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TUGAS OPERAN

STASE ANESTESI RSUD CIAWI


Pembimbing: dr. Helen Yudi Irianto, Sp.An

Koas Anestesi Periode 22 Oktober – 25 November 2018


(Bunga Mayapada, Maryanna Chung, Silvana Fransisca, Vina Calosa)
LEMON
Airway Assessment
LEMON airway assessment
L : LOOK Externally (trauma wajah, lidah lebar,dll)
E : Evaluate the 3-3-2 rule (jarak gigi seri atas dan
bawah 3 jari, jarak hyoid-mental 3 jari, jarak tiroid-
dasar mulut 2 jari)
M : Mallampati
O : Obstruction (abses peritonsilar abses, epiglotis,
retrofaring)
N : Neck mobility (mobilitas leher terhambat)
Evaluate the rule of 3-3-2

M J Reed et al. Emerg Med J 2005;22:99-102

Copyright © BMJ Publishing Group Ltd and the College of Emergency Medicine. All rights reserved.
Mallampati

M J Reed et al. Emerg Med J 2005;22:99-102

• Grade I : pilar faring, uvula, dan palatum mole terlihat jelas, seluruh tonsil terlihat jelas
• Grade II : uvula dan palatum mole terlihat sedangkan pilar faring tidak terlihat
• Grade III : hanya palatum mole yang terlihat
• Grade IV : palatum mole tidak terlihat

Copyright © BMJ Publishing Group Ltd and the College of Emergency Medicine. All rights reserved.
Kebutuhan Cairan
Kebutuhan Cairan Intraoperatif
LANGKAH 1
• Maintenance (M) = 2 cc/kgBB (dewasa)
• Pengganti Puasa (PP) = M x lama puasa (dalam jam)
• Stres operasi (ROI)
• Risiko perdarahan ringan = 2-4 cc/kgBB
Operasi STT, FAM, HIL, TURP, mata NB:
• Risiko perdarahan sedang = 4-6 cc/kgBB Sesuaikan dengan
Operasi SC, bedah tulang kecil, mini laparotomy
jenis operasi!
• Risiko perdarahan berat = 6-8 cc/kgBB
Operasi bedah tulang besar, craniotomy, radical mastectomy, LE
Maintenance (M) untuk Anak
CARA
CEPAT,
tapi hanya
estimasi
saja
Kebutuhan Cairan Intraoperatif
LANGKAH 2
• Jam I = ½PP + M + ROI Sesuaikan jumlah cairan tiap jam-nya.
• Jam II = ¼PP + M + ROI Hitung balance cairan!
(Perbedaan input dan output max ±1000cc)
• Jam III = ¼PP + M + ROI Input = cairan yang masuk
• Jam IV, dst = M + ROI Output = urine output (nilai dari urine bag)
OBESE
Difficult Mask Ventilation
OBESE → difficult mask ventilation

Overweight (BMI >26 kg/m2


Beard
Elderly (>55 years old) Min. 2 (+) factors → probability of
difficult mask ventilation (DMV)
Snoring
Edentulous
STOPBANG questionnaire
Obstructive Sleep Apnea (OSA)
→ screens for obstructive sleep
STOPBANG questionnaire apnea (OSA) only, not central
sleep apnea.

Snore loudly BMI >35 kg/m 2

Tired, fatigue, sleepy during daytime Age >50 years


Observed by anyone that you stop Neck circumference >40 cm
breathing/choking/gasping during sleep

Pressure of the blood is high (or being Gender ♂ male


treated)
→ screens for obstructive sleep
STOPBANG questionnaire apnea (OSA) only, not central
sleep apnea.

• OSA - Low Risk : Yes to 0 - 2 questions

• OSA - Intermediate Risk : Yes to 3 - 4 questions

• OSA - High Risk : Yes to 5 - 8 questions


• or Yes to 2 or more of 4 STOP questions + male gender
• or Yes to 2 or more of 4 STOP questions + BMI > 35kg/m2
• or Yes to 2 or more of 4 STOP questions + neck circumference 17 inches /
43cm in male or 16 inches / 41cm in female
Semoga bermanfaat

😁👍