Ppk Anestesi

7/25/2019 Ppk Anestesi

1/17

RSUD NGUDI WALUYO

WLINGI

Jl. Dr. Soecipto No. 05 Wlingi

Telp.(0342) 691006

Fax. 691040

PANDUAN PRAKTIK KLINIS (PPK)RSUD NGUDI WALUYO WLINGI

Prosedur Pembiusan Umum denan !e"ni" in!ubasi endo!ra#$ea%

1. engertian (De!ini"i) Tin#a$an %enia#a$an n&eri "ecara "entral #i"ertai 'ilangn&a $e"a#aran #aner"i!at pli' "a#ar $e%ali (re*er"ile)

2. +na%ne"i" 1. ,#enti!i$a"i pa"ien-na%a-%r- ala%at #ll2. i/a&at pen&a$it &ang perna' ata "e#ang #i#erita &ang %ng$in

#apat %ena#i pen&lit ane"te"i "eperti alergi-a"%a-#iaet"%ellit"-pen&a$it par $roni$-pen&a$it antng-'ati #an ginal

3. i/a&at oat &ang "e#ang ata tela' #igna$an4. i/a&at opera"i #an ane"te"i &ang #iala%i5. eia"an r$ pa"ien "e'ari'ari "eperti %ero$o$ #an %e%in%

al$o'ol3. e%eri$"aan Fi"i$ 1. e%eri$"aan !i"i$ %elipti $ea#aan p"i$i"-$ea#aan gii-"&"te%

re"pira"i-"&"te% car#io*a"clar-$epala le'er-%alla%pati-"&"te%"&ara!-$lit-region l%al

4. ,n#i$a"i e%i"an 1. pera"i #i #aera' $epala le'er2. pera"i a#o%en ata" #an a/a'3. pera"i e$tre%ita" ata" #an a/a'

5. la"i!i$a"i +S+ enrt a%erican "o"iet& o ! ane"t'e"iolog& (+S+) pa"ien &ang a$anopera"i #i$ategori$an "eagai eri$t +S+ 1 a"ien #ala% $ea#aan "e'at &ang %e%erl$an opera"i+S+ 2 a"ien #engan $elainan "i"te%i$ ringan "a%pai "e#ang ai$$arena pen&a$it e#a' %apn pen&a$it lainn&a+S+ 3 a"ien #engan ganggan ata pen&a$it "i"te%i$ erat &ang#ia$iat$an eragai pen&ea+S+ 4 a"ien #engan $elainan "i"te%i$ erat &ang "ecara lang"ng%enganca% 'i#pn&a+S+ 5 a"ien &ang ti#a$ #i'arap$an 'i#p "etela' 24 a% /alapn#iopera"i ata ti#a$7 7%ergenc&

6. ro"e#renatala$"anaane%i"an 8%%

1 er"iapan alat

e"in ana"te"i &ang "#a' ter"a%ng #engan o$"igen

aringo"$op


2/17

Sg$p %$a

ipa en#otra$eal ( 7TT)

a&o

Stilet (%an#rin 7TT)

Spit 10cc nt$ %engge%ang$an c!! 7TT

Steto"$op

:onector

le"ter 30 c%

e"in "ction #an $anla "ction

+lat %onitor pa"ien

+ir er"i' #ala% /a#a'

