Rencana Kerja Anestesi Operasi Pemisahan

Bayi Kembar Siam

Fahira/PR/7 bln/ 10 kg
Persiapan alat
1. Stetoscope anak 1 unit
2. Video Laringoscope set pediatric (Storch)
3. Tubes : Ett No.3.0, 3.5;4.0 cuff dan non-cuff
4. Airway equipment : OPA, NPA, LMA ukuran bayi
5. Tapes : Hypafix 1 unit, 3M 1unit
6. Introducer : Stylet bayi 2 unit
7. Bogie bayi 1 unit
8. Connector : L&Y 2 Unit
9. Mesin Suction, Cannul suction
10. CVC no 4.0 (Arrow) Triple Lumen 3 set
11. Bag Valve Mask (Ambu) pediatric 2 set
12. USG 1 unit
13. Jelly
14. Handscoon Steril No. 6.0; 6.5 ; 7.0 ; 7.5 (masing – masing
2)
15. Handscoon On 1 Kotak
16. Manometer Invasif (Transducer) 2 lumen
17. Monitor Invasif 2 Unit
18. Infus Warmer 2 unit
19. Blanket Warmer 2 unit
 20. Syringe pump 5 unit
21. Spuit 3 cc; 5cc; 10cc; 20cc; 50cc masing-masing 5 unit
22. Infus Pump 2 unit
23. Breathing Circuit Pediatric 1 Unit
24. Extention tube 4 unit
25. IV Catheter no.26;24;22;20;18 (TERUMO) masing-masing 4
unit
26. Softband 3 dan 5 inci masing-masing 2 unit
27. NGT no 8;10 silikon (TERUMO) masing-masing 2 unit
28. Blood Warmer 1 unit
29. Threeway Buntut 6 unit

Obat-obatan emergency (BB: 3.8 kg)

- Sulfas Atropin : 0,01-0,03 mg/kgbb : 0,05-0,16 mg/kgbb
- Efedrin : 0,1-0,3 mg/kgbb : 0,55-1,65 mg/kgbb
- Ephineprine : 0,05-0,1 mg/kgbb : 0.2-0,5 mg/kgbb
- Lidocain : 1-1,5 mg/kgbb : 5,5-8,25 mg/kgbb
- Aminophyline : 5-8 mg/kgbb : 27,5-44 mg/kgbb
- Dexametasone : 5-10 mg/kgbb : 27,5-55 mg/kgbb
- Amiodarone
- Milrinone
- Dobutamine
- Dopamine
- Epinephrine
- Norepinephrine
- Natrium Bicarbonate
- Calcium Glukonas
- Nitroglycerine
 - CaCl2
- Tranexit

Persiapan General Anestesi

- Midazolam : 0,05-0,1 mg/kgbb : 0,2-0,55 mg/kgbb
- Fentanyl : 2-5 mcg /kgbb : 11-27,5 mcg/kgbb
- Profopol : 2-2,5 mg/kgbb = 11-13,7 mg/kgbb
- Ketamin : 1-2 mg/kgbb = 5,5-11 mg/kgbb
- Rocuronium : 0,6-1,2 mg/kgbb = 3,3=6,6 mg/kgbb

Persiapan Obat General Anestesi

1. Agent Inhalasi : Sevoflurane dan Isoflurane
2. Obat premedikasi : a. Fentanyl : 2-5 mcg/kgbb = 11-27,5
mcg/kgbb
b. Midazolam : 0,05-0,1 mg/kgbb = 0,2-
0,55 mg/kgbb
3. Induksi : a. Profopol : 2-2,5 mg/kgbb : 11-13,7 mg/kgbb
4. Muscle Relaxant :
Rocuronium : 0,6-1,2 mg/kgbb : 3,3 : 6,6 mg/kgbb

