Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
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LAPORAN KASUS GENERAL ANESTESI PADA CHOLELISTECTOMY Pembimbing : dr. Ratna Hutapea, Sp.An Disusun oleh : List ia Ev alina Sit epu 0961000! Hand"i# a $"i% S. 1061000&! Ara'inda Haniastri 10610 0069 (ernand )a*al iel +. 116100101 KEP ANITERAAN KLINIK ILMU ANESTESI AKULTAS KEDOKTERAN UNI!ERSIT AS KRISTEN INDONESIA PERIODE "# $ULI % "& AGUSTUS "'()
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Transcript of Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
7/21/2019 Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
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LAPORAN KASUSGENERAL ANESTESI PADACHOLELISTECTOMY
Pembimbing :
dr. Ratna Hutapea, Sp.An
Disusun oleh :
Listia Evalina Sitepu 0961000!
Hand"i#a $"i% S. 1061000&!Ara'inda Haniastri 106100069
(ernand )a*aliel +. 116100101
KEPANITERAAN KLINIK ILMU ANESTESIAKULTAS KEDOKTERAN
UNI!ERSITAS KRISTEN INDONESIAPERIODE "# $ULI % "& AGUSTUS "'()
7/21/2019 Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
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Penda"uluan
O K%lelitiasis atau iasa diseut atu e*pedu
*erupa#an endapan satu atau lei"#%*p%nen e*pedu -aitu #%lester%l,iliruin, ara* e*pedu, #alsiu*, pr%tein,asa* le*a#, dan /%s/%lipid
7/21/2019 Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
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Penda"uluan
O (iasan-a indi#asi pasien di%perasiadala" untu# *enalani
#%lesiste#t%*i, untu# *e*eas#an%stru#si saluran e*pedue#stra"epati#, atau #eduan-a.
OKean-a#an pasien denan#%lesistitis a#ut "arus distail#andulu seelu* *enalani#%lesiste#t%*i.
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dentitas Pasien
O Na*a2 N-. A
O N%. R3 2 00400454!1
O enis #ela*in 2 Pere*puan
O Usia 2 57 ta"un
O Ala*at 2 Kanina Residen8e, ati'arinin, P%nd%# )ede
O Aa*a 2 sla*
O Su#u 2 a'aO Status 2 (elu* 3eni#a"
O (erat (adan 2 #
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dentitas Pasien
O :ini (adan 2 160 8*
O )%l%nan $ara" 2 O
O $ian%sis pre%perati/ 2;"%lel-tiasis
O :inda#an %perasi 2;"%leliste8t%*-
O enis anestesi 2 Anestesi u*u*O :anal %perasi 2 &! uli &01
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Ana*nesis
O Kelu"an Uta*a 2 n-eri pada perut #anan atas
O Kelu"an uta*a
O N-eri pada daera" ulu "ati
O Ri'a-at pen-a#it se#aran
O Pasien datan denan #elu"an n-eri pada perut#anan atas. N-eri -an dirasa#an sea# < 5 ulanS3RS. N-eri -an dirasa#an pada perut #ananatas *enalar sa*pai #e daera" pinan. N-eri-an dirasa#an pasien erlansun se#itar < 10*enit. A'aln-a n-eri -an dirasa#an %le" pasien
ti*ul se8ara tia4tia dan "ilan ti*ul. N-eri ua dirasa#an pada saat pasien *ela#u#ana#tivitas dan n-eri sanat *enannu a#tivitaspasien. Kelu"an lain -an dirasa#an pasien iala"*ual dan *unta".
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Pe*eri#saaan +isi#
O KU2 ta*pa# sa#it rinan, 8%*p%s*entis
O =ital Sin 2O :$ 2 110>!0 **H
O RR 2 1?>*enit
O HR 2 &?>*enit
O Su"u 2 760;
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O Air'a->Respirasi 2 Air'a- 8lear, (N$
vesi#uler, R"%n#i 4>4, @"eein 4>4,3alla*pati , )ii palsu B4C ii %-anB4C
O ;ir8ulati%n 2 A#ral "anat, ;R: D&,K%nuntiva ane*is 4>4, ( F reuler,*ur*ur B4C, all%p B4C, Ri'a-at Hipertensidisan#al
O Sara/ 2 );S E536=, Kesadaran #%*p%s*entis, Pupil is%#%r 7**>7**, R;L G>G, R;:L G>G, Ri'a-at #ean disan#al.
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Hasil La%rat%riu*
O H2 11,7 >dl
O Leu#%sit 2 6,& riu>ul
O He*at%#rit 2 7,1
O :r%*%sit 2 &&9 riu>ulO 3asa perdara"an 2 & *enit
O 3asa pe*e#uan2 1 *enit
O S)O: 2 && U>L
O S)P: 2 19 U>L
O Ureu* 2 1& *>dl
O ;reatinin 2 0,!1 *>dl
O S*+*us ASA (
7/21/2019 Case Report General Anestesi Pada Cholesistectomy_Bernand_1161050101
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:atala#sana Anestesi
O Pre4%perasi
O $urante4%perasi
O P%st4%perasi
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Pre4Operasi
O ;e# surat persetuuan %perasi dan anestesi
O O& & lp*
O N&O 1 lp*
O s%Iurane & v%l
O =+$ 1 line 2 RL Bt%tal 8airan *asu# 1000*lC
O Pre*edi#asi2
O $%r*i#u* 1, * i.vO +entan-l 100 *8 i.v
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$urante Operasi
O ntuasi
O S:A:;S
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$urante Operasi
O 3ulai dila#u#an anestesi u*u* denan pr%sedurseaai eri#ut 2
O Pasien erarin p%sisi supine, *%nit%r dipasan.
