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Monitoring: Dr. Nasman Puar Span Bagian Anestesiologi FK Unand/RSUP Dr. M. Djamil Padang

This document discusses monitoring during anesthesia. It provides an overview of the key aspects of monitoring oxygenation, ventilation, circulation, and temperature. Monitoring is important to collect physiological data to detect any adverse changes and ensure proper functioning of equipment. The most important monitor is the vigilant anesthesiologist. Standard monitors include pulse oximetry to measure oxygen saturation, end-tidal CO2 monitoring for ventilation, ECG for the heart, non-invasive and invasive blood pressure monitoring, and temperature monitoring. Close evaluation of these vital signs is needed during anesthesia to quickly address any issues.

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Irma Julyanti Panggabean
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93 views26 pages

Monitoring: Dr. Nasman Puar Span Bagian Anestesiologi FK Unand/RSUP Dr. M. Djamil Padang

This document discusses monitoring during anesthesia. It provides an overview of the key aspects of monitoring oxygenation, ventilation, circulation, and temperature. Monitoring is important to collect physiological data to detect any adverse changes and ensure proper functioning of equipment. The most important monitor is the vigilant anesthesiologist. Standard monitors include pulse oximetry to measure oxygen saturation, end-tidal CO2 monitoring for ventilation, ECG for the heart, non-invasive and invasive blood pressure monitoring, and temperature monitoring. Close evaluation of these vital signs is needed during anesthesia to quickly address any issues.

Uploaded by

Irma Julyanti Panggabean
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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MONITORING

Dr. Nasman Puar Span


Bagian Anestesiologi FK Unand/RSUP
Dr. M. Djamil Padang

Monitori ---- monere (latin) = to Warn

Designed to Collect data that


reflect :
physiologic homeostasis,
allowing prompt recognition of
adverse effect
Responses to therapeutic
intervension
Proper function of anesthetic
equipment

Monitoring provides an early


warning of adverse changes or
trends before irreversible damage
occurs

The most important monitor in the


operating room is the VIGILANT
ANESTHESIOLOGIST

ASA STANDARD FOR BASIC ANESTHESIA


MONITORING

Standard I : Qualified anesthesia personel


shall be present in the room throughout
the conduct of all general anesthetics,
regional anesthetics and monitored
anesthesia care
Standard II : During all anesthetics, the
patients oxygenation, ventilation,
circulation, and temperature shall be
continually evaluated

Monitoring :

Requires No Instrumentation
- By : Inspection, Palpation, Percussion,
Auscultation

Requires Instrumentation
-

Oxygenation : Pulse Oxymetri, O2


analyzer,
Ventilation :EtCO2 , Stetoscope,
Circulation : ECG, Urine Output, CVP,
NIBP, Arterial line
Temperature : Thermometer

MONITORING OKSIGENASI
DAN VENTILASI
Stetoskop

Memberikan informasi mengenai Ventilasi,


kualitas suara nafas, regularitas denyut
jantung dan suara jantung
Stetoskop esofagus (pemasangan 28
30cm dari gigi seri)
Stetoskop prekordial (Pemasangan di
dada/suprasternal)
Mudah terganggu dalam mendengarkan
(noisy)

Puls Oksimetri

Mengukur saturasi O2 perifer arteri yang


mencerminkan saturasi oksigenhemoglobin arteri (SaO2)
Hasil yang didapat adalah fungsional
saturasi
Sianosis terjadi jika deoksi Hb lebih dari 5
g%
Nilai normal mendekati 100%
Artefak terjadi pada perfusi yang rendah
dan ada gangguan absorpsi sinar

Kapnograf
ET CO2
Nilai ETCO2 sedikit dibawah PaCO2
Menggambarkan perubahan ventilasi
Volume Tidal dan Volume Semenit
- Alat yang dipergunakan :
- Wright Respirometer
- Pneumotachograf

MONITORING SIRKULASI
TEKANAN DARAH :
1.1. TEKANAN DARAH NON INVASIV (INDIRECT)
1. Korotkoff
2. Palpasi
3. Osilotonometri Electric Automatic
(Misalnya : Dinamp)
4. Ultrasonik Doppler
Yang diukur : TDS,TDD,TAR
TAR = (TDS + 2 TDD) : 3
TDS : berhubungan dengan kebutuhan O2 miokard
TDD : refleksi tekanan perfusi koroner

