DR DR D C Lalenoh MKes SpAnKNA KAO-Kul Pakar Bencana Perut 1-5-14

Persiapan anestesi pada
operasi emergensi bedah

perut
kuliah pakar modul bencana perut
Dr. dr. Diana C Lalenoh, M.Kes, SpAnKNA, KAO

Departemen Anestesiologi dan Terapi Intensif
Divisi Neuroanesthesiology and Critical Care-
Divisi Obstetric Anesthesia
Fakultas Kedokteran UNSRAT/RSU.Prof.RD.Kandou
Manado
Dr.dr.D.Lalenoh,M.Kes,SpAnKNA,KA
5/28/17 1
O-Kul Pakar Bencana Perut
Tujuan instruksional
Mengetahui permasalahan preoperatif pasien
operasi bedah perut emergensi.
Mengetahui permsalahan intraoperatif pasien
operasi bedah perut emergensi.
Mengetahui permasalahan pascaoperatif pasien
bedah perut emergensi
Mengetahui penatalaksanaan preoperatif pasien
operasi bedah perut emergensi
Mengetahui penatalaksanaan intraoperatif pasien
operasi bedah perut emergensi
Mengetahui penatalasanaan pascaopepratif
pasien bedah perut emergensi
5/28/17 2
PENYAKIT /DIAGNOSA pasien yang akan
menjalani bedah perut emergensi:
Appendicitis
Peritonitis
Obstruksi
Diverticulitis
Rupture Aneurisma Abdomen
Acute Abdomen in Pregnancy: Solutio placenta,
kehamilan ektopik terganggu, kehamilan disertai
torsi kista, hamil dengan appendicitis akut.
Perforasi Gaster
Invaginasi
dll
5/28/17 3
Problem PREOPERATIF pasien yang
akan menjalani bedah perut emergensi
Fluid deficit that may require correction prior to

