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Presentasi Kasus (HIL Dextra)

Presentasi KasusRSUD Cilacap bagian Anesthesiology

Safwan Helmi BMRM. Fakhrul YusmanDeslia Anggarini Supriyadi1Identitas PasienNama: Ny. RUsia: 33 tahunNo CM: 9080xxBangsal: MawarAlamat: Kubang, KWTPekerjaan: Ibu Rumah TanggaStatus: MenikahTanggal operasi: 1 November 2012, jam 10.102AnamnesisKeluhan UtamaPerdarahan pervaginam

Riwayat Penyakit SekarangPasien datang kiriman bidan tanggal 1/11/2012 jam 9.00 dengan keterangan perdarahan pervaginam oleh karena plasenta previa totalis. Pasien merasa hamil 8 bulan. Perdarahan pervaginam 500ml sejak tadi malam jam 01.00. Prongkol-prongkol (+), kencang-kencang (+) sejak jam 01.00, nyeri (-). LD (+), AK (-), gerak janin (+), DJJ (+). Pasien pernah mondok di RSUD Cilacap dengan keluhan yang sama dan di diagnosa dengan PP totalis 1 bulan yang lalu.Jam 10.15, perdarahan bertambah banyak usul SC emergency.

3Riwayat Penyakit Dahulu:Riwayat hipertensi (-)Riwayat penyakit jantung (-)Riwayat DM (-)Riwayat asma (-)Riwayat alergi (-)Riwayat operasi sebelumnya (-)Riwayat tindakan anestesi sebelumnya(-)

Anamnesis4Anamnesis

Riwayat Penyakit Keluarga:Riwayat asma(-), Alergi (-),HT (-),DM (-) Penyakit jantung (-)

Anamnesis sistemSistemKeluhanCerebrospinalKejang (-), penurunan kesadaran (-)

KardiovaskularNyeri dada (-), berdebar-debar (-) akral dingin(-)RespiratoriusSesak napas (-) batuk (-)Gastrointestinalmuntah (-), mual(-), BAB lancarUrogenital

BAK lancar, nyeri saat BAK (-), perdarahan pervaginam (+) ~250ccMuskuloskeletalNyeri (-), keterbatasan gerak (-), kelemahan otot (-)Pemeriksaan FisikKeadaan Umum: Baik, tidak anemisKesadaran : CM, GCS E4V5M6Tanda vital Tekanan darah: 130/90 mmHgNadi: 78 x/menitPernafasan: 22 x/menitSuhu: 36.8C Tinggi badan: 154 cmBerat badan : 60 kgBMI: 25.3 kg/m2

Status AnestesiA : Clear, M II, TMD > 6,5 cmB : Spontan, RR 22/menit, Vesicular +/+, Ronchi -/-, Wheezing -/-C : TD 130/90 mmHg, N 78x/ menit, regularS1-S2 murni, bising jantung (-)D : CM, GCS E4 V5 M6

8Pemeriksaan PenunjangHematologi : (1-11-2012)

Hb 10,1 g/dl [12,0-16,0]Hct 31 % [37-47]AE 3,4 x 106 /l [4,2-5,4]

AL 12.590 /l [6.000-16.000 untuk ibu hamil]AT219.000 / l[150.000-450.000]

9Pemeriksaan PenunjangKimia Darah : (1/11/2012)

