erawatan pra dan pasca bedah.pptx

1. Perawatan Pra dan Pasca Bedah
Presentan : Muhammad Bimo Harmaji
Supervisor : Dr. dr. Hery Poerwosusanta, Sp. B, Sp. BA (K), FICS
PROGRAM PENDIDIKAN DOKTER SPESIALIS ILMU BEDAH
FK ULM / RSUD ULIN

2. PRIMUM, NON NOCERE
FIRST, DO NO HARM
HIPPOCRATES’S TENET
(460-335 BC)
TOTAL CARE Tidak Kecolongan / Terkaget-kaget
ada Masalah pada Intra-Pasca Bedah !
10 Butir Total Care / THE 10
COMMANDMENTS :
1. Triage ?
2. Diagnosa ?
3. Kasus bedah / bukan ?
4. Masalah yang dapat timbul ?
5. Jenis op. / teknik op. (School Of
Surgery / School Of Anesthesiology) ?
6. Timing operasi ?
7. Masalah pra bedah ?
8. Masalah intra bedah ?
9. Masalah pasca bedah ?
10. Follow Up ?
Preoperative visiting
- Confirming their identify, history of illnesses,
assessing their current health, and identifying
any issues the patient may have
- Educating patients is important to prepare
them for surgery and provides knowledge on
what is going to happen to them and why.
- This may also help to reduce their anxiety
before anaesthesia on the day of surgery.
Preoperative assessment
Knowledge of these results also improves patient safety and helps to identify anaesthetic
and surgical needs during the procedure Investigations may include areas such as;
Radio opaque dyes (to identify areas of the body and the flow of fluids in the body);
Arteriograms and venograms (to identify problems with the cardiovascular system)
Barium swallow or enema (to identify problems with the GI tract);
Diagnostic imaging (e.g. X ray, ultrasound, magnetic resonance imaging (MRI)
Computerised tomography (CT),

3. Post operative
management
• Respiratory monitoring
• Cardiovascular monitoring
• Neuromuscular monitoring
• Psychological monitoring
• Temperature monitoring
• Pain monitoring
• Monitoring nausea and vomiting
• Fluid monitoring
• Urine output and voiding
• Drainage and bleeding
• Monitoring of the airway
Pain
• The first stage in managing pain is to find out its cause.
• The second stage is to assess the pain. The primary way to assess pain is to
ask patients – if they say they are in terrible pain, then they will need urgent
help to reduce the level of pain
• The final stage is to help reduce pain by using drugs, and to reduce their
side effects to a minimum.
• Systemic opioids
• Nonsteroidal anti‐inflammatory drugs (NSAIDS)
• Regional techniques; spinal or epidural
• Non‐pharmacologic techniques; These can include electrical
stimulation of peripheral nerves, which may affect
pain‐inhibitory pathways, acupuncture or massage.

4. Post Operative Nausea
and Vomiting (PONV)
Anti‐emetic therapy;
• Metoclopromide is a D2 receptor antagonist in the stomach, gut and
chemoreceptor trigger zone.
• Droperidol is a D2 receptor antagonist and an α‐adrenergic agonist. Dosages
up to 2.5 mg can be given.
• Hyoscine (Scopolamine) is anticholinergic and is effective for PONV
associated with vestibular inputs (sense of movement in the inner ear).
• Cyclizine is an H1 receptor antagonist that also produces anticholinergic
responses.
• Ondansetron is a 5‐HT3 receptor antagonist. The 5‐HT3 receptor is a
serotonin receptor found in terminals of the vagus nerve and in certain areas
of the brain
• Dexamethasone is an effective anti‐emetic at a dose of 8 mg. It is a member
of the glucocorticoid class of steroid drugs that has anti‐inflammatory and
immunosuppressant properties