2. er"iapan oat

at in#$"i penotal-propo!ol-$eta%in

at pel%p' otot "cinilcolin-atracri%-norcron #ll

at ana"te"i in'ala"i "e*o!lran-i"o!lran-'alotan

at e%ergenc& "l!a" atropine- ep'e#rine- a#renalin

3. er"iapan a"ien

a. a"ien #ieri ta' tin#a$an &ang a$an #ila$$an "erta

#iper"ila'$an nt$ er#oa

. era/at ana"te"i %engatr po"i"i pa"ien #ala% t i#r

terlentang

c. e%a"ang alat %onitor #an %eng$r tan#atan#a *ital pa#a

pa"ien

#. Do$ter ana"te"i %ela$$an ce$ a#a ti#a$n&a $eocoran %e"in

ana"te"i

e. Sng$p %$a #ileta$$an #i#epan %$a pa"ien- #an #ieri

o$"igen ;10 liter per %enit

!. era/at ana"te"i %e%a"$$an oat in#$"i ata" a#*i" #o$ter

ane"te"i- "egera "etela' pa"ien ti#r &ang #ian#ai #engan

'ilangn&a re!le$ l %ata-#o$ter ana"te"i %elant$an

pe%erian o$"igen le/at "ng$p %$a "a%il "e"e$ali


3/17

%e%eri na!a" atan ila ter#apat 'ipo*entila"i

g. at pel%p' otot #i%a"$an- "etela' pa"ien %engala%i

$el%p'an otot perna!a"an #o$ter an"te"i %e%eri$an na!a"

atan le/at "ng$p %$a "e"ai #engan !re$en"i na!a"

pa"ien

'. Setela' %encapai /a$t pnca$ (pea$) oat pel%p' otot-

#ila$$an inta"i en#otra$eal "etela' er'a"il c!! 7TT

#i$e%ang$an $e%#ian 7TT #i"a%ng$an #engan conector

%e"in ana"te"i.

i. Di la$$an te" $e#ala%an 7TT #engan cara #o$ter ana"te"i

%e%eri$an na!a" atan %elali %e"in ana"te"i #an pera/at

ana"te"i %en#engar$an "ara na!a" pa"ien pa#a 4 lapang

#engar "ara par #engan "teto"$op

. Setela' "ara par ter#engar "i%etri" pa"ien #ipa"ang %a&o

"pa&a pipa en#otrac'eal ti#a$ tergangg $e%#ian

#ila$$an !i$"a"i pa#a $e#a#an&a

$. at ana"te"i in'ala"i %lai #i$a #i"e"ai$an #engan

tan#a2 $e#ala%an ane"te"i - ila pe%e#a'an %e%erl$an

$on#i"i otot pa"ien &ang "angat rile$" %a$a perl #ita%a'$an

oat pel%p' otot "e"ai #engan $et'an #an #o"i"

l. Setela' pe%e#a'an "ele"ai oat ana"te"i in'ala"i #ittp

$e%ali $e%#ian #ila$$an pe%er"i'an alan napa" #engan

cara "ction len#ir pa#a %lt #an "e$itar tenggoro$an pa"ien

#an ila perl #ila$$an "ction %elali lang 'i#ng

%. Setela' er"i' #ila$$an e$ta"i #engan cara %enge%pi"$an

c!! ett $e%#ian %elepa"n&a-#ila$$an "ction lang lal

conector %e"in ane"te"i #i"a%ng$an "ng$p %$a lagi

n. a"ien $e%ali #ieri o$"igen 100< %elali !ace %a"$ lagi

o. "er*a"i "tat" na!a" pa"ien-ila na!a" pa"ien "#a'"pontan a#e$at-pa"ien i"a #ipin#a'$an $e rang pli' "a#ar

gna #ila$$an o"er*a"i lei' lant 'ingga pa"ien "a#ar

p. +latalat #irapi$an $e%ali

=. e%eri$"aanennang

1. e%eri$"aan laoratori% #an i lain


4/17

e%eri$"aan laoratori% a#a 2 &ait pe%eri$"aan %% #an

$'""-e%eri$"aan laoatori% %%

o Dara' >-le$o"it-'itng eni" le$o"it-%a"a pe%e$an #an

%a"a pen#ara'ano Foto t'oraxterta%a nt$ e#a' %a&or

o 7? terta%a nt$ pa"ien &ang er"ia 40 ta'n $eata"

e%eri$"aan $'""

Dila$$an ila a#a ri/a&at ata in#i$a"i-%i"aln&a

o 7? pa#a ana$

o Fng"i 'ati pa#a pa"ien i$ter"

o Fng"i ginal pa#a pa"ien 'iperten"i

o 7le$trolit pa#a pa"ien ile" o"t$ti! ata e#a' %a&or

2. Ji$a #iperl$an-%a$a #o$ter ane"te"i #ianr$an %e%inta $on"lta"i

"pe"ilali"ti$ lain

3. >a"il pe%eri$"aan-e*ala"i -$on"lta"i #an tin#a$ lant #icatat

#ala% #o$%en re$a% %e#i"