Estimasi tekanan terlalu tinggi, jika


Estimasi tekanan terlalu tinggi, jika
Manset terlalu lebar (normal :2/3 lengan)
Manset terlalu longgar
Terlalu rendah dari jantung
Estimasi tekanan terlalu rendah, jika :
Manset terlalu lebar
Terlalu tinggi dari jantung

2 TEKANAN DARAH INVASIV (DIRECT)

Kanulasi melalui a. radialis, a.


ulnaris,a.brakhialis,a. aksilaris,a.femoalis atau
a. dorsalis pedis
Kanul dihubungkan dengan transduser
Harus ada indikasi, mis. op.otak aneurisma
Komplikasi :
Trombosis, kerusakan dinding arteri
emboli
nekrosis

3. PULSE PERIFER (DENYUT NADI)

Perabaan yang teratur selama anestesia


Informasi : kecepatan, volume , ritme
Alat : Pulsemeter, Osiloskop

3. PERFUSI PERIFER
Terutama bermanfaat untuk anak-bayi
Perfusi adekuat bila kulit hangat, kering
dan kemerahan

4. PRODUKSI URIN
Produksi urin menggambarkan
perfusi ginjal
Normal : (1/2-1)/kg/jam
Indikasi pengukuran urin :
besar dengan banyak pendarahan
pasien trauma berat
Pasien sakit kritis, mis. syok
jantung, ginjal

MONITORING JANTUNG
Elektrokardiogram (EKG)
Untuk mendeteksi adanya aritmia,
iskhemia miokard, gangguan elektrolit
dan fungsi alat pacu jantung
Lead yang umum dipergunakan II dan V5
(II untuk aritmia dan V5 untuk iskhemia)
Pasien usia > 40 tahun seharusnya pakai
EKG

Mengukur Curah Jantung (Cardiac Output)


Menilai fungsi jantung status sistem sirkulasi
Belum rutin dalam anestesia, kecuali O.
jantung
Cara : 1.Fick,2.Dye Dilution,3. Termodilusi
Echokardiografi Transesofagus (TEE)
Belum rutin dipergunakan
Mampu menilai : volume dan fungsi jantung

LAIN-LAIN
CVP (Central Venous Pressure)
(Tekanan Vena Sentral)
Kanulasi dapat melalui v. jugularis
int.,v.subclavia,v. Jugularis
ekst.,v.sefalika,v.aksilaris,v.femoralis.
Kateter didorong sampai ujung kateter ada di
muara v. cava sup. Atau atrium kanan.
Kanul dihubungkan dengan manometer air
Nilai normal 5-15 cmH2O
Memantau pemberian transfusi darah dan cairan

PAC (Pulmonary Artery Catheter)


(Swan-Gans Catheter)

Menggambarkan fungsi jantung kiri


Kanulasi melalui vena
Kateter didorong sampai at. Kanan,
vt.kanan,a. pulm.kanan dan terus kapiler
pulmonal
Indikasi : - Curah jantung rendah (low c.o.)
- Edema paru
Normal PAWP : 5-10 mmHg
PAWP : Pulmonary artery wedge pressure

MONITORING PERDARAHAN
1. Warna Perdarahan
2. Jumlah Perdarahan (Cara Gravimetri)
Menimbang

kasa dan duk operasi


Mengukur jumlah yang tertampung
Jumlah Perdarahan (Cara Colorimetri) :
Duk dan dilarutkan sejumlah cairan
kemudian colorimetri :
Jumlah Perdarahan =
Colorimetri terbaca x volumecairan
200 x Hb pasien

MONITORING TEMPERATUR

Anestesia

poikilotermia
Demam

Suhu naik
Hipertermia (>41)

Etiologi suhu meningkat :

Puasa lama
kamar operasi panas
duk operasi tebal
infeksi
obat-obat (mis. atropin)
herediter (hipertermia maligna)

Tempat pemasangan sensor suhu

Kulit
rektal
nasofarings
aksila
esofagus
membrana timpnani

TERIMA KASIH

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