ali sa
DESCRIPTION
spinal anesthesiTRANSCRIPT
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Anestesi Spinal pada Anak
KEPANITERAAN KLINIK STASE ANESTESI
RUMAH SAKIT RSU BAKTI YUDHA
Ali Husain Abdul Kadir
Pembimbin! dr Amelia Sp An
Peri"de #$ Austus %$#& ' %( Austus %$#&
FAKULTAS KEDOKTERAN UKRIDA
(UNIVERSITAS KRISTEN KRIDA WACANA)
Jl. Terusan Arjuna No.6 Keun Jeru! " Ja!ar#a $ara#
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BAB I
PENDAHULUAN
S%&nal anes#es& #er'&r& 'ar& jaru s%&nal an* eneus ruan*an
suara!no&' 'an easu!!an se+ara lan*sun* laru#an anes#es& lo!al !e 'ala
+a&ran sereros%&nal !e#&!a al&ran eas 'ar& +a&ran sereros%&nal '&%erole,. S%&nal
anes#es& (SA) %er#aa !al& '&*una!an %a'a ana!-ana! se!&#ar #a,un /00 ole,
Bainbridge 1 #e#a%& #&'a! enja'& a*&an 'ar& ru#&n&#as %ra!#&! ,&n**a #a,un 0/21
!e#&!a anes#es& re*&onal enja'& le&, %o%uler. Keun#un*an an* '&saran!anun#u! SA %a'a ana!-ana! a'ala, en*,&n'ar& anes#es& uu %a'a ere!a an*
er&s&!o a%nea %as+a-o%eras&.
A%l&!as& %a'a S%&nal Anes#es&
SA #e#a% enja'& %o%uler un#u! a& %rea#ur1 !,ususna an* enjalan&
herniorrhaphy. 3as&en #erseu# ser&n*!al& e&l&!& r&4aa# a%nea %rea#ur1
'&s%las&a ron!o%ulonal&s 'an %ena!&# %aru-%aru !ron&s an* san*a# er&s&!o
un#u! '&la!u!an general anesthesia. Ins&'ens& a%neu %as+a-o%eras& er!orelas&
'en*an us&a !e,a&lan saa# la,&r1 us&a %as+a-!onse%s&onal '& o%eras&1 era# a'an1
ane&a 'an sejara, a%nea. Anes#es& uu en&n*!a#!an r&s&!o a%nea 'an
ra'&!ar'&1 'an an#an a& %rea#ur as&, eres&!o sa%a& se#ela, 62 &n**u
%as+a-!onse%s&.
D& luar asa neona#al1 SA #ela, '&*una!an un#u! #&n'a!an e'a, uu
( &o%s& re!#al1 &ns&s& ases re!#al)1 e'a, urolo*& ( orchidopexy1 s&r!us&s&)1 e'a,
or#o%e'& %a'a e!s#re&#as a4a, 1'an un*!&n se+ara !,usus '&*una!an '& ne*ara
er!ean* sea*a& al#erna#&5 anes#es& uu.
SA #ela, '&saran!an a*& %as&en 'en*an %en**unaan anes#es& uu
en&ul!an #an'a eres&!o1 se%er#& %a'a %as&en 'en*an 4aja, '&sor5&! 'an
!esul&#an &n#uas&1 '&s#ro5& us!ular1 r&4aa# !eluar*a 'en*an !e*anasan
,&%er#er& a#au *ejala %eru# !eun* 'en*an res&!o as%&ras&.
SA ju*a #ela, '&jelas!an %a'a %en**unaan !o&nas& anes#es& uu %a'a
ana!-ana! an* enjalan& o%eras& aor1 &salna1 %a'a #&n'a!an %reo%era#&5
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(or5&n) SA '&*aun* 'en*an anes#es& uu %a'a o%eras& s!ol&os&s 'a%a#
enurun!an !e,&lan*an 'ara, 'an le&, a&! 'ala en*en'al&!an rasa ner&. SA
#ela, '&*una!an ersaa 'en*an anes#es& uu selaa o%eras& bypass
!ar'&o%ulonal %a'a neona#us un#u! en*uran*& res%on s#res1 enja*a !ea'aan
,eo'&na&! 'an enurun!an or&'&#as 'an or#al&#as %er&-o%eras&1 4alau%un
%en**unaana jaran* '&la!u!an. SA #ela, '&*una!an %a'a anajeen ner& an*
ers&5a# !ron&!.
Kon#ra&n'&!as& SA1
Ter'a%a# eera%a !on#a&n'&!as& s%es&5&! SA %a'a ana!-ana! an*
'&*olon*!an '& a4a, &n&7
• Anoral&#as !oa*ulas&
• Se%s&s s&s#e&! a#au &n5e!s& lo!al %a'a #&#&! #usu!an.
• 8&%o9ole& an* #&'a! #era#as&
• Oran* #ua enola! a#au ana! an* #&'a! !oo%era#&5
• :an**uan neurolo*&! se%er#& s%&na &5&'a1 %en&n*!a#an #e!anan
&n#ra!ran&al
• Laana %rose'ur le&, 'ar& 02 en&#.