;. at @a'an #an +lat

9. 7#$a"i 1. a"a #an pe%erian cairan

engo"ongan la%ng #ila$$an #engan pa"a.a"ien #e/a"a #ipa"a$an #ari %a$anan pa#at 612 a% pra e#a'-#ari

%in% "" 6 a% pra e#a' #an #ari %in% air pti' 4 a% pra e#a'.pa"ien

ana$ana$ %engi$ti a#al "eagai eri$t

8%r S"A%a$anan pa#at +ir pti'

B 6 lan 4 a% 2 a%

636 lan 6 a% 3 a%

C 36 lan ; a% 3 a%

10. rogno"i"

11. Ting$at 7*i#en"

12. Ting$at e$o%en#a"i

13. enelaa' riti"

14. ,n#i$ator +na"t'e"i 1. $e"a#aran pa"ien2. re!le$ l %ata


5/17

3. ton" otot polo"4. #ia%eter ppil5. tan#a tan#a *ital

15. ep"ta$aan 1. +ne"te"iologi-F8,-Ja$arta 19;92. organ ?7- :linical 'ar%acolog& ,n'alational +ne"t'etic" in

:linical +ne"t'e"iolog&E 2001- 12=1==

RSUD NGUDI WALUYO

WLINGI


Telp.(0342) 691006

Fax. 691040


Prosedur Pembiusan Umum denan !e"ni" !o!a% in!ra &enous anes!esi (TI'A)

1. engertian (De!ini"i) Tin#a$an %enia#a$an n&eri "ecara "entral #i"ertai 'ilangn&a $e"a#aran #aner"i!at pli' "a#ar $e%ali (re*er"ile) #engan 'an&a %enggna$an oatane"te"i intra *ena

2. +na%ne"i" 1. ,#enti!i$a"i pa"ien-na%a-%r- ala%at #ll


6/17

2. i/a&at pen&a$it &ang perna' ata "e#ang #i#erita &ang%ng$in #apat %ena#i pen&lit ane"te"i "eperti alergi-a"%a-#iaet"%ellit"-pen&a$it par $roni$-pen&a$it antng-'ati #an ginal

3. i/a&at oat &ang "e#ang ata tela' #igna$an4. i/a&at opera"i #an ane"te"i &ang #iala%i5. eia"an r$ pa"ien "e'ari'ari "eperti %ero$o$ #an

%e%in% al$o'ol3. e%eri$"aan Fi"i$ 1. e%eri$"aan !i"i$ %elipti $ea#aan p"i$i"-$ea#aan gii-"&"te%


4. ,n#i$a"i e%i"an 1. opera"i "ing$at (0-5 1 a%) tanpa %e%$a rongga pert2. $ea#aan %% pa"ien c$p ai$3. la%ng 'ar" $o"ong

5. la"i!i$a"i +S+ enrt a%erican "o"iet& o! ane"t'e"iolog& (+S+) pa"ien &ang a$anopera"i #i$ategori$an "eagai eri$t +S+ 1 a"ien #ala% $ea#aan "e'at &ang %e%erl$an opera"i+S+ 2 a"ien #engan $elainan "i"te%i$ ringan "a%pai "e#ang ai$

$arena pen&a$it e#a' %apn pen&a$it lainn&a+S+ 3 a"ien #engan ganggan ata pen&a$it "i"te%i$ erat &ang#ia$iat$an eragai pen&ea+S+ 4 a"ien #engan $elainan "i"te%i$ erat &ang "ecara lang"ng%enganca% 'i#pn&a+S+ 5 a"ien &ang ti#a$ #i'arap$an 'i#p "etela' 24 a% /alapn#iopera"i ata ti#a$7 7%ergenc&

