PANDUAN ANESTESI DALAM KAMAR OPERASI

RSUP Dr. MOHAMMAD HOESIN PALEMBANG

DIREKTORAT MEDIK DAN KEPERAWATAN

RSUP Dr.MOHAMMAD HOESIN PALEMBANG
2014
1

PANDUAN ANESTESI DALAM KAMAR OPERASI

RSUP. DR. MOH. HOESIN PALEMBANG

Penyusun:
Zulkifli, dr., SpAn, M.Kes, MARS.
Rizal Zainal, dr., SpAn
Yusni Puspita, dr., SpAn. KAKV. KIC, M.Kes

DEPARTEMEN / BAGIAN ANESTESIOLOGI DAN TERAPI INTENSIF

RSUP. DR. MOH. HOESIN PALEMBANG
2014

KATA PENGANTAR
Assalamualaikum Wr. Wb.
Puji syukur kami panjatkan kepada Allah SWT yang telah memberikan
rahmat dan hidayah-Nya sehingga Panduan Anestesi dalam Kamar Operasi
RSUP. Dr. Moh. Hoesin Palembang telah berhasil kami susun. Panduan ini
disusun Tim dari Departemen/Bagian Anestesiologi dan Terapi Intensif dan
diharapkan dapat menjadi dasar dalam membuat Standar Prosedur Operasional
Anestesi dalam Kamar Operasi.
Seiring dengan perkembangan waktu dan semakin dengan meningkatnya
kesadaran masyarakat akan kesehatan, maka profesi seorang dokter dituntut
untuk dapat memberikan pelayanan kesehatan yang prima. Hal ini sesuai
dengan visi RSUP. Dr. Moh. Hoesin Palembang yaitu menjadi Rumah Sakit
Umum Pusat Pelayanan Kesehatan, Pendidikan dan Penelitian Terbaik dan
Bermutu se-Sumatera.
Kami ucapkan banyak terima kasih pada pihak-pihak yang telah membantu
dalam penyusunan Panduan Manajemen Nyeri ini. Kritik dan saran demi
perbaikan Panduan ini sangat kami harapkan.
Wassalamualaikum Wr. Wb.

Mengetahui,
Direktur Medik dan Keperawatan

Ka. Departemen Anestesiologi dan

Terapi Intensif

DR. Dr. Alsen Arlan, SpB, KBD, MARS

Dr. H. Zulkifli, SpAn, M.Kes, MARS

NIP. 19620604 198903 1 005

NIP. 19650330 199503 1 001

DAFTAR ISI
TIM PENYUSUN.........................................................................................................
i
KATA PENGANTAR.....................................................................................................
ii
DAFTAR ISI.................................................................................................................
iii
DAFTAR TABEL..........................................................................................................
iv
DAFTAR GAMBAR......................................................................................................
v
BAB I PENDAHULUAN ..............................................................................................
1
BAB II RUANG LINGKUP MANAJEMEN NYERI.........................................................
2
II.1 PENILAIAN DERAJAT NYERI
....................................................................................................................
2
II.2 MANAJEMEN NYERI
....................................................................................................................
14
II.2.1 MANAJEMEN NYERI PEDIATRI
.............................................................................................................
15
II.2.2 MANAJEMEN NYERI DEWASA
.............................................................................................................
19
II.2.2.1 MANAJEMEN NYERI AKUT DEWASA
19
II.2.2.2 MANAJEMEN NYERI PADA GERIATRI
24
II.2.2.3 MANAJEMEN NYERI PADA PERSALINAN
PERVAGINAM
27

II.2.2.4 MANAJEMEN NYERI KRONIS DEWASA

31
BAB III FARMAKOLOGI OBAT ANALGETIKA ............................................................
38
III.1 OBAT ANTI INFLAMASI NONSTEROID (OAINS)
..................................................................................................................
38
III.2 OPIOID
..................................................................................................................
46
III.3 ANALGETIK TAMBAHAN
..................................................................................................................
58
III.4 BLOK NERVUS PERIFER
..................................................................................................................
63
III.5 BLOK NEURAKSIAL
..................................................................................................................
64
BAB IV DOKUMENTASI .............................................................................................
67
DAFTAR PUSTAKA.....................................................................................................
68
LAMPIRAN..................................................................................................................
70

DAFTAR TABEL

TABEL 1 Alat Ukur Berdasarkan Rentang Umur..........................................................

3
TABEL 2 Neonatus Infant Pain Scale (NIPS)...............................................................
4
TABEL 3 Skala CRIES ................................................................................................
4
TABEL 4 Skala FLACC ...............................................................................................
5
TABEL 5 Comfort Scale...............................................................................................
11
TABEL 6 Non Verbal Pain Scale Revised....................................................................
12
TABEL 7 Behavioral Pain Scale (BPS) .......................................................................
12
TABEL 8 Skala BIIP ....................................................................................................
13
TABEL 9 Perbedaan Nyeri Akut dan Kronis.................................................................
14
TABEL 10 Terapi Nonfarmakologi................................................................................
18
TABEL 11 Manajemen Efek Samping Opioid ..............................................................
19
TABEL 12 Functional Pain Scale ................................................................................
25
TABEL 13 Skor DIRE...................................................................................................
36
TABEL 14 Panduan Penggunaan OAINS....................................................................
44
TABEL 15 Obat-Obatan Non-Opioid Pada Pediatrik....................................................
45
TABEL 16 Sediaan Kombinasi NSAID dan Opioid Untuk Nyeri Moderat.....................
54
TABEL 17 Opioid Oral.................................................................................................
55

TABEL 18 Penggunaan Opioid dalam Anestesi ........................................................

55
TABEL 19 Opioid Pada Pediatri...................................................................................
56
TABEL 20 Panduan adjuvant Analgetika.....................................................................
62
TABEL 21 Analgetika Lain Pada Pediatri.....................................................................
63
TABEL 22 Opioid Epidural...........................................................................................
64
TABEL 23Anastesi Lokal Epidural ..............................................................................
64
TABEL 24Analgesia Epidural Untuk Pediatri...............................................................
65

DAFTAR GAMBAR
GAMBAR 1 FACES PAIN SCALE-REVISED...............................................................
6
GAMBAR 2 Skala Nyeri Wong-Baker FACES ............................................................
7
GAMBAR 3 Skala Oucher ..........................................................................................
7
GAMBAR 4 Skala Analog Visual .................................................................................
8
GAMBAR 5 Skala VNS................................................................................................
8
7

GAMBAR 6 Noncommunicating Childrens Pain Checklist .........................................

9
GAMBAR 7 Algoritme Nyeri pada Pediatri...................................................................
15
GAMBAR 8 Algoritme Manajemen Nyeri Akut.............................................................
23
GAMBAR 9 Algoritme Pemberian Opioid Intermitten Intravena Untuk Nyeri Akut .......
24
GAMBAR 10 Algoritme Manajemen Nyeri Kronik........................................................
34
GAMBAR 11 Rencana Perawatan Pasien Nyeri Kronik...............................................
3