surgery how long the patient has been without
normal oral fluid intake and whether or not he has
been exposed to extenuating circumstances or other
sources of fluid loss such as vomiting.
The time course and severity may result in
dehydration, increases in plasma osmolality. An
additional consideration is the lack of oral intake after
midnight experienced by most colorectal patients.
Bleeding (blunt & sharp abdominal trauma, ectopic
pregnancy,placenta praevia) etc.
Shock
SIRS; Septic
5/28/17 4
Emergent Concerns
5/28/17 5
Emergency Presentations
Unstable Vital Signs:
Fever > 102 F
Hypotension Shock?
Decreased urinary output
Incidence of hypertension
Tachycardia >120 bpm X 4 hours
Tachypnea
Hypoxia
A state requiring pharmacologic or mechanical support to
maintain a normal blood pressure or adequate cardiac output
Abdominal pain or colic
Nausea + Emesis
Full of gastric contents Need NGT?
Increased risk for aspiration due to small volume of stomach
Leaks and Sepsis
5/28/17 6
Out of range clinical Perfusion Failure
measurements (Shock)
5/28/17 7
Pre-Operative
Assessment
Conventional Assessments of fitness for anesthesia
and surgery cannot be followed
Rapid assessment and intervention to stabilise the
patient
5/28/17 8
In admitting a patient for surgery the
following questions should be answered:
Is the diagnosis firmly established?
Has the disease and the procedure been
adequately explained
Is there a need for further assessments to stage
the disease or to deal with other diseases?
How risky is the operation?
Are corrections of blood volume, nutritional status
or electrolyte imbalances needed?
What are the prophylactic measures needed?
What are the particular preparations required prior
or during the surgery ?
Is a cross match needed?
What is the likely course immediately post-op?
5/28/17 9
The preoperative Assessment
History
CVS ( MI), RS, Smoking, BP, DM, Bleeding diathesis,
CVA.
Drugs, Allergies and Alcohol.
Reactions to Anaesthesia.
Examination
CVS, RS, nutritional status, mental status.
Neck, Jaw and presence of dentures.
Investigations
Routine
Special
5/28/17 10
The Diagnosis
This can be established by a combination:
The Patients Document:
The Chronology of OPD notes.
The Chronology of correspondence or consultations.
Report of lab., radiological & histopathological
investigations.
The Patient:
Complete history and physical examinations
Note any changes in symptoms or signs.
The family or relatives
Complete any missing links.
Ask for any voluntary information.
5/28/17 11
Risk assessment
Importance & Aims:
Patient selection:
Finding the balance between benefit vs risk
Provides a guide to the degree of support
required in post-op period.
Provides a data base for risk adjusted
outcomes.
5/28/17 12
Risk Assessment
Risk Factors I
Age
Cardiovascular
Respiratory diseases
Smoking
GI: malnutrition, Jaundice & Adhesions
Renal dysfunction
Haematological disorders
Obesity
Diabetes
Surgeon and Operative severity
Emergency
Drugs
5/28/17 13
Risk Factors II
Obesity
Age BMI> 30
Distinction must be Increased risk in:
made between DVT,
physiological state and Wound infections &
chronological age. Dehiscence
Are less mobile, Respiratory
intercurrent disease, complications & sleep
less physiological apnoea.
reserve.
Intercurrent diseases.
Operative difficulty
Caution with regards to:
IVF & Narcotic
Relative risk of mortality
analgesia. 3-5
More likely to have Advise controlled wt
wound infection. reduction
In 65 CVA 1%, In 80 CVA Arrange ICU post-op
3%
5/28/17 14
Risk Factors III
Cardiovascular Diseases
Predictors: CPCEN
Major: Action:
Unstable coronary Evaluation:
syndrome. Clinical, Specialist opinion, ECG,
Decompensated CCF. Stress ECG, CXR, Echo
Significant Arrhythmias ..others
Severe valvular disease
IF Major:
Intermediate:
Cancel unless life
threatening
Mild angina Consider CABG prior to
PMH MI elective surgery.
Compensated CCF If intermediate:
DM Objective performance.
Minor Hypertension:
Age, abnormal ECG..etc
Indicates CAD
More likely to develop
hypotension during surgery.
Control prior to surgery.
5/28/17 15
Risk Factors IV
Respiratory diseases
Estimate function: Smoking
Clinical and Specialist opinion. 10 cigr.=6 fold increase in
ABG post-op respiratory
CXR complications.
Spirometry: FEV1/FVC, PEFR Respiratory and CVS effects
Chest infection: Carbon monoxide has higher
Postpone for 2 weeks affinity for O2 than Hb.
Antibiotics & Physio. Nicotine increases heart rate
COAD and BP.
Leis with specialist Hypersecretion of thick
Reschedule surgery.
mucus
Plan to transfer to ICU for Immunosuppressive
mechanical ventilation Stop 3 months= improve
pending:
pulmonary functions
Lung function, type & Stop 1-2 days= Decreases CO
duration of surgery.
levels.
5/28/17 16
Risk Factors V
Gastro intestinal diseases
Malnutrition
Loss o15-20% of body wt is Jaundice poses a risk for:
associated with severe Sepsis
impairment of physiological Clotting disorders
function Renal failure
No evidence of benefit of Liver failure
preop feeding. Fluid and electrolyte
abnormalities
Adhesions: Drug metabolism
Higher risk of bowel injury Management:
and subsequent fistula Vit k & FFP
formation Adequate hydration and
Longer duration of surgery
diuretics & oral Lactulose
Antibiotics
Nutrition.
5/28/17 17
Risk Factors V
Diabetes
Interest to the surgeon:

Patients are more sensitive
to protein depletion, U&E&
glucose imbalance.
Surgical stress can NSC Minor LA
precipitate DKA.
DKA is a cause of acute 4 hourly close Type II
abdomen observations GA
Decreased phagocytosis, Omit dose in mane.
Management:
neutrophil activation and Specialist
Either lowOpinion
dose infusion
required
antibody production or fixed dose insulin
Small vessel disease
GIK Type I GA
Peripheral vascular disease
G: 500 ml 10% dextrose
Peripheral neuropathy
I : Insulin sliding scale
Autonomic neuropathy
K : Potassium 10 mmol
Recognition of Continue till first light
hypo/Hyperglycaemic meal
attacks
5/28/17 18
Risk Factors V
Renal & haematological Disorders
Renal:
Anaemia
Correction 1 week pre-op
Identify the cause: Correction day preop is
Pre-renal, eg: cardiac, undesirable
hypovolaemia Haemodilution
Renal, eg: acute
tubular necrosis( drug Thrombocytopaenia
induces) In splenomealy, Platelets must be
Post renal, eg: transfused immediately preop and
obstructive uropathy. on ligating the arterial supply.
Identify pt for renal Sickle cell disease