BAB II
TIN)AUAN PUSTAKA
Pertimbanan Anat"mis
Seua, *ar&s an* en*,uun*!an a*&an a#as !r&s#a &l&a!a eo#on*
suu #ulan* ela!an* se#&n*!a# L;-S %a'a neona#us 'an a& sa%a& us&a sa#u
#a,un 'an se#&n*!a# L<-L; %a'a ana! an* le&, #ua. Susu #ulan* ela!an*
era!,&r se!&#ar L= %a'a 4a!#u la,&r 'an se!&#ar L-L %a'a ana! 'en*an us&a '&
a#as #a,un.
Jara! an#ara !ul&# 'en*an ruan* suara!no&' '&%en*aru,& ole, us&a1 ula&
'ar& 2-; %a'a %er#aa !al& !ela,&ran. Jara! an#ara !ul&# 'en*an ruan*
suara!no&' 'a%a# '&,uun*!an 'en*an #&n**& a#au era# en**una!an 5orula7
Jara! 'ar& !ul&# !e ruan* suara!no&' (+) > 212= ? #&n**& (+)
Jara! 'ar& !ul&# !e ruan* suara!no&' (+) > ( ? era#) @ ().
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'&ers&,!an 'en*an laru#an al!o,ol se%er#& !loro,e!s&'&n (@B- &o'&ne).Kul&#
'&&ar!an en*er&n* 'an 'u! s#er&l '&le#a!!an '& a#asna 'en*an luan* un#u!
eer&!an area !erja.11<
An#ara %os&s& 'u'u! a#au 'e!u&#us la#eral #ela, '&jelas!an sea*a& %os&s&
%un!s& lual. K&#a ,arus e%una& %en*alaan 'ala ela!u!an %os&s& la#eral
un#u! ean*un!an neona#us a#au a&1 #e#a%& %er,a#&an an* +era# ,arus
'&ara,!an un#u! enja*a !ea'aan jalan na%as a!&a# %os&s& an* ea,aa!an.
3os&s& la#eral le&, u'a, 'ar&%a'a %os&s& 'u'u! a*a& %as&en an* le&, #ua an*
en'a%a#!an se'as& &n#ra9ena eru%a enGo'&aGe%&n se%er#& &'aGola sesua&
&n'&!as&.
3un!s& lual '&la!u!an %a'a L=-L< a#au L<-L;. $era*a& u!uran 'an
%anjan* jaru '&se'&a!an #er*an#un* us&a ana!. 3en**unaan jaru #an%a stylet
#&'a! '&re!oen'as&!an seja! jar&n*an e%&#el an* 'a%a# #ers&%an '& ruan*
&n#ra#e!al 'an 'a%a# enea!an #uor 'ero&' %a'a suu neural.
Al&ran eas 'ar& +a&ran sereros%&nal ,arus '&'a%a#!an !e#&!a jaru
s%&nal en+a%a& ruan* &n#ra#e!al. Ala# %enun#&! anes#es& '&ser#a!an 'an laru#an
anes#es& '&&nje!s&!an le&, 'ar& =2 en&#. Ka!& #&'a! ole, '&an*!a# se#ela, &nje!s&
s%&nal #ela, '&er&!an1 seal&!na a!an #&ul lo! an* erle&,an.
SA en*,as&l!an 'eraja# se'as& %a'a a& aru la,&r 'an a& se,&n**a
%enaa,an se'as& &n#ra9ena #&'a! '&%erlu!an. Se'as& &n#ra9ena ,arus '&,&n'ar&
j&!a a& eres&!o a%nea. Ka& eneu!an '& 'ala laru#an su!rosa ua#an a#au
a'u 'a%a# ean#u enelesa&!an asala, &n&.
3era4a#an 3as+a O%eras&
Ana!-ana! '&!eluar!an 'ar& ruan* %era4a#an %as+a anes#es& !e#&!a e5e!
anes#es& #ela, en*,&lan*1 sea*a& +on#o, !eal&na %er*era!an eas 'ar&
#un*!a& a4a,. Ana! 'a%a# '&er&!an a!an1 asal!an #&'a! #er'a%a# %ea#asan
o%eras&. Seua a& an* le&, u'a 'ar& 62 &n**u %as+a !onse%s& '&%an#au
selaa < ja '& an*sal se#ela, #&n'a!an SA
Ko%l&!as& 'ar& SA=1<
Ter'a%a# eera%a !o%l&!as& 'ar& SA an* er%o#ens& '&seu#!an '& a4a, &n&7
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• $er%o#ens& #raua a!&a# %un!s& 'an !erusa!an sara5 s%&nal. Te!n&! an*
+era# 'an %erala#an an* sesua& ser#a %e#u*as an* #erla#&, enja'& %en#&n*.
