Regional Anestesi Subarachnoid Blok

Laparatomi Appendiktomi Pada Laki - laki

Usia 26 Tahun Dengan Appendisitis
Oleh :
Apryana Damayanti AR

Pembimbing
Dr. Albinus Cobis, Sp.An, M.kes
PENDAHULUAN Appendisitis merupakan penyebab abdomen akut
yang dapat mengenai semua kelompok usia.

Apabila tidak dilakukan tindakan pengobatan,

maka angka kematian akan tinggi, terutama
disebabkan karena perforasi, peritonitis dan
shock.

Pada laporan kasus ini akan dibahas secara

komprehensif mengenai appendicitis terutama
dalam segi anestesi.
 Your Picture Here

Anatomi dan
fisiologis
appendiks

Appendiks vermiformis merupakan organ

berbentuk tabung, dengan panjang kira-
kira 10 cm (kisaran 3-15 cm).

Appendiks dapat terletak intraperitoneal

(pada 65% kasus), retroperitoneal, atau di
tepi lateral kolon asendens.
Appendisitis

Definisi
01 Appendisitis adalah peradangan
pada appendiks vermiformis.

02 Periapendikular infiltrate adalah

suatu keadaan menutupnya
appendiks vermiformis yang
meradang oleh omentum, usus
halus, atau adneksa sehingga
terbentuk massa periapendikuler
 Epidemiologi

Insiden appendisitis di Appendisitis dapat

negara maju lebih tinggi ditemukan pada semua
dari pada di negara umur, dan jarang
berkembang dilaporkan insidens
appendisitis yang tinggi
pada anak kurang dari
satu tahun

Insidens tertinggi appendisitis yakni pada kelompok umur

10 atau 20 tahun hingga 30 tahun, dan setelah itu menurun.
Etiopatogenesis
Appendisitis dapat disebabkan oleh infeksi
bakteri.

Berbagai hal berperan sebagai pencetusnya,

yakni antara lain sumbatan lumen appendiks
vermiformis yang dapat disebabkan oleh
adanya hiperplasia jaringan limfe, fecalith,
tumor appendiks, dan cacing askaris.

Appendiks mengalami
Peningkatan tekanan hipoksia, peradangan
obstruksi luminal
intraluminal lumen appendiks, dan
pembesaran appendiks
 Manifestasi klinis
Nyeri mulai di Nyeri pindah ke kanan Nyeri kanan
epigastrium atau bawah dan bawah bila
regio umbilicus menunjukkan tanda tekanan di sebelah
disertai nausea rangsangan peritoneum kiri dilepaskan
dan anorexia local di titik Mc-Burney (Blumberg sign)

Nyeri kanan bawah bila

peritoneum bergerak, Nyeri kanan
Demam disertai misalnya saat napas bawah pada
gejala dalam, berjalan, batuk, tekanan kiri
gastrointestinal mengedan (rovsing sign)
 DIAGNOSIS
Anamnesis
Nyeri epigastrium
Mual muntah nafsu makan menurun
Demam

Pemeriksaan Fisik
Nyeri tekan McBurney
Rebound tenderness
Rovsing sign
Psoas sign
Obturator sign

Pemeriksaan Penunjang
Leukositosis
Peningkatan jumlah neutrofil (shift to the left)
 RADIOLOGI

Pemeriksaan radiologi berupa

pemeriksaan ultrasonografi
(USG) abdomen dapat Pemeriksaan ultrasonografi abdomen
membantu dalam diagnosis memiliki sensitivitas tinggi (86%
appendisitis sekaligus membantu -100%), spesifisitas (88%-95%), dan
dokter ahli bedah untuk akurasi (91%-92%) dalam
mengambil keputusan yang tepat mendiagnosis apendicitis akut.
 Karakteristik Skor

Symptom Migrasi nyeri ke kuadran kanan bawah 1

Avarado Score
Anorexia 1

Nause 1

Signs Nyeri tekan abdomen kuadran kanan bawah 2

Nyeri alih 1

Febris (suhu antara 37,5-38,5 °C) 1

Labaratory Leukositosis (WBC > 10.000/ ul) 2

Shift to the left of neutrophils (> 75%) 1

Total 10
Interpretasi : 1-4 = sangat tidak mungkin appendisitis akut, tetap observasi
5-6 = bisa jadi appendisitis akut, observasi teratur
7-8 = mungkin appendisitis akut, operatif
9-10 = pasti appendisitis akut, operatif
 Diagnosis Banding
Do you need
an online
doctor now? Gastroenteritis

