LVP

MEIGS SYNDROME
- Benign tumor
- Efusi pleura
- Ascites

Management
1. Pre op
- RO Thorax Ascites/ sesak,
berpengaruh/

tidak

re-

breathing, albumin rendah/

tidak.
2. Intra op
- Perhatikan pooling effect
- Ascites >> penekanan

PA

PAD

9-16

15- 4-12

hig >12

>25

30
>3

>12

h
....

>35

0
>4

>20

>18

....

....
Pulmonary circulation has therefore
been very difficult with drugs
N2O inhalasi

vena cava inferior venous

Prostaglandin

return menurun cardiac

phosphodiesterase

inhibitor

output turun
Managemen cairan yang baik

(sidenofil)

pulmonary

PROPOFOL

(>48 jam)
Increased

mg/kg/jam)
Tandanya:

dan

vasodilators

INFUSION

SYNDROME (MORGAN)
- >> pada critically ill children
- Long term propofol infusion
doses

asidosis

(>

rhobdomiolin,
metabolik,

hemodinamik

instable,

hepatomegali, multiple organ

disfunction.

2-8

MPA

PULMONARY
PRESSURE (MULLER)

ARTERY

ANATOMIC
SYSTEM

NERVOUS

Autonomic Nervous System

Parasimpatis

Simpatis
Paraganglionare
Cholinergic Ach

Paraganglionare

Cholinergic Ach (nicotinic))

Postganglion

Ganglion
Postganglion
Cholinergic Ach (muscarinic)

Endorgen

Endorgen

Simpatis

cathecolamines
1. Nor epinephrine
- Binds + receptor
-1 adrenergic meningkatkan

sinaps to adrenergic reseptor

Include 1, 1, 2, 3
-Nor epinefrin 2 reseptor
presinaps
-Dopamine D1 postsinaps, D2
presinaps
Parasimpatis
n.cranialis

..............

III,

VII,

IX,

X,

ADRENERGIC
PHARMACOLOGY
A. Endogenous

-Preganglion simpatis Ach

-Norepinefrin + epinefrin post

Dari

Adrenergic NE

SVR
help life 2,5 menit; infus rate
3 mcg/mm
-Vasokonstriksi, pulmoner renal
2. Epinephrine
-Binds + receptor
-Positif inotropy, chromotropy
(1)
- ................................................
(2)
-Vasokonstriktor (1)
3. Dopamine
-, , dopaminergic receptor

-stimulating

norepinephrine

release from vesicles

-Continous infusion 0,5
mcg/kg/...
-D1...........
-1meningkatkan

-Reduce

norepinephrine
-Sedative, ..............., analgetic
1. Clonidine
-Selective 2 adrenoreceptors
-...........
-Lobitolol ............. syndrome
2. Detmedofomide
-Dosis 0,3-0,7 mcg/kg/jam
-Meningkatkan
sedatif,

cardiac

contractility
B. Syntetic cathecolamines
1. Isoproterenol
-Nonselective

adrenergic
stimulation
-1 >> 2 adrenergic
2. Dobutamine
-Dammand 1 effect
-............ in CHF/miocard infark
-Waspada takikardi
3. Fenildopa
-Selective D1 agonist + potent
vasodilators
C. Non
cathecolamines
Simpatomimetik
1. Ephedfine
-Meningkatkan tekanan

analgesia,
Mengurangi

SELECTIVE

2 ADRENERGIC RECEPTOR

ADRENERGIC

RECEPTOR

effectpf N.E
-...........................
3. .................
-2 antagonist

RECEPTOR AGONIST
1 Adrenergic Agonists

ADRENERGIC ANTAGONIST
for
IHD,
post
........
management,

aritmia,

kardiomiopati, hipertensi, gagal

mcg/mm
->> 1 mg SVT

-Simpatolitik

CO,

ANTAGONIST
1. ...................
1 + 1antagonist
2. Prazosine
-Potent selective 1 blocker
-Antagonist
vasokonstrictor

ADRENERGIC

2 Adrenergic Agonist

HR,

AGONIST
-.................. airway......
-Ventolin

darah

1. Phenilephome
-Selective 1 agonist
-Pheripheral vasoconstrictor
-Bolus 40-100 mcg; inf 10-20

amnesia.

circulating cathecolamine

dan ..............

peripheral

jantung, migrain, glaukoma.

Propanolol, ..................., ...........
...........

DM ................... or long terms

adrenergic antagonist.
adrenergic blockers
1. Propanolol
-Non selective blockers
-Bolus 0,1 mg/kg
2. Metoprolol
3. .................
- Competitor antagonist 1 dan
-

adrenergic
4. Esmolol

Ach effect HR meningkat,

sedasi, ...............
Atropine,

glikopriolote,

skopolamine

Antisialogu
g
Sedatif
Inc........
CNS ..........
.....
..................
...
Midriasis
HR

Physostigmin,

..................
...................

Scopolami
ne
+++

+
0
+

+++
0
++

++

++

+
++

+++
0/+

2. Cholinesterase inhibitor
Impair
the
activation

Ach

neuromuscular

dari

VACTERL
-Vertebral anomalies
-Anal atresia
-Cardiovascular anomalies
-Tracheoesup..... fistula
-Renal and/or ....... anomaly
-Limb defect
WHO

three

steps

analgetic

ladder for cancer pain

Step I mild cancer pain non
analgetics

adjuvant

medication
Glikopriolot
Step II moderate cancer pain
weak

opioid,

non

opioid

analgesic, + adjuvant medication

Step III severe cancer pain
strong

opioid,

non

opioid

analgesic, + adjuvant medication

on

WEAK OPIOIDS

Hidrocodone

..................

lorech,noico

system

cholinergic agonist at nicotinic

and muscarinic receptor.

dengan

.......................