6. ro"e#renatala$"anaane%i"an 8%% *iaT,+

1 er"iapan alat


aringo"$op

Sng$p %$a


a&o



Steto"$op

:onector

le"ter 30 c%


+lat %onitor pa"ien

2. er"iapan oat


7/17

at in#$"i Tiopental 2-5


8/17



%a"a pen#ara'an

o 7? terta%a nt$ pa"ien &ang er"ia 40 ta'n $eata"e%eri$"aan $'""


o 7? pa#a ana$









B 6 lan 4 a% 2 a%

636 lan 6 a% 3 a%

C 36 lan ; a% 3 a%

10. rogno"i"

11. Ting$at 7*i#en"12. Ting$at e$o%en#a"i

13. enelaa' riti"14. ,n#i$ator +na"t'e"i 1. $e"a#aran pa"ien

2. re!le$ l %ata3. ton" otot polo"4. #ia%eter ppil5. tan#a tan#a *ital

15. ep"ta$aan 1. +ne"te"iologi-F8,-Ja$arta 19;9 2. organ ?7- :linical 'ar%acolog& ,n'alational +ne"t'etic" in :linical+ne"t'e"iolog&E 2001- 12=1==


9/17

RSUD NGUDI WALUYO

WLINGI


Telp.(0342) 691006

Fax. 691040


Prosedur Pembiusan Umum denan !e"ni" &ia a#e mas" (sun"u mu"a)

1. engertian (De!ini"i) Tin#a$an %enia#a$an n&eri "ecara "entral #i"ertai 'ilangn&a $e"a#aran #aner"i!at pli' "a#ar $e%ali (re*er"ile) #engan %enggna$an oat ane"te"iin'al"i &ang #ile/at$an "ng$p %$a

2. +na%ne"i" 1. ,#enti!i$a"i pa"ien-na%a-%r- ala%at #ll2. i/a&at pen&a$it &ang perna' ata "e#ang #i#erita &ang

%ng$in #apat %ena#i pen&lit ane"te"i "eperti alergi-a"%a-#iaet"%ellit"-pen&a$it par $roni$-pen&a$it antng-'ati #an ginal


%e%in% al$o'ol3. e%eri$"aan Fi"i$ 1. e%eri$"aan !i"i$ %elipti $ea#aan p"i$i"-$ea#aan gii-"&"te%


4. ,n#i$a"i e%i"an 1. opera"i "ing$at (0-5 1 a%) tanpa %e%$a rongga pert2. $ea#aan %% pa"ien c$p ai$3. la%ng 'ar" $o"ong

5. la"i!i$a"i +S+ enrt a%erican "o"iet& o! ane"t'e"iolog& (+S+) pa"ien &ang a$anopera"i #i$ategori$an "eagai eri$t +S+ 1 a"ien #ala% $ea#aan "e'at &ang %e%erl$an opera"i+S+ 2 a"ien #engan $elainan "i"te%i$ ringan "a%pai "e#ang ai$$arena pen&a$it e#a' %apn pen&a$it lainn&a+S+ 3 a"ien #engan ganggan ata pen&a$it "i"te%i$ erat &ang#ia$iat$an eragai pen&ea+S+ 4 a"ien #engan $elainan "i"te%i$ erat &ang "ecara lang"ng%enganca% 'i#pn&a+S+ 5 a"ien &ang ti#a$ #i'arap$an 'i#p "etela' 24 a% /alapn#iopera"i ata ti#a$7 7%ergenc&

6. ro"e#r 1 er"iapan alat


10/17

enatala$"anaane%i"an 8%% *ia!ace %a"$


aringo"$op

Sng$p %$a


a&o



Steto"$op

:onector

le"ter 30 c%


+lat %onitor pa"ien

2. er"iapan oat

at in#$"i Tiopental 2-5


11/17

"ng$p %$a #ala% po"i"i $epala pa"ien &ang

e$"ten"i-"eai$n&a #ag #itari$ "e#i$it $eela$ang agar alan

na!a" ea" #an pernapa"an pa"ien lancar- "a%il "e"e$ali

%e%eri na!a" atan apaila ter#apat 'ipo*entila"i.