dialysis. Crisis caused by : dehydration,
infection, hypoxia, hypothermia.
Check K levels
Jaundice & anaemia
Splenic infarctions: sepsis
Prevention: Warm, well hydrated,
Accurate fluid balance well analogised
Look for signs of fluid Consider exchange transfusion in
overload. SS
Do not misinterpret
poly ureamic phase Correction of coagulopaties
5/28/17 19
Risk Factors
Operative Severity
Minor:
Procedures under LA, Uncomplicated hernia
Moderate:
Appendicectomy, Cholecystectomy
TURP
Major:
Laparotomy, Bowel resection
Major+:
AP resection, hepatioco-pancreatic surgery
Emergency surgery.
5/28/17 20
Risk Factors
ASA ( American Society of Anaesthesiologist)
Physical Status Class

Normal healthy individual 1
Mild-moderate systemic disease eg: DM, 2
BP
Severe systemic disease, NOT 3
incapacitating eg: CCF with limited
exercise tolerance
Incapacitating disease, constant threat to 4
life. with or with out surgery eg:
Uncontrolled angina
Moribund pt not expected to live, surgery 5
is the last resort.
Patient requiring emergency surgery. E
5/28/17 21
Anesthetic Management
Preoperative Assessment
Laboratory Investigations
Monitoring
Induction
Maintenance
Recovery / Shifting to ICU
5/28/17 22
A
Primary Survey B
C
D
E
DIAGNO
ASSESS TREAT
SE
5/28/17 23
Airway
Breathing Diagno
Assess Treat
Circulation se
Disability (Neurology)
If not assessed, diagnosed and treated immediately you

may not have a live patient on the operating table
5/28/17 24
Airway Assessment
Assessment of patency and anatomy
Difficult Laryngoscopy with risk of
failed intubation
Beware of
C- Spine Injury
Full Stomach
5/28/17 25
Difficult Airway - LEMON
Look
Surgery
Evaluate Hematoma
Mallampatti Obesity
Radiation
Obstruction Tumor
Neck Mobility
Low Threshold for Surgical Airway
5/28/17 Assess neck for access ( SHORT)
26
Treat
Simple airway maneuvers- Jaw Thrust,
chin lift
Simple airway adjuncts- oral, nasal
airways
Endotracheal Intubation Gum elastic
bougie
Surgical Access - Cricothyroidotomy
5/28/17 27
Breathing with ventilatory
support
Respiratory rate Bradypnoea,
tachypnoea
Breath sounds- 5 life threatening
conditions
Oxygen saturation very useful if
signals are picked up
5/28/17 28
Anticipated problems needing
intervention
1. Tension pneumothorax
2. Massive Hemothorax
3. Open Pneumothorax
4. Flail Chest
5. Cardiac Tamponade
Treatment Intercostal drain insertion

Sealing of the wound
5/28/17
Intubation & ventilation
29
Circulation
Assessment of circulatory state
Pulse Rate, Volume, character,
Cold extremities
Level of Consciousness
Blood Pressure Potentially late sign
Shock Index Heart Rate <0.7

Systolic Pressure
Higher the ratio poorer
5/28/17
the prognosis
30
5/28/17 31
Diagnose-5 places to look
for
External
Long bones
Chest x ray chest
Abdomen - FAST
Pelvis and Retro peritoneum
Shock in a multiply injured patient is

hemorrhagic shock unless proved otherwise
5/28/17 32
Treat- Management of shock
Stop Bleeding
Surgical intervention /
interventional Radiology
2 large bore canulae peripheral
send for group, cross matching - lab
2 litres of warm crystalloids ???
Exsanguinating hemorrhage o -ve
packed cells
5/28/17 33
PREOPERATIVE HYPOVOLEMIA
(NON TRAUMATIC/ NON
BLEEDING CASES)
Based on those alterations, some
authors suggest that low levels of
crystalloid replacement (<500 mL) may
improve subjective sensations such as
thirst, whereas large volumes of
replacement (2 L) improve postoperative
symptoms such as dizziness and nausea.
5/28/17 34
Fluid resuscitation
Early Transient Non
responders responders responders
Definitive Damage control Life Saving

surgery surgery Surgery
5/28/17 35
5/28/17 36
Neurological
Quick GCS
Secondary Neurological damage
Hypoxia
Hypotension
Hypercapnia
Permissive Hypotension probably is not to be