• Insu5&s&ens& res%&ras& ( 'en*an a#au #an%a !ar'&o9as!ular) !arena
%eer&an 'os&s #&n**& %a'a SA a#au %eer&an se'as& se!un'er se+ara
&n#a9ena. T&n'a!an resus&#as& ,arus '&la!u!an (A$C)- &n#uas& #ra!eal 'an
9olue resus&#as& 'a%a# '&ser#a!an.
• Kon9uls& a!&a# 'os&s an* erle&,an 'ar& anes#es& lo!al. Seua 'os&s
se,arusna '&%er,&#un*!an se+ara +era# 'an '&%er&!sa ole, %ra!#&s&
la&nna.• Ner& !e%ala %as+a %un!s& 'ural. 8al #erseu# #ela, '&la%or!an %a'a ana!
/ #a,un1#e#a%& !eja'&an %a'a ana! an* le&, u'a 'r& us&a #erseu# elu
jelas1 sul&#na en&la& %enea an* sea*&an '&sea!an !arena sa!&#
!e%ala an* #erja'& %a'a a& 'an ana!-ana!.
• Ko%l&!as& eru%a &n5e!s& se%er#& en&n*&#&s. Te!n&! ase%#&! an* %erlu
se'&!&# er,a#&-,a#& %a'a !asus se%er#& en&n*&#&s ,arus '&*una!an se#&a%
saa# 'an %eer&an ul#& 'os&s a%ul anes#es& lo!al #&'a! '&anjur!an.
Ka& enaran!an un#u! en*ulan* %un!s& lual %a'a %as&en an*
en*ala& 'ea se#ela, '&la!u!an #&n'a!an SA.
• :an**uan neurolo*&s a!&a# %eer&an &nje!s& +a&ran an* #&'a! #e%a#.
3er,a#&an #era&! '&%erlu!an se#&a% saa# 'ala %ers&a%an 'an %eer&!saan
oa#.
Kes&%ulan
Ins&'ens& an* ser&us 'ar& !o%l&!as& an* er,uun*an 'en*an #&n'a!an
SA san*a# ren'a, a,!an !e+&l %a'a a& %rea#ur. Te!n&! &n& ene'&a!an
al#erna#&5 #era&! %eer&an anes#es& uu %a'a a& aru la,&r an* eres&!o
'an a*& a& an* se'an* enjalan& o%eras& a'o&nal a#au #un*!a& a4a,
selaa 6 ulan !e,&'u%an. SA 'a%a# '&*una!an un#u! en*,&n'ar& #&n'a!an
anes#es& uu %a'a %as&en sela&n asa neona#al1 j&!a '&u#u,!an 'a%a#
'&!o&nas&!an 'en*an %eer&an se'as& se+ara &n#ra9ena. SA san*a# er,as&l
'&*una!an sea*a& #e!n&! #un**al1 #era#as %a'a o%eras& an* erlan*sun*
!uran* 'ar& 02 en&#. SA %a'a ana! eu#u,!an !ea%uan #e!n&! 'ar&
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seoran* an* #ela, er%en*alaan 'ala &'an* anes#es&. Neona#us 'an a&
eres&!o #&n**& #er,a'a% !o%l&!as& selaa o%eras&1 #erle%as 'ar& jen&s
anes#es&1 'an a'ana seoran* !l&n&s& #erla#&, 'ala &'an* %e'&a#r&! anes#es&
an* '&er&!an an'a#.
BAB III
LAP,RAN KASUS
Identitas
• Naa 7 An. C,ol&la,
• Us&a 7 < #a,un
• Jen&s Kela&n 7 3ere%uan
• Alaa# 7 Jl S#u'&o Ala TVRI RT =BRW0-=
Su!ajaa
• A*aa 7 Isla
• 3e!erjaan 7 T&'a! $e!erja
• S#a#us 3ern&!a,an 7 $a4a, uur
• Tan**al RS 7 < A*us#us 2;
• No. R 7 22;6;???
• $era# $a'an 7 <; !*
• T&n**& $a'an 7 ; +
Pre-,perasi
Anamnesa Kun.unan Pre-,perasi /#& Austus %$#&0
• A ( Alergy)7 #&'a! a'a r&4aa# aler*& #er,a'a% oa#-oa#an1 aler*& a!anan1
au%un asa.
• ( Medication)7 #&'a! se'an* enjalan& %en*oa#an a%a%un.
• 3 ( Past Medical History)7 #&'a! '&'a%a#!an r&4aa# ,&%er#ens&1 '&ae#es
ell&#us1 en*oro! saa# #&'ur1 !ejan*1 ner& 'a'a1 !e#era#asan a!#&5&#as
a!&a# sesa! 'an #&'a! a'a *an**uan %a'a a!#&5&#as se,ar&-,ar&. R&4aa#
anas#es& 'an anas#es& seeluna elu a'a. O%eras& &n& eru%a!an
%en*alaan %er#aa %as&en en*ala& %ee'a,an anes#es&. ero!o!
(-)1 !onsus& &nuan eral!o,ol (-). Kea'aan %s&!&s7 !esan #enan*.