p. 8nt$ %e%per$at e!e$ analge"ti$ oat in#$"i ter$a#ang

perl #ita%a'$an oat analgeti$ opioi# peti#in #ll

G. @er"a%aan #engan ti#rn&a pa"ien oat ane"te"i in'ala"i

#apat %lai #i$a "a%pai 1< #an "e#i$it #e%i "e#i$it

("e"#a' "etiap 510 $ali tari$an na!a" #inai$$an 1< "a%pai

34< tergantng rea$"i #an e"ar t' pen#erita)

r. e#ala%an ane"te"i #inilai #ari tan#a2 tan#a %ata (ola %ata

%enetap) na#i ti#a$ cepat #an ter'a#ap rang"ang n&eri ti#a$

era'

". ala "ta#i% ane"te"i "#a' c$p #ala%-ra'ang "#a'

le%a"-#apat #i%a"$$an pipa oro!aring (ge#el)

t. at in'ala"i #apat #i$rangi %ena#i 1 1-5 < tergantng

re"pon ter'a#ap rang"ang opera"i.

. at in'ala"i #i$rangi #an #i'enti$an eerapa %enit

"eel% opera"i "ele"ai

*. a"ien $e%ali #ieri o$"igen 100< %elali !ace %a"$ lagi

/. "er*a"i "tat" na!a" pa"ien-ila na!a" pa"ien "#a'

"pontan a#e$at-pa"ien i"a #ipin#a'$an $e rang pli' "a#ar

gna #ila$$an o"er*a"i lei' lant 'ingga pa"ien "a#ar

x. +latalat #irapi$an $e%ali

=. e%eri$"aanennang

1. e%eri$"aan laoratori% #an i lain




%a"a pen#ara'an


e%eri$"aan $'""



12/17

o 7? pa#a ana$



;. at @a'an #an +lat9. 7#$a"i 2. a"a #an pe%erian cairan





B 6 lan 4 a% 2 a%

636 lan 6 a% 3 a%

C 36 lan ; a% 3 a%

10. rogno"i"

11. Ting$at 7*i#en"


13. enelaa' riti"

14. ,n#i$ator +na"t'e"i 6. $e"a#aran pa"ien=. re!le$ l %ata;. ton" otot polo"9. #ia%eter ppil

10. tan#a tan#a *ital

15. ep"ta$aan 1. +ne"te"iologi-F8,-Ja$arta 19;92. organ ?7- :linical 'ar%acolog& ,n'alational +ne"t'etic" in :linical+ne"t'e"iolog&E 2001- 12=1==


13/17


14/17

RSUD NGUDI WALUYO

WLINGI


Telp.(0342) 691006

Fax. 691040


Prosedur Pembiusan reiona% denan !e$ni" sub ara#$noid b%o" (SA*)

1. engertian (De!ini"i) Tin#a$anpe%erian analeti$ local nt$ %eng'a%at 'antaran "&ara!"en"ori$ "e'ingga i%pl" n&eri

2. +na%ne"i" 1. ,#enti!i$a"i pa"ien-na%a-%r- ala%at #ll2. i/a&at pen&a$it &ang perna' ata "e#ang #i#erita &ang

%ng$in #apat %ena#i pen&lit ane"te"i "eperti alergi-a"%a-#iaet"%ellit"-pen&a$it par $roni$-pen&a$it antng-'ati #an ginal


%e%in% al$o'ol

3. e%eri$"aan Fi"i$ 1. e%eri$"aan !i"i$ %elipti $ea#aan p"i$i"-$ea#aan gii-"&"te%re"pira"i-"&"te% car#io*a"clar-$epala le'er-%alla%pati-"&"te%"&ara!-$lit-region l%al

4. ,n#i$a"i e%i"an 1. 8nt$ pe%e#a'an-#aera' t' &ang #iper"&ara!i caang T4$ea/a' (#aera' papila %a%ae $ea/a')