advocatedDr.dr.D.Lalenoh,M.Kes,SpAnKNA,KA
for head injured patients
5/28/17 37
Radiology
X rays
Chest
Pelvis
C Spine lateral view
FAST
CT ????
Do Not Shift Hemodynamically unstable

patient to Radiology Room
5/28/17 38
Lab
Hb/ Hct
Screening
Sugar
Lactate
Group/ cross match
Coagulation
PT INR
APTT
5/28/17 39
Shifting of Patients from
Resuscitation Suite
Primum Non nocere Dont think
Only down the corridor
Airway
Ventilation
Fluids and drugs
Monitoring
Check Battery of ventilators, Oxygen
cylinders, Syringe pumps
Only half way through PS Beware of
undiagnosed injuries
5/28/17 40
Positioning
Beware lines- tubes- bags
All are inserted as they are important
so keep them accessible
Take care of fractured limbs
Every shifting in a hypovolemic
patient can cause further fall in blood
pressure
5/28/17 41
Monitoring
Basic Monitors
Pulse Oximetry, ECG, Temperature, NIBP
Invasive Arterial blood pressure-
Dont waste time in getting an arterial

line-
can be placed after surgeons have

started hemorrhage control
CVP PCWP ??
5/28/17 42
DASAR DASAR
ANESTESIA I
Dr. dr. H. J. Lalenoh, SpAnKMN, KAO
5/28/17 43
General Anestesia (GA)/Anestesia
Umum
Definisi : Suatu keadaan dimana terjadi

kehilangan kesadaran secara reversible
yang disebabkan oleh obat anestesia,
disertai oleh hilangnya sensasi nyeri
diseluruh tubuh.
Trias G.A. :
1. Hilangnya Keasadaran (Sedatif
Tidur)
2. Analgesia
3. Penekanan Refleks (Supresi Refleks)
5/28/17 44
JENIS-JENIS TEKNIK GA
1. Pemberian melulu obat-obatan

parenteral :
Pentothal
Ketamin
Propofol, dll
2. Pemberian melulu obat-obat inhalasi :
a. Volatile :
Halotan
Isofluran
Sevofluran, dll
b. Gas : N2O
5/28/17 45
3. Pemberian obat-obat parenteral &
inhalasi :
a. Parenteral :
Pentothal
Ketamin
Propofol, dll
b. Inhalasi (Volatile) :
Halotan
Isofluran
Sevofluran, dll
c. Inhalasi (Gas) : N2O
5/28/17 46
Teknik General Anestesia
:
Persiapan Pra-Anestesia

Induksi Anestesia

Stadium Anestesia Yang Diinginkan

Maintenance Anestesia

Mengakhiri Tindakan Anestesia

Fase Pemulihan Ruang Pulih (R.R.)
5/28/17
47
CONTOH TEKNK GENERAL ANESTESIA :
1.Persiapan praanestesia (di ruang pre-operatif) :

Pemeriksaan ulang tensi, nadi, resp, temp, dll
Cek ulang ada gigi palsu, gigi goyah
Cek Ulang hal-hal yang merupakan kontra-
indikasi anestesi (lihat kuliah persiapan pra-
anestesi)
Pemasangan infus harus ada vena terbuka
Premedikasi obat apa yang akan diberikan
i.m. (1/2 1 jam pra anestesia), atau
i.v. (5 pra anestesia)
Transport pend dari ruang pra-operatif ke ruang
bedah
Menyiapkan obat-obat anestesia yang akan
dipakai dan obat-obat yang diperlukan pada
keadaan darurat /
obat-obat untukDr.dr.D.Lalenoh,M.Kes,SpAnKNA,KA
5/28/17
resusitasi jantung paru 48
2. Induksi anestesia: Bisa dengan
obat parenteral atau obat inhalasi
atau kedua-duanya
a. Parenteral :
@ Tiopenton
@ Ketamin
@ Propofol
@ Midazolam , dll
b. Inhalasi :
# Halotan
# Ether
# Halotan + N2O/O2
# Enfluran + N2O/O2
5/28/17 # Sevofluran , Bencana
dll Perut
O-Kul Pakar
49
3. Stadium anestesia yang diinginkan Stadium III
Plane 2 atau 3
4. Maintenace anestesia Dosis obat dikurangi
untuk
mempertahankan penderita pada stadium
anestesia yg
diinginkan, dengan obat-obat seperti :
* Ether
* Halotan + N2O/O2
* Enfluran + N2O/O2
* Isofluran + N2O/O2
* Sevofluran , dll
5. Mengakhiri tindakan anestesia Obat
anestesia
dihentikan pemberiannya
6. Fase Pemulihan Di ruang pulih (Recovery
Room)
Monitoring penderita Refleks -refleks (+) / sadar

