Anestesi resiko tinggi
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Transcript of Anestesi resiko tinggi
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ANESTESI RESIKO TINGGI
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KELAINAN JANTUNG KELAINAN JANTUNG
AHLI BEDAHAHLI BEDAH ANESTESIANESTESI AHLI JANTUNGAHLI JANTUNG
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GAGAL JANTUNG
PRINSIP ANESTESI Rasio ventilasi perfusi Perfusi jaringan
Vasodilator Kurangi tonus simpatik Fungsi miocard karena myocardial after load
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Oksigenasi dengan cara konsentrasi oksigen inspirasi
Tekanan intra thoracic karena spontan respirasi
Oedema paru
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RESIKO Kematian post operasi Thrombo emboli Infeksi paru
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Hati-hati menggunakan glikosidaHati-hati menggunakan glikosida Terapi diurerik jika fungsi ginjal Terapi diurerik jika fungsi ginjal Monitor pemberian cairan / Monitor pemberian cairan /
elektrolitelektrolit
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GANGGUAN IRAMA JANTUNG
• Tachycardia• Bradycardia• DisritmiaAnastesi Pengaruh pada
cardiac out put
Interaksi anti disritmia dengan obat anastesi
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Cegah hipoksia Cegah hipercarbia
Gangguan konduksi
Blok left BBB berbahayaGangguan klep & shunt Jadi gagal jantung
Gangguan irama
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Prinsip Cegah cardiac out put Thrombo emboli Haemolysis Coronary insufficiency Endocarditis
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Pada Shunt: Dosis obat mengalami pengenceran Aliran paru meninggi zat anastesi
banyak di ambil Pemberian antibiotik prophylactic Anti coagulant pada klep buatan
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Infarct
Kemungkinan infarct berulang cegah Tachycardia Hipertensi
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Gangguan paru
• Periksa VT VC FEV1
ObstruksiFEV1
(PEFR)VC
Restriksi
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1. Obstruksi :
◊ Asma◊ Bronchitis kronis◊ Bronchi ectasis◊ Emphysema
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2.Restriksi
Gangguan rongga dada Penyakit paru
Perlu tenaga menggembangkan paru masalah batuk
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Diabetes mellitus
Tindakan anastesia & bedah
Gula darah meningkat 20-40 mg/100cc
Lebih tinggi pada :Bedah majorBedah abdominalAktifitas simpatis
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DM: -gula darah puasa > 163 mg %
-gula darah random > 203 mg%
Dm: -Dependent insulin
-keto asidosis
-Maturity onset diabetes
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Prinsip Anastesi
1. Cegah stimulasi simpatik
2. Cegah obat yang memblok respon simpatik terhadap hipoglikemia
3. Cegah tehnik yang menghasilkan tidak sadar yang lama
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N2O & O2 & relaksan ,CR +Analgesia i.v suppl
Cegah hipercarbia
hipoventilasi
Tidak boleh berikan lebih dari 100 cc D5/jam
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GANGGUAN HATIGANGGUAN HATI
PremedikasiPremedikasiAnalgetik dan sedatifAnalgetik dan sedatif CNSCNSDiazepamDiazepam Globulin Globulin KerjaKerja
AnestesiAnestesi GeneralGeneral Splanchnic Blood FlowSplanchnic Blood Flow
RegionalRegionalKerusakan hatiKerusakan hati
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PENTING
1. Oksigenisasi
2. Cegah hipotensi
3. P CO2 normal
Hindari obat yang metabolisme di hati
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Globulin Pavulon
Dosis >Efek panjang
Hindari : CyclopropaneDiethyl etherMethoxy flurane
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Post operasiSeperti fungsi hati
Berhubungan dengan operasi
Lama Besar
Normal setelah 5-10 hari
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Jaundice
Prothrombin time Bilirubin 11,5 mg/100 cc
Diuretik
Mannitol
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Penting diingat
1. Faktor koagulasi
2. Fluid & sodium retensi pakai D5
3. Protein abnormal
4. Obstruksi bile toxic obat
Usus Ginjal
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Gangguan Ginjal
RBF 1300 ml/menit (25 % )Filter 170-200 liter / 24 jam
– (50-60 X plasma volume )
Anestesi umum
RBF + tensi
Urine
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Morfin dan inhalasi anestesiMorfin dan inhalasi anestesi
Stimulasi ADHStimulasi ADH
Gagal ginjalGagal ginjal
Creatinine > 2 mg/100ccCreatinine > 2 mg/100cc
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PreoperatifPreoperatif
1.1. ElektrolitElektrolit
2.2. Asam basaAsam basa
3.3. HbHb
4.4. Obat-obatanObat-obatan
5.5. InfeksiInfeksi
6.6. A.V ShuntA.V Shunt
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Dialisa PreoperatifDialisa Preoperatif
Water over loadWater over load
K 6mmol/LK 6mmol/L
Gangguan asam basaGangguan asam basa
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Problem Anestesi
OdemaHindari Atropin karena : anemia
Tachycardia
InfeksiDarah , screen Hb AgHindari obat ekskresi Per Urine
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Relaxant Depol K 0,5 mmol/L
Non depol Dosis
Anestesi inhalasiRBF , GFR, Urine
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Post operatif
Operasi besar Hemodialisa Infeksi Paru Chest fisioterapi
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