...............by the cholinesterase

and

NMBA

meningkatkan

opioid

Atropin
e
+

neostigmin,

junction.

CHOLINERGIC

PHARMACOLOGY
1. Antagonis muscarinic
- Kompetitor Ach release, blok

Lortob,

vicodin,

Codeine : tylenol 3, 4
Propotyrhene : dorvan, darvocol

subcutaneous

STRONG OPIOIDS

Morphine

mediasternal emphyema)
Bleeding
Chylothorax
Arterial injury/ ............
Air embolisme
Nerve injury
Disritmia
-Secondary to in situ catheter

MPIR,

msantin,oromosph, .........
Oxycodone

CR

roxicodone,

oxicantrin
Fentanyl : duragesic, .........

or

Hydromorphine : blaudid

ICU
-Koreksi FiO2

Methadone : dolophine

Rumus:

Oxymorphine : neuromorphane

A (713 x FiO2) (1,25 x PCO2)

B(

CENTRAL

VENOUS

CHATHETERIZATION
1. Indikasi
-Monitoring: CVP, Pulmonary
artery chatheterization
-Therapeutic Intervention:
Hemodialisis
Temporary
transvenous
pacing
Aspiration of air emboli
Infusion of vasoactive drugs

A x 80
PO 2 )
B+(1,25 x PCO 2)
713

FiO2 koreksi = C
-Pemberian Oksigen
Nasal canule 1-2 l

or total parenteral nutrition

Need for reported blood
sampling
Cannulae placement
Inadequate
peripheral
venous ..........
2. Komplikasi
-Secondary
to
palcement:
Airway/

Lung

(pneumothorax, su

catheter
injury

0,21 0,24

2l

0,24 0,26

3l

0,27 0,3

4l

0,31 0,38

5l

0,38 0,4

Masker rebreathing
0,75

FiO2

7l

0,35

10 l
Masker NR

0,65 1,00

150 mEq/ L) morgon, or at least

until symptoms have abated.
Contoh kasus:
Seorang laki-laki usia 80 tahun

4-10 l 0,4 1,00

CHRONIC HYPONATREMIA
brom

cells

dengan Na+ 160 mEq. Target

berusaha

mempertahankan

normalnya Na+ 140 mEq. TBW

volume

60% BB.

intrasel dengan mengeluarkan

osmolaritas
kalium

dan

yang

isinya

onions.

Ketika

Normal TBW x 140 = present

TBW x Na+ plasma atau
(70 x 0,6) x 140 = present

Present TBW = 3,67 liter

TBW=x 160
Water defect
normal TBW

hiponatremia dikoreksi, sel otak

harus

persen TDW atau (70 x 0,6)

mengembalikan

osmolaritas

36,7 = 5,3 liter

Jadi koreksinya: 5% Dextrose,

dengan

mengumpulkan effector .....

5300 cc over 48 h olw 110 ml/h

atau air yang mengakibatkan

hipertonic

......

sehingga

Hyponatremia

menyusut. Penyusutan tersebut

Nonosmolaritas = hyponatremia <

ditandai dengan ......................

138 mEq/ l (Morgon)

dan ettrapontme yang ditandai

dengan quadraplegia, seizures,

Symptoms:

..........................

Letargy, Apathy, muscle cramps.

breath,
Correction should not except 1-1,5
per

jam,

seizures,

koma,

death,...........

................
Treatment:

peningkatan 12 mEq/ l.

Nausea,

Signs: disorientasi, cheyne stokes

Koreksi awal 10 mEq/ l

mEq/l

Anoreksia,

-Loop

ANEST........
CONSIDERATIONS
Elective surgery should
postponed

in

patients

significant

hyponatremia

be
with
(>

diuretic,

solve

if

only

necessary
Acute symptomatic hiponatremi
........ probably

Hypertonic saline + furosemide,

dextrose in water) dalam 48

serum

checked

jam. Kecepatan tidak boleh

frequently
Chronic ............... hyponatremia

lebih cepat dari 0,5 mEq/ L/

electrolit,

should be corrected slowly to

avoid

risk

of

demyelmotion

osmotic

jam.
-Normal TBW x 140 = persen
TBW x .......
Stooltmy Na > 145 mEq/L

ELECTROLITE
DISTURBANCES
1. HYPERNATREMIA (Na+ > 158

Symptoms:

poliuria,

polidipsi,

ortostatis, restlessness, irritability,

letargia.

mEq/L)

Signs: ...................., ....................,

..............

tremor, atasia, muscle spastrecty

Lethargy coma

focal and generated seizures, dialh.

............... deadth
Hypernatremia

Biasanya karena pemberian Na 3%,

hiperaldosteronemia,

cushing

syndrome.

Euvolemia

Hipervolemia

.....................

.....................

.....................

.....................

.....................

Hipovolemia

Treatment:
-...........

air

biasa

dikoreksi

dengan cairan hipotonic (5%

.....................