Obat-obatan emergency
- Sulfas Atropin : 0,01-0,03 mg/kgbb : 0,03-0,1 mg/kgbb
- Efedrin : 0,1-0,3 mg/kgbb : 0,38-1,14 mg/kgbb
- Ephineprine : 0,05-0,1 mg/kgbb : 0,19-0,38 mg/kgbb
- Lidocain : 1-1,5 mg/kgbb : 3,8-5,7 mg/kgbb
 - Aminophyline : 5-8 mg/kgbb : 19-30,4 mg/kgbb
- Dexametasone : 5-10 mg/kgbb :19-38 mg/kgbb

Persiapan General Anestesi

- Midazolam : 0,05-0,1 mg/kgbb : 0,19-0,38 mg/kgbb
- Fentanyl : 2-5 mg /kgbb : 7,6-19 mg/kgbb
- Profopol : 2-2,5 mg/kgbb : 7,6-9,5 mg/kgbb
- Ketamin : 1-2 mg/kgbb : 3,8-7,6 mg/kgbb
- Rocuronium : 0,6-1,2 mg/kgbb : 2,2-4,5 mg/kgbb

Persiapan Obat General Anestesi

1. Obat premedikasi : a. Fentanyl : 2-5 mcg/kgbb : 7,6-19

mg/kgbb
b. Midazolam : 0,05-0,1 mg/kgbb :
0,19-0,38 mg/kgbb
2. Induksi : a. Profopol : 2-2,5 mg/kgbb : 7,6-9,5 mg/kgbb
b. Rocuronium : 0,6-1,2 mg/kgbb : 2,2-4,5
mg/kgbb
3. Emergency : a. Efedrine : 0,1-0,3 mg/kgbb : 0,38-1,14
mg/kgbb
b. Sulfas Atropin : 0,01-0,02 mg/kgbb : 0,03-
0,1 mg/kgbb
4. Maintenance : Sevoflurance 2,0 Mec
Rencana kerja

1. Posisikan pasien supine

2. Preoksigenisasi 2-5 L/i
3. Injeksi premedikasi  Sulfas Atropin Inj. Midazolam 
Inj. Fentanyl
4. Induksi  Inj.Ketamin  nistagmus (+)
5. Ventilasi (+)  Inj. Rocuronium  Sleep apnoe
6. Oksigen 3-5 menit
7. Insersi Ett N0 5,5  cuff (+)
8. Cek suara nafas  Kanan=kiri  Fiksasi kuat
9. Cek ulang hemodinamik

Obat Dalam Jumlah Pengenceran Dalam Dosis 1 cc

 sediaa di spuit (mg/kgBB) spuit
n sediaan =
Pethidin ampul 100mg/2 2cc + 10 cc 0,5-1 10 mg
cc aquadest 8cc
Fentanyl 0,05 0,05m
mg/cc g
Recofol ampul 200mg/ 10cc + 10 cc 2-2,5 10 mg
(Propofol) 20cc lidocain 1
ampul
Ketamin vial 100mg/cc 1cc + 10 cc 1-2 10 mg
aquadest 9cc
Efedrin ampul 50mg/cc 1cc + 10 cc 0,2 5 mg
HCl aquadest 9cc
Sulfas ampul 0,25mg/c Tanpa 3 cc 0,005 0,25
Atropin c pengenceran mg
Ondansentr ampul 4mg/2cc Tanpa 3 cc 8 mg 2 mg
on HCl pengenceran (dewasa)
(Narfoz) 5 mg (anak)
Aminofilin ampul 24mg/cc Tanpa 10 cc 5 24 mg
pengenceran
Dexametha ampul 5 mg/cc Tanpa 1 5 mg
son pengenceran
Adrenalin ampul 1 mg/cc 0,25-0,3
Midazolam ampul 5mg/5cc Tanpa 0,07-0,1 1 mg
(Sedacum) pengenceran
Ketorolac ampul 60 Tanpa 30 mg
mg/2cc pengenceran
Difenhidra ampul 5mg/cc Tanpa 5 mg
min HCl pengenceran
Obat-Obatan Induksi