• L ( Last Meal )7 %as&en #era!,&r a!an %u!ul .22
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• E ( Elicit History)7 %as&en en*elu, ner& %eru# '& !anan a4a, seja! ; ,ar&
SRS. 3as&en ju*a en*elu, %us&n* 'an a#u!.Pemeriksaan Penun.an Pre-,perasi
A33ENDIKO:RA
3eer&!saan %a'a #an**al < A*us#us 2;7
-Ta%a! !on#ras en*&s& sa%a& %ro!s&al !olon 'es+en'ens
- Cae+u #&'a! #a%a! !ela&nan
- Ta%a! !on#ras en*&s& Appendix se+ara %ars&al1&rre*ular
- Ta%a! a%%en'&+ol&#, (3ars&al illing appendix)
3eer&!saan Laora#or&u
3eer&!saan #an**al < A*us#us 2;
N&la& Sa#uan N&la& Ruju!an Kesan
Dara, Len*!a%
8eo*lo&n .2 *B'L .<-;. Noral
Leu!os&# 6.0 2=B= <1-1= Noral
8ea#o!r&# =/ =/ - < NoralTroos&# =2 2=B= < " << Noral
S:OT UBL =; Noral
S:3T 6 UBL <2 Noral
Ureu *B'l 2-;2 Noral
Crea#&n&n 2.; *B'l 2.;-.; Noral
8$sA: Non
rea!#&5 Noral
Plannin
• Tan**al '&la!u!an anes#es& 7 ; A*us#us 2;
• Jen&s anas#es& 7 S%&nal Anas#es&a
• Jen&s %ee'a,an 7 A%en'&!#o&
Persiapan Pre-,perasi
• Sura# %erse#ujuan o%eras& 'an anes#es&
• 3uasa ula& ja .22 (< A*us#us 2;)
• IVFD RL ;22 ++
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Durasi ,perasi
• Laa o%eras& 7 222-22
• Laa anas#es& 7 26;2-2=2
• e'&!as& 7
o Inj. &'aGola *
o Inj. Ce'an#ron *
Lan*!a, T&n'a!an Anas#es&7
3ers&a%an7
. en&a%!an eja o%eras& 'an a!sesor&sna. en&a%!an es&n 'an ala# anes#es&
=. en&a%!an !o%onen STATICS7
a. S+o%e7 s#e#os!o%1 lar&n*os!o%
. Tues7 ETT +u55e' s&Ge' 12 !&n! 5&?
+. A&r4a7 oro#ra+,eal a&r4a
'. Ta%e7 %les#er un#u! 5&!sas&
e. In#ro'u+er7 un#u! ean'u a*ar %&%a ETT u'a, '&asu!!an
5. Conne+#or7 %enaun* an#ara %&%a 'ana ala# anes#es&
*. Su+#&on7 eas#&!an #&'a! a'a !erusa!an %a'a ala# su+#&on
<. en&a%!an oa#-oa# anes#es&a an* '&%erlu!an.
;. en&a%!an oa#-oa# resus&#as&7 a'renal&n1 a#ro%&ne1 a&no5&l&n1
na#r&u &!arona#1 'an la&n-la&nna.
6. en&a%!an #&an* &n5use1 %les#er1 'an la&n-la&nna.
. easan* on&#or1 sa#uras& O1 #e!anan 'ara,1 na'&1 'an EK:
Te!n&! Anes#es&7
/. en&a%!an %as&en '& a#as eja o%eras& 'en*an %os&s& &r&n* !e !anan
'an eun*!u!.
0. enen#u!an #e%a# #usu!an 'ar& %er%o#on*an *ar&s an*
en*,uun*!an !e'ua !r&s#a &l&a!a 'en*an #ulan* %un**un*1 a&#u L<a#au L<-L;.
2. ens#er&l!an #e%a# #usu!an 'en*an sa9lon 'an easan* 'o! s#er&l.
. eer&!an &n5&l#ras& lo+al %a'a #e%a# #usu!an1 a&#u 'en*an
l&'o!a&n se+u!u%na.
. D&la!u!an %enun#&!an jaru s%&nal : '& #e%a# %enusu!an %a'a
&'an* e'&al 'en*an su'u# 2-=2 #er,a'a% &'an* ,or&Gon#al !eara,
+ran&al. Jaru lual a!an eneus l&*aen#u su%ras%&nosu1
l&*aen#u &n#ers%&nosu1 l&*aen#u 5la9u1 la%&san 'urae#er1
'an la%&san suara+,no&'. S#&le# !eu'&an '&+au#1 se,&n**a +a&ran
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sereros%&nal a!an !eluar. Oa# anas#e#&! (De+a&n 1; *) an* #ela,
'&s&a%!an '&sun#&!!an !e 'ala ruan* suara+,no&'.
=. Te%a# %enun#&!!an '&#u#u% 'en*an %les#er.