Penderita bisa kembali ke ruangan.
5/28/17 50
Problem INTRAOPERATIF pasien yang
akan menjalani bedah perut emergensi:
I. Problem respirasi :
1) Depresi pernapasan Penyebabnya o/k:
- Tekananan intraabdominal
- Penekanan terhadap diafragma
- Penyakit dasar yang menyebabkan kejadian bencana perut
- Premedikasi narkotik >>

2) Obstruksi Jalan Napas Penyebabnya :
Lidah jatuh menutup farings
Pipa Endotrakeal tertekuk / tersumbat
Laringospasme
Bronkospasme
Lendir, gigi palsu, perdarahan, dll
3) Pernapasan tidak adekwat Penyebabnya airway (jalan napas)

tidak bebas, ataupun stadium anestesia agak dalam CO2, O2
(Hiperkarbia, Hipoksemia/Hipoksia) :
Denyut jantung
Tensi
Takipnu
5/28/17 51
II. Problem kardiovaskuler :
1) Hipotensi Penyebabnya :
Perdarahan (luka operasi)
Penyakit yang mendasari kejadian bencana perut
Obat premedikasi atau induksi atau maintenance anestesia
2) Hipertensi Penyebabnya:
Kesakitan, CO2 , O2
Riwayat hipertensi sebelumnya (yg tidak terdeteksi atau sudah ada
sebelumnya)
3) Takikardi Penyebabnya :
Refleks fisiologis pada hipotensi
Penyakit dasar yang menyebabkan bencana perut
Dehidrasi, hipovolemia
SIRS, Sepsis
Kesakitan
CO2 , O2
Kelainan irama/kelainan jantung yang mendasari sebelumnya
Obat premedikasi (vagolitik), Obat anestesia
4) Bradikardi Penyebabnya :
Vagal refleks
Kelainan irama/kelainan jantung yang mendasari sebelum ya
Rangsang parasimpatis o/ pembedahan
Obat anestesia
5/28/17 52
5) Gangguan irama jantung Penyebabnya:
Gangguan irama jantung sebelumnya
Penyakit yang mendasari kejadian bencana perut
CO2
Kesakitan
Obat anestesia
6) Syok (Hipotensi, Takikardi, Nadi Kecil, Akral Dingin)
Penyebabnya:
Peradarahan (luka operasi)
Reaksi anafilaktik (obat anestesia)
7) Henti jantung (cardiac arrest) Penyebabnya (point 1 - 6
yang dibiarkan / tidak diatasi) Resusitasi jantung paru.
III. Muntah & Regurgitasi :

Bersihkan jalan napas (miringkan pend & rendahkan kepala
pend)
Pasang nasogastric tube
Intubasi endotrakeal
IV. Malignant - Hyperthermia:
Terutama beresiko pada pasien dengan febris sebelum
5/28/17
operasi (temp 380O-Kul
C) Pakar Bencana Perut 53
hal Yang Harus Diperhatikan
1. Apakah kebutuhan O2 cukup Lihat pada

warna darah dari luka operasi, warna kuku,
dll.
2. Jumlah perdarahan Apakah cukup
dengan cairan infus atau perlu transfusi.
3. Apakah derajat relaksasi otot cukup, mis.
pada operasi abdominal Anestesia perlu
didalamkan atau pemberian obat
pelumpuh otot.
4. Observasi akibat yang ditimbulkan oleh
manipulasi operasi,
5/28/17
misl : traksi pada
54
Problem PASCAOPERATIF bedah perut
emergensi YANG HARUS DIPERHATIKAN:
- Support ventilasi post operasi Perlu Ventilator? Rawat ICU