Dosis awal Dosis Durasi Efek samping

(mg/kgBB rumatan (menit
) (mg/kgBB) )
 Non depol long-acting
1. D-tubokurarin (tubarin) 0.40-0.60 0.10 30-60 Hipotensi
2. Pankuronium
0.08-0.12 0.15-0.020 30-60 Takikardi
3. Metakurin
4. Pipekuronium 0.20-0.40 0.05 40-60 Hipotensi
5. Doksakurium
0.05-0.12 0.01-0.015 40-60 KV stabil
6. Alkurium (alloferin)
0.02-0.08 0.005-0.010 45-60 KV stabil
0.15-0.30 0.5 40-60 Takikardi
Non depol intermediate acting
1. Gallamin (flaxedil) 4-6 0.5 30-60 Hipotensi
2. Atrakurium (tracrium/notrixum)
0.5-0.6 0.1 20-45 Amanhepar&ginja
3. Vekuronium (norcuron)
4. Rokuronium 0.1-0.2 0.015-0.02 25-45 l
(roculax/esmeron/noveron) 0.6-1.0 0.10-0.15 30-60
5. Cistacuronium
0.15-0.20 0.02 30-45
Isomer atrakurium
Non depol short acting
1. mivakurium (mivacron) 0.20-0.25 0.05 10-15 Hipotensi &
2. ropacuronium
1.5-2.0 0.3-0.5 15-30 histamin +
Depol short acting
1. suksinilkolin (scolin) 1.0 3-10
2. dekametonium
1.0 3-10

5. Emergency :
a. Efedrine : 0,1-0,3 mg/kgbb : 0,55-1,65mg/kgbb
b. Sulfas Atropin : 0,01-0,02 mg/kgb : 0,05-0,16mg/kgbb

Rencana kerja
Obat-obatan emergency
- Sulfas Atropin : 0,01-0,03 mg/kgbb : 0,03-0,1 mg/kgbb
- Efedrin : 0,1-0,3 mg/kgbb : 0,38-1,14 mg/kgbb
- Ephineprine : 0,05-0,1 mg/kgbb : 0,19-0,38 mg/kgbb
- Lidocain : 1-1,5 mg/kgbb : 3,8-5,7 mg/kgbb
- Aminophyline : 5-8 mg/kgbb : 19-30,4 mg/kgbb
- Dexametasone : 5-10 mg/kgbb :19-38 mg/kgbb

Persiapan General Anestesi

- Midazolam : 0,05-0,1 mg/kgbb : 0,19-0,38 mg/kgbb
- Fentanyl : 2-5 mg /kgbb : 7,6-19 mg/kgbb
- Profopol : 2-2,5 mg/kgbb : 7,6-9,5 mg/kgbb
- Ketamin : 1-2 mg/kgbb : 3,8-7,6 mg/kgbb
- Rocuronium : 0,6-1,2 mg/kgbb : 2,2-4,5 mg/kgbb

Persiapan Obat General Anestesi

2. Obat premedikasi : a. Fentanyl : 2-5 mcg/kgbb : 7,6-19

mg/kgbb
b. Midazolam : 0,05-0,1 mg/kgbb :
0,19-0,38 mg/kgbb
2. Induksi : a. Profopol : 2-2,5 mg/kgbb : 7,6-9,5 mg/kgbb
b. Rocuronium : 0,6-1,2 mg/kgbb : 2,2-4,5
 mg/kgbb
4. Emergency : a. Efedrine : 0,1-0,3 mg/kgbb : 0,38-1,14
mg/kgbb
b. Sulfas Atropin : 0,01-0,02 mg/kgbb : 0,03-
0,1 mg/kgbb
4. Maintenance : Sevoflurance 2,0 Mec