<. ene%a#!an !eal& %as&en 'ala %os&s& su%&ne 'an %as&en '&#ana
a%a!a, !e'ua #un*!a& en*ala& %aras#es& 'an sul&# un#u! '&*era!!an
'an '&#ana!an a%a a'a !elu,an ual-un#a,1 ner& !e%ala1 'an sesa!.
;. eas#&!an !on'&s& %as&en s#a&l 'en*an 9&#al s&*n 'ala a#as
noral.
• on&#or&n*
o 3erna5asan 7 O nasal +anule1 l%
o Selaa anes#es& 7 Traa'ol 22 *
Lap"ran Anestesi P"st-,perasi
Lap"ran Anestesi P"st-,perasi di Post Anesthesi Care Unit /PA1U0 /#&
Austus %$#&0
Pasien masuk pukul $2%$
Kelu3an! ual (-)1 un#a, (-)1 %us&n* (-)1 ner& (-)
Aldrete s4"re! 2 %as&en 'a%a# '&%&n'a,!an !e ruan*an.
Terapi Pas4a Beda3!
o O nasal +anul l%
o In5us RLBNS 0; ++Bja
o An#&&o#&!a7 sesua& TS e'a,
o Inj. Ran&#&'&n ?;2 *
o Inj. Ke#orola+ =?=2 *
o $&la ualBun#a,7 !e%ala '&&r&n*!an1 ,ea' 'o4n1 !B% '& su+#&on1 Inj.
On'ansen#ron < *o $&la !esa!&#an7 Inj. Traa'ol 22 *
o &nu a!an7 &la #&'a! a'a ualBun#a,
M"nit"rin!
Ce! 9&#al s&*n #&a% ; en&# selaa ja
o $&la RR 2?Ben er&!an O NR$ 2 l%
o $&la na'& ;2?Ben er&!an sul5as a#ro%&ne 2.; * &9
o J&!a #e!anan 'ara, ss#ole 028*1 er&!an RL ;22 ++ 'ala =2 en&#
(e5e'r&n ; * &9)o 3&n'a, ruan*an j&!a al're#e s+ore /
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$AK 'en*an !a#e#er1 %ro'u!s& ur&n '&#a%un* @<2 ++Bja @2.// ++B!*$$B
ja1 !un&n* jern&,. $er'asar!an ra#a-ra#a %ro'u!s& ur&n an* 'a%a# '&%er&!sa1
'&'a%a#!an a,4a jula, 'an !ejern&,an %ro'u!s& ur&n 'ala a#as noral.
• $; " $o4el
3a'a bowel 1 ,al-,al an* er!a&#an 'en*an %enul&# anes#es& #&'a! '&#eu!an.
• $6 " $oneB$o'
Dala a#as noral.
3eer&!saan 3enunjan*
Luas +a!u%an %eer&!saan %reanes#es& #ela, sesua& 'en*an !ea'aan 'an
!eu#u,an %as&en1 !on'&s& +o-or&' saa# &n&1 'an %rose'ur e'a, an*
'&ren+ana!an.
Kes&%ulan 3en&la&an 3reo%era#&5
Dar& ,as&l ananesa1 %eer&!saan 5&s&!1 'an %eer&!saan %enunjan*1
%as&en #&'a! en'er&#a %ena!&# s&s#e&!1 #an%a l&&#as& a!#&9&#as se,ar&-,ar&1
se,&n**a '&!las&5&!as&!an 'en*an ASA- - 'en*an a%en'&s&#&s a!u#.
8as&l %eer&!saan A%en'&!o*ra enunju!!an %as&en en*ala&a%en'&s&#&s a!u#.
Masukan ,ral
Un#u! e&n&al!an r&s&!o as%&ras& &s& laun* !e jalan na5as selaa
anes#es&1 seua %as&en an* '&ja'4al!an un#u! o%eras& se%er#& %as&en &n& #ela,
enjalan& %uasa selaa %er&o'e #er#en#u seelu &n'u!s& anes#es&. Laa %uasa
%a'a %as&en &n& #ela, sesua& 'en*an #asting $uideline Pre%operati - Aer&+an
So+&e# o5 Anes#,es&olo*&s# a!n& !onsus& +a&ran a!s&al ja %reo%eras&1
a!anan ren'a, lea! 6 ja %reo%eras&1 'an a!anan #&n**& lea! / ja
%reo%eras&1 '&ana %as&en #ela, er%uasa #&'a! en*!onsus& a!anan ja
.22.
Terapi 1airan
Keu#u,an a&n#enan+e noral 'a%a# '&%er!&ra!an 'ar& %as&en &n& (era#
a'an @<; !*)7
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$era# $a'an Jula, 3er,&#un*an un#u!
