#n)anana'!#'( +4a+. M#mr!(man)$an '('!#m($ -ar(

nam&uran '!u-, &r4'#-ur m#-a"anm#n-u$un) n-a&a! a"3a ana+)#'(a #&(-ura+

-#n)an an#'!#'( +4a+ ,an) -($4m(na'($an-#n)an m#m#r($an 4&(4(-' +#(" a($ -ar(&a-am#n#r(ma m#-($a'( 'a+a" 'a!u ana+)#'(a 'a%a.

P#nama"an 4&(4(-' $# ana'!#'( +4a+m#mun)$(n$an un!u$ m#n)uran)( -4'('

an#'!#'( +4a+ -#n)an -#m($(an m#m(n(ma+('a'((n'(-#n'( "(&4!#n'( -an +4$ m4!4r(.


39/44

Pr#m#-($a'(M(-a4+amOa! (n-u$'( %an)$a

n-#$ a!au&r#m#-($a'(

m#+("araan an#'!#'(#$#r%a #&a! -an $ar#na

!ran'*4rma'(m#!a4+($n,a #&a! -an+ama $#r%an,a '(n)$a!

#$#r%a $ua!m#n(mu+$an '#-a'( -an

(n-u$'( !(-ur.

F#n!an(+

Ana+)#'( 4&(4(-F#n!an(+ (a+a" a! '(n!#!($'#r!( !(-(n -#n)an$#$ua!an 100?m4rn.

L#(" +aru! -a+am +#ma$

-(an-(n)$an !(-(n -anm#n#mu' 'a3ar

%ar(n)an -#n)an mu-a".


40/44

In-u$'(Pr4&4*4+

Oa! (n-u$'( '#-a'('a-ar. On'#!

#&a!+ama $#r%an-#$. E*#$ &una$1 m#n(! +ama a$'( 510 m#n(!. A$umu+a'(

m(n(ma+ #&a!-(m#!a4+('m#mu+("an #&a!.

A!raur(um

P#+um&u" 4!4!n4n-#&4+ar('a'(

(n"((!4r $4m!(!(*!a$($urar#7 #r($a!an

-#n)an r#'#&!4rn($4!(n($$4+(n#r)($

!#!a&( !a$m#n,#a$an

-#&4+ar('a'( "an,am#n)"a+an)( a'#!(+$4+(n m#n#m&a!(n,a'#"(n))a a'#!(+$4+(n!a$ -a&a! #$#r%a

F#n!an,+


41/44

E&(-ura+Mara(nK4n'#n!ra'( #*#$!(* m(n(ma+ 0.125.

Mu+a $#r%a +#(" +ama! -(an-(n)+(-4$a(n !#!a&( +ama $#r%a 'am&a( 9

%am. S#!#+a" 'un!($an $au-a+

#&(-ura+ a!au (n+!ra'( $a-ar &+a'ma&una$ -(a&a( -a+am /5 m#n(!$#mu-(an m#nurun r+a"an+a"an

-a+am ;9 %am.


42/44

Oa!4a!an '#+ama

4ra'(E*#-r(n

E*#$ $ar-(4@a'$u+ar:!#$anan '('!4+($ m#n(n)$a!

-an (a'an,a %u)a !#$anan-(a'!4+($ '#r!a !#$anan

na-( m#m#'ar.P#n(n)$a!an !#$anan -ara"

(n( '#a)(an -('#a$an

4+#" @a'4$4n!r($'( !#!a&(!#ru!ama 4+#" '!(mu+a'(%an!un) ,an) m#n(n)$a!$an$#$ua!an $4n!ra$'( %an!un)

-an ura" %an!un).

A!raur(um

P#+um&u" 4!4!

n4n-#&4+ar('a'( (n"((!4r$4m!(!(* !a$($urar#7#r($a!an -#n)an r#'#&!4rn($4!(n($$4+(n#r)($ !#!a&(

!a$ m#n,#a$an-#&4+ar('a'( "an,a

m#n)"a+an)( a'#!(+$4+(nm#n#m&a!(n,a '#"(n))a

a'#!(+$4+(n !a$ -a&a!#$#r%a


43/44

E&(-ura+ P4'!4ra'(M4rna$!u &aru" !#rm(na+

&a-a m#r(an m4rn(n!ra!#$a+ ra!ara!a

a-a+a" 80 m#n(! 0 1/0 m#n(!7. E+(m(na'(

!4!a+ m4rn -a+ama(ran '#r#r4'&(na++uma+ #r$('ar 12

%am. P#m#r(an 4&(4(-"(-r4+($ m4rn7

r#&(-ura+ %u)am#nurun$an $#u!u"an

4&(4(- '('!#m($(n!ra4ra!(* mau&un

un!u$ &a!(#n!4n!r4++#-

Mara(n

P#n))unaan &a-a'&(na+#&(-ura+ un!u$ana+)#'( &4'!4ra'(

'an)a! a($ !an&a +4$

m4!4r($


44/44

TERIMA KASI$

anestesi epidural dan umum pada laparatomy

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