Atresia Bilier
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Atresia Bilier
305
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I. IDENTITAS PASIEN
• Nama : An. Zevanna• Umur : 5 bulan• Jenis Kelamin : Perempuan• No. RM : 15022456
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Anamnesis• Keluhan Utama: Seluruh tubuh tampak kuning• Sejak lahir pasien dikeluhkan seluruh tubuh tampak
kuning. Satu minggu kemudian os dibawa ke dokter umum dan hanya disuruh sering berjemur. 2 bulan kemudian os masih tampak kuning sehingga dibawa ke RS Salamun yg kemudian dirujuk ke RS Soreang kemudian dirujuk ke RSHS. BAB seperti dempul (+), riwayat asma (-), alergi obat (-), riwayat kejang (-).Pasien lahir dr ibu dgn P1A0 cukup bulan, SC ai CPD, langsung menangis, riw. kebiruan (-), kel. kongenital lain (-) BBL : 2,6 kg
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Pemeriksaan Fisik• KU : Aktif • HR : 142 x/mnt RR : 28 x/mnt BB : 6 kg SatO2 : 99% (udara bebas) Suhu : 36,7 oC• Kepala : konjungtiva anemis -/-, sklera ikterik +/+
Malampati sulit dinilai Leher : ROM baik
• Thoraks : bentuk dan gerak simetris– Cor : BJ S1,S2 reguler, murmur (-)– Pulmo : VBS ki = ka, rh -/-, wh -/-
• Abdomen : cembung, BU (+), ascites (-) • Ekstremitas : akral hangat, CRT < 2”
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LaboratoriumHb Ht L Tr SGOT SGPT Bil.
TotalBil. DIrek
Bil. Indirek
11,7 34 8700 437000
330 142 13,89 11,88 2,01
PT INR APTT Na K Ur Cr
15,7 1,25 34 137 4,1 13 0,13
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• Diagnosa : Atresia Bilier• Rencana : Kasai procedure + IOC
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• Assesment :• ASA III
• Planning :• Puasa 6 jam preop• Sedia darah• GA
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Konsiderasi Anestesi
• Preop :• Pemberian vit. K• Pastikan volume cairan cukup• Induksi:• Propofol dan atracurium
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• Intraop :• Pasien dgn hiperbilirubinemia obat bebas
dalam darah meningkat menyebabkan DOA menjadi lebih pendek
• Cegah hipotermi, pastikan cairan cukup
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• Post op :• Pain management• Dilakukan ekstubasi jika hemodinamik stabil
dan kehilangan darah minimal• PICU
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Terima Kasih