%as&en &n&
2!* %er#aa < LB!*Bja <2 LBja2!* er&!u#na @ LB!*Bja @ 2 LBja
T&a% !* '& a#as 2!* @ LB!*Bja @ ; LBja
To#al !eu#u,an +a&ran a&n#enan+e %as&en &n&7 /; LBja
De5&s&# &sa '&,&#un* 'en*an en*al&!an !eu#u,an +a&ran a&n#enan+e
'en*an 4a!#u %uasa. 3a'a %as&en &n& un#u! o%eras& #an**al < A%r&l 2; %u!ul
.22 (0 ja %uasa) a!a !eu#u,an +a&ran un#u! eenu,& 'e5&s&# +a&ran
seelu o%eras&7 0 ? /; lBja > 6; l. 3a'a %as&en '&er&!an RL sea*a&+a&ran a&n#enan+e seana! ;22++ sa%a& 'en*an o%eras&.
Premedikasi
3ree'&!as& &ala, %eer&an oa# - ja seelu &n'u!s& anes#es&
'en*an #ujuan un#u! elan+ar!an &n'u!s&1 rua#an 'an an*un 'ar& anes#es&
(an* '&er&!an %a'a %as&en &n& a'ala, +e'an#ron * 'an &'aGola *)
'&an#arana7
• ere'a!an !e+easan 'an !e#a!u#an
• e%erlan+ar &n'u!s& anes#es&
• en*on#rol ner& %os# o%eras&
• en*uran*& se!res& !elenjar lu'a, 'an ron!us
• e&n&al!an jula, oa# anes#es&
• en*uran*& ual un#a, %as+a o%eras&
• en+&%#a!an anes&a
• en*uran*& res&!o as%&ras& &s& laun*
Mana.emen Anestesi
Pemili3an Teknik Anestesi
3a'a %as&en &n& '&la!u!an s%&nal anes#es&. 3e&l&,an anes#es& s%&nal
sea*a& #e!n&! anes#es& %a'a %as&en &n& er'asar!an %er#&an*an a,4a %as&en
a!an enjalan& o%eras& a%en'&!#o& se,&n**a %as&en eerlu!an lo!a'e %a'a
re*&o a'oen a4a, un#u! e%eru'a, o%era#or 'ala ela!u!an o%eras&.
Te!n&! &n& uuna se'er,ana1 +u!u% e5e!#&51 'an u'a, '&*una!an.
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Saa# seelu o%eras& '&ula&1 %as&en '&%os&s&!an supine1 selanju#na
%as&en '&er& &'aGola an* 'a%a# en*,as&l!an e5e! se'as& an* e5e!#&5 %a'a
%reo%eras&. Se'an*!an cedantron '&*una!an sea*a& anti e&etic un#u! en+e*a,
%as&en ual. Se#ela, &#u1 %as&en '&%os&s&!an &r&n* !e !anan un#u! en*e!s%ose
area lual an* a!an '&la!u!an anes#es&. Se#ela, eer& #an'a %a'a L; a#au
S1 !eu'&an #e%a# #usu!an '&#en#u!an. Se#ela, &#u1 area #erseu# '&s#er&l!an
'en*an e#a'&n a#au al!o,ol. Anes#e#&! lo+al 'en*an l&'o!a&n - '&er&!an %a'a
#e%a# #usu!an.
Te!n&! anes#es& re*&onal %a'a %as&en &n& 'en*an en**una!an jaru :
'an '&an#u 'en*an introducer (%enun#un jaru). Se#ela, &n#ro'user '&sun#&!!an
se'ala !&ra-!&ra + a*a! se'&!&# !e ara, se5al1 !eu'&an jaru s%&nal er&!u#
an'r&nna '&asu!!an !e luan* jaru #erseu#. Se#ela, res&s#ens& en*,&lan*1
an'r&n jaru s%&nal '&+au# 'an !eluar l&!uor. Se#ela, #erja'& aro#a*e1 a&#u
!eluarna +a&ran sereros%&nal #an%a '&ser#a& !eluarna 'ara,1 a!a %asan*
se%r&# er&s& oa# 'an oa# 'a%a# '&asu!!an %elan-%elan (21; lB'e#&!)
'&selan*& as%&ras& se'&! ,ana u#u! ea!&n!an %os&s& jaru #e#a% a&!.
3a'a %as&en &n& '&er&!an oa# anes#es& 'e+a&n '&!arena!an #o!s&s&#as
'e+a&n le&, ren'a, '&an'&n*!an l&'o+a&n. Walau%un onse# !erja 'e+a&n le&,
laa (2-; en&#) '&an'&n*!an l&'o+a&n (;-2 en&#) #e#a%& 'uras& !erjana
le&, laa a&#u se!&#ar (1;-/ ja) '&an'&n*!an l&'o+a&n (- ja). Sela&n &#u
'&er&!an #raa'ol 22 * sea*a& anal*e#&!.
Terapi 1airan
Tera%& +a&ran &n#ra9ena 'a%a# #er'&r& 'ar& &n5us !r&s#alo&'1 !olo&'1 a#au
!o&nas& !e'uana. Ca&ran !r&s#alo&' a'ala, +a&ran 'en*an &on lo4 ole+ular
4e&*,# (*ara) 'en*an a#au #an%a *lu!osa1 se'an*!an +a&ran !olo&' ju*a
en*an'un* Ga#-Ga# ,&*, ole+ular 4e&*,# se%er#& %ro#e&n a#au *lu!osa %ol&er
esar. Ca&ran !olo&' enja*a #e!anan on!o#&! !olo&' %lasa 'an un#u! sea*&an
esar &n#ra9as!ular1 se'an*!an +a&ran !r&s#alo&' +e%a# ene&an*!an 'en*an
'an en'&s#r&us&!an seluru, ruan* +a&ran e!s#raseluler 6.