5. la"i!i$a"i +S+ enrt a%erican "o"iet& o! ane"t'e"iolog& (+S+) pa"ien &ang a$anopera"i #i$ategori$an "eagai eri$t +S+ 1 a"ien #ala% $ea#aan "e'at &ang %e%erl$an opera"i+S+ 2 a"ien #engan $elainan "i"te%i$ ringan "a%pai "e#ang ai$$arena pen&a$it e#a' %apn pen&a$it lainn&a+S+ 3 a"ien #engan ganggan ata pen&a$it "i"te%i$ erat &ang#ia$iat$an eragai pen&ea+S+ 4 a"ien #engan $elainan "i"te%i$ erat &ang "ecara lang"ng%enganca% 'i#pn&a+S+ 5 a"ien &ang ti#a$ #i'arap$an 'i#p "etela' 24 a% /alapn#iopera"i ata ti#a$7 7%ergenc&

6. ro"e#renatala$"anaane%i"an regional#engan te'ni$ S+@

1 er"iapan alat



15/17

gna pe%erian o$"igen $epa#a pa"ien "ela%a pe%e#a'an

erlang"ng

Jar% "pinal no 26-26 ata 2= (#i"e"ai$an #engan $on#i"i

pa"ien)

Spit $ran 5 %l

a"a "teril

Sarng tangan "teril

@eta#in "ec$pn&a

@antal $epala

+lat %onitor pa"ien

2. er"iapan oat

at ane"te"i local 'iperari$ *ipa$ain #lll

at e%ergenc& "l!a" atropine- ep'e#rine- a#renalin

3. er"iapan a"ien

a. a"ien # ieri ta' t in#a$an &ang a$an #ila$$an "erta

#iper"ila'$an nt$ er#oa

. e%a"ang alat %onitor #an %eng$r tan#atan#a *ital

pa#a pa"ien

c. era/at ana"te"i %engatr po"i"i pa"ien #ala% po"i"i

##$ ata eraring lateral #engan !le$"i %a$"i%al.

4. Te'ni$

a. ,n"pe$"i gari" &ang %eng'ng$an 2 titi$ tertinggi $ri"ta

ilia$a $anan $iri a$an %e%otong gari" tenga' pnggng

"etinggi 4 ata H5.

. alpa"i nt$ %engenal rang antara # a*ertera l%ali"

c. ng"i l%al 'an&a antara 2-3-4 ata 5 S1

#. Do$ter ane"te"i %e%a$ai "arng tangan "teril #an

%e%er"i'$an #aera' &ang a$an #ila$$an png"i.at

ane"te"i lo$al #i"iap$an #ala% "pit $ran 5 %l-"etela'

#itent$an lo$a"i png"i-ar% "pinal #i"nti$an pa#a i#ang


16/17

%e#ian #engan ara' 1030 #eraat ter'a#ap i#ang 'ori"ontal

$eara' $ranial pa#a rang antar *etera l%ali" &ang "#a'

#ipili' ta#i.Jar% "pinal a$an %ene%" eerapa liga%en

&ang tera$'ir a#ala' #ra%ater "ara'noi#Setela' "tilet

#icat cairan "erero"pinali" a$an %enete" $elar

"elantn&a #i"nti$$an oat ane"te"i lo$al $e #ala% rang

" arac'noi# ter"et.

e. Setela' oat ana"te"i lo$al %a"$ $erang "arac'noi#

ar% "pinal #itari$ $e%ali #an e$a" "nti$an #ittp #engan

ple"ter

!. "er*a"i pencapaian lo$ &ang #iingin$an

g. +lat2 #irapi$an $e%ali

'. a"ien #ieri o$"igen %elali %a"$er #engan aliran o2 6

10 lp% ata $anle na"al 24 lp% lagi

i. Sela%a pe%e#a'an 'ar" #io"er*a"i TT-terta%a

a#an&a $o%pli$a"i 'ipoten"i #an ra#i$ar#i=. e%eri$"aan

ennang1. e%eri$"aan laoratori% #an i lain




%a"a pen#ara'an


e%eri$"aan $'""


o 7? pa#a ana$









17/17


B 6 lan 4 a% 2 a%

636 lan 6 a% 3 a%

C 36 lan ; a% 3 a%

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15. ep"ta$aan 1. +ne"te"iologi-F8,-Ja$arta 19;92. organ ?7- egional +ne"t'e"ia I ain %anage%ent in :linical

ane"t'e"iolog&E 2001- 2532;1

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