Kuliah Anestesia Elektif

8/13/2019 Kuliah Anestesia Elektif

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Penilaian Prabedah

Persiapan prabedah kurang memadai

kecelakaan anestesia

Tujuan kunjungan pra anestesia:

morbiditas dan mortalitas

biaya operasi

kualitas yankes


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Anamnesis

Obat-obatan

Alergi dan reaksi obat

Reaksi alergi nyata

Antibiotika

Alergi makanan

Riwayat alergi halotan atau suksinilkolin

Alergi anestetika lokal gol. Amide

Reaksi simpang dan efek samping

Interaksi obat


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Anamnesis

Riwayat anestesi

Catatan anestesia sebelumnya

Anamnesis anestesia sebelumnya

Riwayat keluarga

Riwayat sosial

Merokok

Obat-obatan dan alkohol


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Anamnesis

Review of system

ISPA

Spasme bronkus

Diabetes

Hipertensi tidak terkontrol

Kehamilan


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Pemeriksaan fisik

Tanda vital

BB dan TB

Tekanan darah

Denyut nadi

Pernafasan

Leher dan kepala

Ukuran buka mulut: Mallampati score


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Pemeriksaan fisik

Jarak thyromental

Thyromental distance: distance

of lower mandible in the midline

from the mentum to thyroid

notch.


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Pemeriksaan fisik

Struktur gigi: protruding teeth


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Pemeriksaan fisik

Deviasi trakea

Goiter Deviasi trakhea


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Pemeriksaan fisik

Prekordial

Paru

Abdomen

Ekstremitas

Punggung

Neurologis


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Pemeriksaan laboratorium

Diseleksi berdasarkan kondisi pasien

Hb dan Ht

CBC

PT, PTT Elektrolit

Gula Darah

Kreatinin

Enzim hati EKG

Foto toraks


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Hubungan dokter anestesi-pasien

ketakutan

menjelaskan tahapan perioperatif:

puasa

estimasi lama operasi

premedikasi dan obat yg tetap diteruskan

Tahapan menjelang operasi

Post operasi : PACU

ICU


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Informed consent:

rencana pilihan anestesia

alternatif

komplikasi


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Premedikasi

Tujuan sedasi dan analgesi :

kecemasan

nyeri selama kanulasi vascular

regional anestesia dan posisi

membantu induksi


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Thyromental distance

Thyromental distance: distance of lower

mandible in the midline from the mentum

to thyroid notch.

Measurement:

adult patient's neck fully extended, and

determine how readily the laryngeal axis

will fall in line with the pharyngeal axis

when the atlantooccipital joint is extended.

If thyromental distance is short (< 3 finger breadths, or < 6 cm in adults),

the laryngeal axis makes a more acute angle with the pharyngeal axis, and

it will be difficult to achieve alignment. There is less space for the tongue to

be displaced during laryngoscopy. Check that the floor of the mouth is

pliable.


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Mallampati Classification

The Mallampati classification relates tongue size to pharyngeal size.This test is performed with the patient in the sitting position, the headheld in a neutral position, the mouth wide open, and the tongueprotruding to the maximum. The subsequent classification is assignedbased upon the pharyngeal structures that are visible.

Class I = visualization of the soft palate, fauces, uvula, anterior andposterior pillars.Class II = visualization of the soft palate, fauces and uvula.Class III = visualization of the soft palate and the base of the uvula.Class IV = soft palate is not visible at all.

The classification assigned by the clinician may vary if the patient is inthe supine position (instead of sitting). If the patients phonates, thisfalsely improves the view. If the patient arches his or her tongue, theuvula is falsely obscured. A class I view suggests ease of intubationand correlates with a laryngoscopic view grade I 99 to 100% of thetime. Class IV view suggests a poor laryngoscopic view, grade III or IV100% of the time. Beware of the intermediate classes which may resultin all degrees of difficulty in laryngoscopic visualization.


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Difficult Intubations

Several factors may predispose to difficult intubation. 1 These includeanatomical factors, congenital problems, disease states affecting theneck region and trauma to the head and neck.

Besides these factors, suboptimal standard technique can make aroutine intubation difficult.2 The most common mistake made duringintubation is cranking back on the laryngoscope handle in order to

lever the top of the blade to provide better visibility. This maneuvermay improve glottic visualization, however, it restricts the intubatorsability to manipulate the tube by limiting the size of the oral opening,and it jeopardizes the teeth. Lifting the laryngoscope and blade upwardand forward both improves glottic visibility and increases the oralopening, allowing more room for manipulating the endotracheal tube.

Also, there are guidelines for airway control which are extremelyvaluable in reviewing the approach to airway management, specifically,the difficult airway. The reader should be familiar with these task forceguidelines.3


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Difficult Intubations

Table 1. Predisposing Factors for Difficult Intubation

Anatomic Variations Congenital Abnormalities Disease States Trauma

Short, thick mandible

Thick/fat "bull neck

Narrow mouth opening

Large tongue

Dental anomalies/protruding teeth

Limited ROM of cervicalspine

Scoliosis

Mandibular hypoplasia

Maxillary hypoplasia

Klipper-Feil Syndrome(decreased number ofcervical vertebrae)

Cleft lip/palate

Temporomandibular jointdisorder

Degenerative cervical spinedisease / arthritis

Ankylosing spondylitis

Infection (retropharyngealabscess, Ludwig's angina)

Airway Edema

Foreign bodies

Malignancy

Previous tracheostomy

Facial

Mandibular

Maxillary

Cervical

Kuliah Anestesia Elektif

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