O O#sien & lp* *ulai dialir#an #e "idun pasien.O $ila#u#an pre*edi#asi anestesi denan pe*erian
d%r*i#u* 1, * i.v, /entan-l 100 *8 i.v
O $ila#u#an indu#si anestesi denan pr%p%/%l 10 *i.v
O Peri#sa reIe#s ulu *ata pasien untu# *ene8e#
#esadaran pasien, pasan uedel setela" pasiendipasti#an tida# sadar.
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$urante Operasi
O ;uJ dipasan dan dila#u#an antuanna/as denan ain.
O O#sien & lp*, N&O 1 lp*, danis%Iurane & dialir#an *elalui 8uJuntu# ru*atan anestesi.
O $ila#u#an intuasi end%tra#eal denanE:: n%*%r 6.
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3%nit%rin
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u*la" 3edi#asi
O Pr%p%/%l 10 *
O +entan-l 10 *8
O Pr%p%/%l 0 *
O E8r%n *O As. :rane?a*at 70 *
O +entan-l 0 *8
O E8r%n 1 *
O +entan-l & *8
O E8r%n & *O Ondansetr%n 5 *
O Ket%r%la8 70 *
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P%st4Operasi
O (ila #esa#itan 2 Ket%r%la8 7?70 * i.v
O (ila *ual>*unta"2 Ondansetr%n 5* i.v
OAntii%ti# 2 sesuai instru#si %perat%r B$PPCO Oat4%atan lain 2 As. :rane?a*at 7?0 * i.v
O n/us 2 RL 2 $ & 2 1 > &5 a*
O 3a#an>*inu* 2 erta"ap ila pasien sadarpenu", isin usus BGC
O 3%nit%rin 2 te#anan dara", /re#uensi nadi danperna/asan tiap 1 *enit sela*a 6 a*. Nasal8anul O& 7 lp*
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:inauan Pusta#a
O Koleli*i+sis
O K%lelitiasis atau iasa diseut atu e*pedu*erupa#an endapan satu atau lei"
#%*p%nen e*pedu -aitu #%lester%l,iliruin, ara* e*pedu, #alsiu*, pr%tein,asa* le*a#, dan /%s/%lipid.
O Keadian #%lelitiasis iasan-a dii#uti denan
#e*un8ulan elaa peradanan #andune*pedu atau diseut #%lesistitis.
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:inauan Pusta#a
O Anes*esi Umum
O Anestesi u*u* adala" tinda#an*eniada#an n-eri se8ara sentral disertai
"ilann-a #esadaran dan ersi/at reversible. Anestesi u*u* -an se*purna*en"asil#an #etida#sadaran, analesia,rela#sasi %t%t tanpa *eni*ul#an resi#%-an tida# diinin#an dari pasien.
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The American Society Of Anesthesiologist BASAC
O ASA
O ASA
O ASA O ASA =
O ASA =
O E
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Pre *edi#asi
O Oat %at pre*edi#asi -an isadieri#an antara lain 2
O )%l. Anti#%lineri#
O )%l. Hipn%ti# sedative
O )%l. Analeti# nar#%ti#
O )%l. :ransuilier
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ntuasi
O S
O :
O AO :
O
O ;
O S
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3ala*pati
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Anestesi n"alasi
SO+LURAN
SE=O+LURAN
N&O HALO:AN
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)eneral Anestesi pada Hepat%ilier
O Pen-a#it "epat%ilier ditandaidenan #%lestasis, ter"a*atn-a
a"#an ter"entin-a aliran e*pedu.
O Pen-ea uta*a teradin-a#%lestasis adala" %stru#si salurane*pedu e#stra"epati# Bi#terus%stru#ti/C.
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Perti*anan
O Pre4Operati/ O Seai#n-a dieri#an vita*in K parenteral
-an *un#in e#era %pti*al setela" &5
a*
O ntra%perati/ O Oat4%at -an terantun pada e#s#resi
e*pedu "arus diantisipasiO Pe*antauan "e*%dina*i#
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SKOR PEMULIHAN PASCA ANESTESI
AL$RE::ES;ORE
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Pe*a"asan
O Pada pasien N-. A, 57 ta"un -an didian%sa ;"%lel-tiasis denan tinda#anpe*eda"an ;"%leliste8t%*-, setela"
dila#u#an ana*nesis dan pe*eri#saanMsi# serta penunan pada #ununanpre%perati/ dapat disi*pul#an statuspr%n%sisn-a adala" ASA 1
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Pe*a"asan
O :erapi *edis -an dapat dieri#an adala" su8ti%nnas%astri8, pe*erian 8airan in/us, antii%ti#, dananaleti# %piat. Pasien -an *enala*i %stru#sisaluran e*pedu e#stra"epati# apapunpen-ean-a iasan-a *enderita deMsiensi vita*inK.
O ntra%perati/ pasien dieri#an asa* trane?a*at,%at ini adala" %l%nan antiMrin%liti# -ane#era *enurani perdara"an denan 8ara
*en"a*at a#tivasi plas*in%en *enadi plas*inpada 8as8ade pe*e#uan dara". Karena plas*iner/unsi *enderadasi Mrin, *a#a asa*trane?a*at e#era *en"a*at deradasi Mrin.
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Pe*a"asan
O Pada pasien denan %stru#si salurane*pedu, pe*ananan durasi %at4%at-an terantun pada e#s#resi e*pedu
"arus diantisipasi. Pili"la" %at4%at-an dieli*inasi di inal.
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