Albumin 3,10 g/dl [3,50-5,00]Creatinine 0,5 mg/dl [0,7-1,2]Cholesterol total 225 mg/dl[15 kg body wt0.25-0.3 mg/kg,between 5-15 kg0.3-0.4 mg/kg.Infant up to 5 kg0.4-0.5 mg/kg.Kontraindikasi: Acute active CNS disease eg meningitis, poliomyelitis, intracranial haemorrhage & demyelinating increased intracranial pressure, cerebral & spinal tumors; spinal stenosis & active disease (eg spondylitis, tumour) or recent trauma (fracture) in the vertebral column; uncorrected hypotension, cardiogenic or hypovolaemic shockPerhatian khusus: hentikan pengunaan bila terdapat tanda toxisitas sistemis. Patient w/ cardiac block, impaired liver function & CV disturbances; w/ pleural effusions may suffer resp collapse. Increased risk for high or total spinal blockade in elderly & in late stages of pregnancy. Efek samping: Hypotension, bradycardia, postdural puncture headache. High or total spinal blockade; neurological & allergic reactions; acute systemic toxicity. Intercostal paralysisPregnancy Category C: Penelitian pada hewan menunjukan efek samping terhadap fetus (teratogenic or embryocidal or other) dan tidak ada penelitian pada wanita. Obat hanya diberikan bila potensi keuntungan melebihi potensi resiko terhadap janin. ondansetronIndikasi: mual dan muntak karena cytotoxic chemotherapy, radiotherapy atau post-op.Dosage: OralPrevention of post-opnausea and vomiting: One 8-mg tab 1 hr before anaesth, followed by 2 doses of 8-mg tab 8 hrly.Radiotherapy-induced nausea and vomiting 8 mg orally 1-2 hr before radiotherapy followed by 8 mg orally 8 hrly for up to 5 days.InjTreatment of post-op nausea and vomiting 4 mg IM as single dose or slow IV inj.Highly emetogenic chemotherapy: Initially 8 mg by slow IV inj or 15-min infusion immediately before chemotherapy, then continuous IV infusion of 1 mg/hr for up to 24 hr or by further 2 doses of 8 mg by slow IV inj or 15-min infusion 4 hr apart. Either regimen is then followed by 8 mg orally 12 hrly up to 5 days.Less emetogenic chemotherapy8 mg by slow IV inj or 15-min infusion immediately before chemotherapy or 8 mg orally 1-2 hr before chemotherapy followed by 8 mg orally 12 hrly for up to 5 days.Perhatian khusus: Pregnancy & lactation, elderly.Efek samping: Constipation, headache, sensation of flush or warmth in the head & epigastrium.Pregnancy Category B: penelitian reproduksi hewan tidak menunjukan resiko terhadap fetus tetapi tidak ada penelitian pada wanita hamil.ephedrineDosage: Adult:PODiabetic neuropathic oedema30-60 mg 3 times/day.IVReversal of spinal or epidural anesth-induced hypotension As 3 mg/mL soln: 3-6 mg, up to 9 mg, may repeat every 3-4 mins if needed.

Kontraindikasi: Hypersensitivity. Hypertension, thyrotoxicosis, BPH. Lactation.Perhatian khusus: Ischaemic heart disease, hyperthyroidism, diabetes mellitus, hypertension, angle-closure glaucoma, renal impairment; prostatic enlargement; pregnancy, elderly.Efek samping: Anxiety, tachycardia, tremor, dry mouth, hypertension, cardiac arrhythmias, impaired circulation to the extremities, nervousness, insomnia, palpitations. Difficulty in micturition in patients with prostatic enlargement. Nasal drops: Local irritation, rebound nasal congestion and drug-induced rhinitis on prolonged use.

Pregnancy Category C: Penelitian pada hewan tidak menunjukan efek samping terhadap fetus (teratogenic or embryocidal or other) dan tidak ada penelitian pada wanita atau penelitian pada wanita dan hewan tidak tersedia. Hanya diberikan bila potensi keuntungan melebihi potensi resiko terhadap janin. Carbazochrome sodium sulfonateIndikasi: Hemorrhagic tendency (purpura, etc) karena menurunnya resistensi kapiler dan meningkatnya permeabilitas kapiler. Hemorrhage in skin, mucous membrane & internal membrane, eyeground; nephrotic hemorrhage, metrorrhagia. AbnormalHemorrhage during surgery & post-op due to decreased capillary resistance.Dosage: AdultTab30-90 mg/day in 3 divided doses.Amp25-100 mg IV inj or drip.Perhatian khusus: ElderlyEfek samping: Skin eruption, rash, pruritus. Loss of appetite, abdominal discomfort, nausea, vomiting after oral administration. Farmadol (paracetamol)Indikasi: Headache, fever,myalgia &toothache. For the short-term treatment of moderatepain(esp after surgery) &fever. Dosage: TabAdult & childn >12 yr1 tab,6-12 yr tab,3-5 yr tab. To be taken 3-4 times daily.VialAdult & adolescent w/ >50 kg body wt100 mL IV infusion for 15 min up to 4 times daily. Max daily dose: 4 g.Adult & adolescent 33 kg body wt (approx 11 yr)1.5 mL/kg body wt up to 4 times daily. Max daily dose: 60 mg/kg body wt or 3 g. Kontraindikasi: severe hepatocellular insufficiency.Perhatian khusus: Renal & hepatic failure. Increase risk of liver damage w/ doses higher than recommended. Hepatocellular insufficiency, severe renal insufficiency (CrCl