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Ca&ran '&%&l&, sesua& 'en*an jen&s !e,&lan*an +a&ran an* '&*an#&!an.
Un#u! !e,&lan*an #eru#aa an* el&a#!an a&r1 %en**an#&an 'en*an +a&ran
,&%o#on&!1 ju*a '&seu# +a&ran jen&s &aintenance. J&!a !e,&lan*an el&a#!an a&!
a&r 'an ele!#rol %en**an#&an 'en*an +a&ran ele!#rol&# &so#on&!1 ju*a '&seu#
+a&ran jen&s replace&ent 6.
Karena !eana!an !e,&lan*an +a&ran &n#rao%era#&5 a'ala, &so#on&!1 +a&ran
jen&s replace&ent an* uuna '&*una!an. Ca&ran an* %al&n* uu
'&*una!an a'ala, laru#an R&n*er la!#a#. es!&%un se'&!&# ,&%o#on&!1 ene'&a!an
se!&#ar 22 L 5ree 4a#er %er l&#er 'an +en'erun* un#u! enurun!an na#r&u
seru =2 E B L1 R&n*er la!#a# uuna e&l&!& e5e! an* %al&n* se'&!&#
%a'a !o%os&s& +a&ran e!s#raseluler 'an eru%a!an enja'& +a&ran an* %al&n*
5&s&olo*&s !e#&!a 9olue esar '&%erlu!an. Ke,&lan*an 'ara, se4a!#u o%eras&
&asana '&*an#&!an 'en*an +a&ran RL seana! = ,&n**a < !al& jula, 9olue
'ara, an* ,&lan*.
e#o'e an* %al&n* uu '&*una!an un#u! e%er!&ra!an !e,&lan*an
'ara, a'ala, %en*u!uran 'ara, 'ala 4a'a, ,&sa%Bsu+#&on 'an se+ara 9&sual
e%er!&ra!an 'ara, %a'a s%ons a#au la% an* #eren'a 'ara,. Un#u! s%on
u!uran <?< + 'a%a# enera% 'ara, 2 ++ se'an*!an un#u! la% 'a%a# enera%
22-;2 ++ 'ara,. 3en*u!uran #erseu# enja'& le&, a!ura# j&!a s%ons a#au la%
#erseu# '&#&an* seelu 'an sesu'a, #eren'a ole, 'ara,1 naun %a'a o%eras&
%as&en &n& #&'a! '&la!u!an.
3a'a %as&en &n& jula, 'ara, an* ,&lan* '&'a%a#!an 'ar& !assa 22 ++.
3eer&an &n%u# +a&ran %reo%era#&5 au%un 'uras& o%eras& san*a# %en#&n*
'ala !ese&an*an ,eo'&na&! %as&en saa# o%eras& erlan*sun*. Den*an
en*,&#un* es#&a#e' loo' 9olue (E$V) > era# a'an ? a9era*e loo'
9olue > <; !* ? 6; lB!*$$ > 0; l1 allo4e' loo' loss (A$L) > ? E$V1
> ,eo*lo&n &n&s&al (,&) " ,eo*lo&n #eren'a, an* '&%erole,!an. 3a'a
!asus !e*ananasan ,eo*lo&n #eren'a, an* '&%erole,!an a'ala, / *B'L. a!a
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A$L %as&en &n& a'ala, > ? 0; > 2/1</ 2/ l1 !eu#u,an +a&ran
a&n#enan+e > /; ++Bja1 a!a 'a%a# '&%er!&ra!an jula, +a&ran an* asu! #&a%
jana 'e& e%er#a,an!an !ese&an*an ,eo'&na&! +a&ran selaa o%eras&
erlan*sun*.
3a'a %ee'a,an a!an enea!an +a&ran %&n'a, !e ruan* !e#&*a1 !e
ruan* %er&#oneu1 !e luar #uu,. Un#u! en**an#&na #er*an#un* esar !e+&lna
%ee'a,an 1 a&#u 7
6-/ lB!* un#u! e'a, esar
<-6 lB!* un#u! e'a, se'an*
-< lB!* un#u! e'a, !e+&l
O%eras& &n& #erasu! e'a, se'an* se,&n**a en**una!an ruus +a&ran 6
lB!*. Se,&n**a O6 ? era# a'an %as&en a'ala, ;2 ++. Ja'& se#&a% ja na
selaa o%eras& %as&en en'a%a# +a&ran ==; ++Bja (@O6 > /; ++ @ 2 ++ > ==;
++).