- Apakah tetap terintubasi? Berapa lama?
- Apakah perlu support kardiovaskular? Kalau perlu
vassopressordengan infus pump atau syringe pump titrasi
- Bagaimana Intake dan maintenance cairan
- Bagaimana Intake nutrisibila perlu parenteral nutrisipasang CVP
- Bagaimana Balance Cairan?
- Bagaimana seluruh sistem tubuh? Breathing, Blood, Brain, Bowl,
Bladder, Bone (6B)
- Koreksi: electrolyte imbalance, fluid deficit, hypoalbumine,
hypoproteinemia, malnutrition, hypo/hyperthermia, arrhytmias,
hypo/hyperglycemia , dan kelainan lain
- Pemberian Antibiotik dan obat lain
- Mobilisasi/fisioterapi
- Rawat bersama sejawat lain/disiplin ilmu terkait
5/28/17 55
Postoperative Nutrition
Purely restrictive procedures
Gastric Banding, Sleeve Gastrectomy, Vertical Banded
Gastroplasty
Daily multivitamin
Monitor protein intake
1 gm protein/kg ideal body weight/day
Primarily Restrictive with some malabsorption
Gastric Bypass
Calcium, Iron and B-complex vitamins supplemented
at higher than daily recommended levels
Prioritize protein intake
5/28/17 56
Apparatus Anestesia lain yang sering dipakai
Berikut ini adalah gambar contoh alat-alat

anestesia :
1. Endotracheal tube (= pipa endotrakeal) :
Ada dua tipe : # Oro-trakeal
# Naso-trakeal
2. Oropharyngeal tube (= gudel) :
5/28/17 57
5/28/17 58
3. Laryngoscope :
4. Ambu - bag
Ambu bag (= Air - Viva) :
5/28/17 59
Laryngeal Mask Airway (LMA)
5/28/17 60
Face Mask Corrugated - Anesthesia
apparatus - Bag
5/28/17 61
Face Mask
5/28/17 62
Anaesthesia Machine
5/28/17 63
Anaesthesia Machine
5/28/17 64
refferences
Bamboat ZM, Bordeianou L Periooerative Fluid Management. Sweeney
WB (Ed). Perioerative Management and Anesthesia. Clinics in Colon and
Rectal Surgery. Journal List Clin Colon Rectal Surg v22(1); Feb 2009.
Bhat R. Anesthesia for Emergency Surgery in Hemodynamically
Unstable Patient. Ganga Hospital Coimbatore.
Kadowaki M. Perioperative Care of The Bariatric Patient. Wellmont
Surgical Semas Heysprint Tenessee.
AlAmoudi AB. Preoperative Assessment.
Leonard A, Thompson J. Anesthesia for Ruptured Abdominal Aortic
Aneurysm. Continuing Education in Anaesthesia, Crit Care & Pain;
8(1):2008: 11-6. Downloaded from
http://ceaccp.oxfordjournals.org/by guest on April 21 , 2014.
Chhetri RK, Shrestha ML. A Comparative Study of Preoperative with
Operative Diagnosis in Acute Abdomen. Kathmandu University Medical
Journal; 3(2): 2005: 107-10.
Kilpatrick cc, Monga M. Approach to The Acute Abdomen in Pregnancy.
Obstet Gynecol Clin N Am; Elsevier Saunders: 2007: 389-93.
Lalenoh HJ. Dasar-Dasar Anesthesia I. Kuliah Anestesiologi. FK UNSRAT,
2010.
Lalenoh D. Dasar-Dasar Anesthesia IIb-III. FK UNSRAT, 2010.
5/28/17 65

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Persiapan anestesi pada

operasi emergensi bedah

kuliah pakar modul bencana perut

Dr. dr. Diana C Lalenoh, M.Kes, SpAnKNA, KAO

Fluid deficit that may require correction prior to

Interest to the surgeon:

Identify pt for renal Sickle cell disease

Physical Status Class

If not assessed, diagnosed and treated immediately you

Treatment Intercostal drain insertion

Shock Index Heart Rate <0.7

Shock in a multiply injured patient is

Definitive Damage control Life Saving

Permissive Hypotension probably is not to be

Do Not Shift Hemodynamically unstable

Dont waste time in getting an arterial

can be placed after surgeons have

Dr. dr. H. J. Lalenoh, SpAnKMN, KAO

Definisi : Suatu keadaan dimana terjadi

1. Pemberian melulu obat-obatan

1.Persiapan praanestesia (di ruang pre-operatif) :

3) Pernapasan tidak adekwat Penyebabnya airway (jalan napas)

III. Muntah & Regurgitasi :

1. Apakah kebutuhan O2 cukup Lihat pada

- Support ventilasi post operasi Perlu Ventilator? Rawat ICU

Berikut ini adalah gambar contoh alat-alat

2. Oropharyngeal tube (= gudel) :

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