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Anestesi

Pada Bayi Dengan Atresia


Duodenum yang dilakukan
Duodenoduodenostomy
Tim Pediatrik Anesthesia

Anamnesa
Identitas pasien :
Nama
Umur

: By. M
: 1,5 bulan

Keluhan utama : muntah muntah sejak umur 4 hari


Umur 4 hari muntah kuning dirawat RSUD Tasik,
dirawat 5 hari, kemudian di rujuk ke RSHS
(Lahir spontan cukup bulan 38 mgg, ditolong bidan
langsung menangis BBL 3900g)
Dirawat oleh TS IKA dan direncanakan untuk
operasi sambung-sambung usus duabelas jari.

Pemeriksaan Fisik

Ku : Aktif, menangis kuat


BB : 2700 g

Nadi
Respirasi
SpO2
Suhu
Jalan napas
Kepala
Thoraks

Abdomen
distensi
Extrimitas

Post Conceptional Age: 45minggu

: 138-142 x/menit
: 38-40 x/min,
: 98%
: 36,4 C
: sulit dinilai
: ubun ubun tidak cekung, ikterik (-)
: bentuk & gerak simetris
pulmo: rhonki -/-, wheezing -/-, suara napas vesikular
cor : normal, murmur (-)
: BU (+) ,teraba lembut, tidak tegang, tidak ada
: akral hangat

Terapi di Ruang Rawat


Pediatri
Nutrisi Parenteral D 10/D 40/NaCl 3%/KCl
7,46/Lipid 20%/Aminosteril
9cc/jam
Akses vena melalui PICC di vena basilica kiri
NGT (+): 12cc/4jam hijau
Diuresis : popok 5cc/jam
Ampicyclin 4 x125 mg
Gentamycin 1x10 mg
Paracetamol prn

Laboratorium
Hb
(21/8
)

Ht

Leuko

Tr

Ur

Cr

Alb

Prot
total

9,8

27

9.700

79.000

43

0,33

3,1

5,2

PT

INR

aPTT

Na

10,9

0,98

28,8

137

5,6

Pemeriksaan Penunjang
Rontgen Thoraks :
kesan Pneumonia (-),
kardiomegali (-)

Pasien dengan Status Fisik ASA III


Rencana tindakan Anestesi umum

Rencana Anestesi
Preoperatif
Informed consent tentang tindakan anestesi
umum, puasa preoperatif dan manajemen nyeri
pasca operasi dan ruang rawat pasca operasi.
IVFD RL 12cc/jam
Persiapan darah

Pre Induksi
Dipasang monitor EKG, SpO2 dan Temp
Radiant warmer, PRC tersedia dan blood warmer
Akses vena untuk tranfusi
Check GDS

Induksi
Dilakukan suction dari NGT hingga bersih. Diberikan preoksigenasi,
kemudian diberikan propofol 7,5 mg, setelah pasien tertidur,
diberikan rocuronium 3,5mg dilakukan intubasi dengan ETT non
spiral no.3
Kemudian dihubungkan kembali ke sirkuit anesthesia (Jackson
Rees,gas flow 3lpm) Maintenance dengan sevoflurane 2-3 vol%.
O2:N2O=50:50%.
Sebelum insisi diberikan fentanyl 5 mcg
Dilakukan penggantian darah yang hilang dengan darah
Mencegah hipotermia
.

Post operatif
Analgetik post op dengan
paracetamol 4x10 dan fentanyl
Ruang rawat

Anesthetic management of
duodenal atresia case
Incidence: 1 in 2500-5000 live births
In 25-40% of cases, the anomaly is
encountered with trisomy 21
Down syndrome
Treatment: duodenoduodenostomy in
the newborn period.

Differential diagnosis of neonatal


upper GI obstruction
Esophageal atresia
Malrotation with midgut volvulus
Pyloric stenosis
Duodenal atresia and stenosis
Annular pancreas

Presentation
Onset of vomiting within hours of birth.
Vomitus is most often bilious, it may be
nonbilious because 15% of defects
occur proximal to the ampulla of Vater.
Duodenal stenosis baby might present
later with above complaints
Scaphoid abdomen with epigastric
fullness.

Medical management before


definitive surgery
Dehydration, weight loss, and electrolyte
imbalance soon follow unless fluid and
electrolyte losses are adequately replaced.
If intravenous (IV) hydration is not begun, a
hypokalemic/ hypochloremic metabolic
alkalosis with paradoxical aciduria develops,
as with other high GI obstruction.
An orogastric (OG) tube in an infant with
suspected duodenal obstruction typically
yields a significant amount of bile-stained
fluid

Pre-op preparation
Adequate intravenous (IV) hydration,
Total parenteral nutrition,
Gastric decompression are essential
until the neonate has been stabilized for
surgical repair.
Special attention to cardiac and
pulmonary function before undertaking
duodenal repair

Intra-op management
Standard monitoring
Thorough suctioning of the NG tube.
Pre-oxygenation adequately.
RSI
Maintenance with proper analgesia and
anesthesia (inhalational / I.V)

Intra-op suctioning of the NG tube


might be needed
Also manipulation of NG tube might
be needed during the repair, take
proper care for ETT.

Post -op
Proper analgesia
i.v fluid management
Oral fluid allowed only after passing
flatus and or drainage from the OG is
less than 1 mL/kg/h and is clear.
Feeding can then be advanced slowly
by mouth.