Ole, !arena o%eras& erlan*sun* #&'a! le&, ja1 a!a !eu#u,an +a&ran
selaa o%eras& a'ala,7
Keu#u,an +a&ran rua#anBa&n#anan+e 7 /; ++Bja ? ja > /; ++
Jula, %ro'u!s& ur&ne 7 > 22 ++
Jula, 'ara, an* ,&lan* 7 > 22 ++ @
/; ++
3a'a %as&en &n& '&er&!an &n%u# +a&ran 7
- NS 7 <22 ++
M"nit"rin
3a'a !asus &n& selaa %roses anes#es&1 sa#uras& o!s&*en %es&en #&'a! %erna,
0;1 #e!anan 'ara, %as&en 'ala a#as noral er!&sar (S7 2-21 D7 2-/2)1
na'& an#ara 62-/2?Ben&#. RR7 <-/?Ben&#.
Mana.emen Anastesi P"st ,perasi
'ecovery 'ar& S%&nal Anas#es&
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3a'a %as&en &n&1 ren+ana o%eras& erjalan sesua& ren+ana 'ar& %u!ul 2.22 -
22. Den*an erjalanna o%eras& sesua& ren+ana a!a re+o9er %a'a %as&en &n&
ju*a +e%a# !arena %as&en en**una!an #e!n&! anes#es& s%&nal.
Kr&#er&a D&s+,ar*e 'ar& 3ACU
Sa#u ja se#ela, o%eras& 'an anes#es& era!,&r %as&en '&e9aluas& seelu
'&!eluar!an 'ar& 3ACU er'asar!an +r&#er&a Al're#e S+ore. 3a'a %as&en &n&
'&'a%a#!an7
Oe! Kr&#er&a N&la&
A!#&9&#as a%u en**era!!an < e!s#re&#as
Res%&ras& a%u na5as 'ala 'an a#u!
Te!anan 'ara, $erua, sa%a& 2 'ar& %ra e'a,
Kesa'aran Sa'ar a&! 'an or&en#as& a&!
Warna !ul&# Keera,an
N&la& To#al 2
Den*an n&la& #o#al al're#e s+ore %as&en !eu'&an '&%&n'a,!an !e ruan*an 'en*an
ren+ana on&#or&n* an* '&la!u!an su'a, enar 'an sesua& !eu#u,an %as&en.
BAB 5
PENUTUP
3as&en a'ala, %ere%uan us&a < #a,un 'en*an a%en'&s&#&s a!u#1 an*
'&la!u!an o%eras& a%en'&!#o& %a'a #an**al ; A%r&l 2;. T&n'a!an anes#es&
an* '&la!u!an a'ala, anes#es& s%&nal. 8al &n& '&%&l&, !arena !ea'aan %as&en
sesua& 'en*an &n'&!as& anes#es& s%&nal.E9aluas& %re o%eras& %a'a %as&en 'ala a#as noral. T&'a! '&#eu!an
!ela&nan la&n an* enja'& !on#ra&n'&!as& '&la!u!anna anes#es& s%&nal.
Selaa o%eras&1 #&'a! #erja'& !o%l&!as&. Kon'&s& %as&en rela#&5 s#a&l
sa%a& o%eras& selesa&.
Selaa '& 3ACU ( Post Anesthesy Care nit ) %as&en +u!u% s#a&l 'en*an
Aldrete core ern&la& 2 'an #&'a! #er'a%a# s+ore 21 se,&n**a %as&en 'a%a#
'&%&n'a,!an !e ruan* ra4a# &asa.
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DA+TAR PUSTAKA
. El&one Krane D. 3ae'&a#r&+ Anes#,es&a an' 3a&n ana*een#1 :u&'el&nes
5or %ae'&a#r&+ re*&onal anes#,es&a1 Lu+&le 3a+!ar' C,&l'ren 8os%&#al1 S#an5or'
Un&9ers&# e'&+al Cen#re1 a 22
. T. Lo%eG1 FJ SanjeG1 JC :arGon1 C.ur&el1 S%&nal Anes#,es&a &n 3ae'&a#r&+
%a#&en#s1 De%ar#en# o5 Anes#,es&olo*1 Un&9ers#&# 8os%&#al o5 Salaan+a1
S%a&n1 Januar 2
=. $aras,1 3. :.1 Cullen1 $. F.1 S#oel#&n*1 R. K.1 Ca,alan1 . K.1 S#o+!1 . C.
220. Handboo" o Clinical Anesthesia. 6#, e'&#&on. USA7 L&%%&n+o##
W&ll&as W&l!&ns.
<. &ller RD1 Er&!sson LI1 Fle&s,er LA1 W&ener J31 Moun* WL. 220. &llers
Anes#,es&a #, e'. US 7 Else9&er
;. Al're#e JA1 Kronl&! D7 A postanesthetic recovery score. Anes#, Anal*
02H<070< an' Al're#e JA7 T,e %os#-anes#,es&a re+o9er s+ore re9&s&#e'. J
Cl&n Anes#, 00;H7/0.
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