8/13/2019 Kuliah Anestesia Elektif
1/20
8/13/2019 Kuliah Anestesia Elektif
2/20
Penilaian Prabedah
Persiapan prabedah kurang memadai
kecelakaan anestesia
Tujuan kunjungan pra anestesia:
morbiditas dan mortalitas
biaya operasi
kualitas yankes
8/13/2019 Kuliah Anestesia Elektif
3/20
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
8/13/2019 Kuliah Anestesia Elektif
4/20
Anamnesis
Riwayat anestesi
Catatan anestesia sebelumnya
Anamnesis anestesia sebelumnya
Riwayat keluarga
Riwayat sosial
Merokok
Obat-obatan dan alkohol
8/13/2019 Kuliah Anestesia Elektif
5/20
Anamnesis
Review of system
ISPA
Spasme bronkus
Diabetes
Hipertensi tidak terkontrol
Kehamilan
8/13/2019 Kuliah Anestesia Elektif
6/20
Pemeriksaan fisik
Tanda vital
BB dan TB
Tekanan darah
Denyut nadi
Pernafasan
Leher dan kepala
Ukuran buka mulut: Mallampati score
8/13/2019 Kuliah Anestesia Elektif
7/20
8/13/2019 Kuliah Anestesia Elektif
8/20
Pemeriksaan fisik
Jarak thyromental
Thyromental distance: distance
of lower mandible in the midline
from the mentum to thyroid
notch.
8/13/2019 Kuliah Anestesia Elektif
9/20
Pemeriksaan fisik
Struktur gigi: protruding teeth
8/13/2019 Kuliah Anestesia Elektif
10/20
Pemeriksaan fisik
Deviasi trakea
Goiter Deviasi trakhea
8/13/2019 Kuliah Anestesia Elektif
11/20
Pemeriksaan fisik
Prekordial
Paru
Abdomen
Ekstremitas
Punggung
Neurologis
8/13/2019 Kuliah Anestesia Elektif
12/20
Pemeriksaan laboratorium
Diseleksi berdasarkan kondisi pasien
Hb dan Ht
CBC
PT, PTT Elektrolit
Gula Darah
Kreatinin
Enzim hati EKG
Foto toraks
8/13/2019 Kuliah Anestesia Elektif
13/20
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
8/13/2019 Kuliah Anestesia Elektif
14/20
Informed consent:
rencana pilihan anestesia
alternatif
komplikasi
8/13/2019 Kuliah Anestesia Elektif
15/20
Premedikasi
Tujuan sedasi dan analgesi :
kecemasan
nyeri selama kanulasi vascular
regional anestesia dan posisi
membantu induksi
8/13/2019 Kuliah Anestesia Elektif
16/20
8/13/2019 Kuliah Anestesia Elektif
17/20
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.
8/13/2019 Kuliah Anestesia Elektif
18/20
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.
8/13/2019 Kuliah Anestesia Elektif
19/20
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
8/13/2019 Kuliah Anestesia Elektif
20/20
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