Pelvic Inflamataory Disease (PID)

Kehamilan ektopik terganggu (KET)

Kista ovarium
 Tatalaksana

Bila diagnosis klinis sudah jelas, tindakan paling tepat dan merupakan satu-satunya
pilihan yang baik adalah apendectomy

Pada appendisitis tanpa komplikasi, biasanya tidak perlu diberikan antibiotik,

kecuali pada appendisitis ganggrenosa atau appendisitis perforate

Apendectomy bisa dilakukan secara terbuka atau dengan laparoskopi

Prognosis
• Angka kematian dari appendisitis tanpa komplikasi
sangat rendah. Bahkan dengan appendisitis
perforasi, tingkat kematian pada kebanyakan
kelompok hanya 0,2%, meskipun mendekati 15%
pada orang tua
Komplikasi
• Komplikasi yang paling membahayakan adalah
perforasi yakni appendisitis perforate (sekitar 20%).
 Anestesi
regional
Teknik anestesi regional pertama
yang dilakukan adalah anestesi
spinal, dan operasi pertama
dengan anestesi spinal dilakukan
pada tahun 1898 di Jerman pada
bulan Agustus

Anestesi spinal adalah teknik

anestesi neuraksial dimana
anestesi lokal ditempatkan Memahami anatomi dermatom sangat penting
langsung di ruang intratekal untuk memahami tingkat blokade struktur
(ruang subarachnoid) target.
 Anestesi
Spinal
Anestesi spinal juga disebut spinal
analgesia atau sub-arachnoid block
(SAB), adalah bentuk anestesi regional
yang melibatkan injeksi agen anestesi
lokal ke dalam ruang subarachnoid.

Terlepas dari agen anestesi yang

digunakan, efek yang diinginkan
adalah untuk memblokir transmisi
sinyal saraf aferen dari nosiseptor
perifer Tingkat blokade neuron tergantung pada
jumlah dan konsentrasi anestesi lokal yang
Sinyal sensorik diblokir, sehingga digunakan dan sifat akson
menghilangkan rasa sakit
 Anestesi spinal adalah teknik anestesi regional yang sederhana dan andal yang
01 memberikan sensor blokade motorik dan kualitas tinggi

Pemberian larutan kristaloid yang cepat sebelum anestesi spinal

02 direkomendasikan oleh banyak ahli anestesi untuk mencegah hipotensi.
Preloading secara rutin dilakukan sebelum pembentukan blok neuraxial.

Sekitar 500 - 1000 ml cairan (10-15 ml / kg kristaloid selama 20 menit) atau

03
koloid (seperti 6% hidroksietil pati, 4% suksinilasi gelatin) digunakan

04 Kristaloid dengan cepat bergerak ke ruang interstisial

Posisi yang tepat sangat penting untuk
keberhasilan konduksi anestesi spinal.
Hal ini sering dilakukan saat pasien
dalam posisi duduk atau lateral.
Posisi Lateral Untuk
Di lateral, pasien diposisikan dengan Anestesi Spinal
punggung paralel dengan sisi meja
operasi. Paha tertekuk ke atas, dan
leher tertekuk ke depan .

Dalam posisi duduk, kaki pasien Sitting Position

diletakkan di atas bangku sementara
pasien duduk tegak, kepalanya
tertekuk, lengan memeluk bantal
Anestesi appendicitis laparotomi

Evaluasi
pre
operatif

Evaluasi
peri
operatif

Tatalaksana
post
operatif
 Evaluasi
Preoperatif
Tujuan evaluasi pra operasi
adalah untuk mendapatkan status
medis saat ini dan sebelumnya
Evaluasi preoperasi akan
memberi kemampuan
manajemen pasien perioperative.

Karena masalah medis dapat

mempengaruhi anestesi, dokter
anestesi harus memiliki
pengetahuan dan menanganinya
secara perioperative.

Penilaian risiko pra operasi dilakukan dengan

menggunakan sistem klasifikasi risiko ASA yang
dikembangkan pada tahun 1941
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