Rencana kerja

10. Posisikan pasien supine

11. Preoksigenisasi 2-5 L/i
12. Injeksi premedikasi  Sulfas Atropin Inj. Midazolam
 Inj. Fentanyl

13. Induksi  Inj.Ketamin  nistagmus (+)

14. Ventilasi (+)  Inj. Rocuronium  Sleep apnoe
15. Oksigen 3-5 menit
16. Insersi Ett N0 5,5  cuff (+)
17. Cek suara nafas  Kanan=kiri  Fiksasi kuat
18. Cek ulang hemodinamik
 Obat Dalam Jumlah Pengenceran Dalam Dosis 1 cc
sediaa di spuit (mg/kgBB) spuit
n sediaan =
Pethidin ampul 100mg/2 2cc + 10 cc 0,5-1 10 mg
cc aquadest 8cc
Fentanyl 0,05 0,05m
mg/cc g
Recofol ampul 200mg/ 10cc + 10 cc 2-2,5 10 mg
(Propofol) 20cc lidocain 1
ampul
Ketamin vial 100mg/cc 1cc + 10 cc 1-2 10 mg
aquadest 9cc
Efedrin ampul 50mg/cc 1cc + 10 cc 0,2 5 mg
HCl aquadest 9cc
Sulfas ampul 0,25mg/c Tanpa 3 cc 0,005 0,25
Atropin c pengenceran mg
Ondansentr ampul 4mg/2cc Tanpa 3 cc 8 mg 2 mg
on HCl pengenceran (dewasa)
(Narfoz) 5 mg (anak)
Aminofilin ampul 24mg/cc Tanpa 10 cc 5 24 mg
pengenceran
Dexametha ampul 5 mg/cc Tanpa 1 5 mg
son pengenceran
Adrenalin ampul 1 mg/cc 0,25-0,3
Midazolam ampul 5mg/5cc Tanpa 0,07-0,1 1 mg
(Sedacum) pengenceran
Ketorolac ampul 60 Tanpa 30 mg
mg/2cc pengenceran
Difenhidra ampul 5mg/cc Tanpa 5 mg
min HCl pengenceran
 Obat-Obatan Induksi

Dosis awal Dosis Durasi Efek samping

(mg/kgBB rumatan (menit
) (mg/kgBB) )
Non depol long-acting
1. D-tubokurarin (tubarin) 0.40-0.60 0.10 30-60 Hipotensi
2. Pankuronium
0.08-0.12 0.15-0.020 30-60 Takikardi
3. Metakurin
4. Pipekuronium 0.20-0.40 0.05 40-60 Hipotensi
5. Doksakurium
0.05-0.12 0.01-0.015 40-60 KV stabil
6. Alkurium (alloferin)
0.02-0.08 0.005-0.010 45-60 KV stabil
0.15-0.30 0.5 40-60 Takikardi
Non depol intermediate acting
1. Gallamin (flaxedil) 4-6 0.5 30-60 Hipotensi
2. Atrakurium (tracrium/notrixum)
0.5-0.6 0.1 20-45 Amanhepar&ginja
3. Vekuronium (norcuron)
4. Rokuronium 0.1-0.2 0.015-0.02 25-45 l
(roculax/esmeron/noveron) 0.6-1.0 0.10-0.15 30-60
5. Cistacuronium
0.15-0.20 0.02 30-45
Isomer atrakurium
Non depol short acting
1. mivakurium (mivacron) 0.20-0.25 0.05 10-15 Hipotensi &
2. ropacuronium
1.5-2.0 0.3-0.5 15-30 histamin +
Depol short acting
1. suksinilkolin (scolin) 1.0 3-10
2. dekametonium
1.0 3-10
 1. Posisikan pasien supine
2. Preoksigenisasi 2-5 L/i
3. Injeksi premedikasi Inj Sulfas Atropin  Inj. Midazolam
 Inj. Fentanyl
4. Induksi  Inj.Ketamin  Nistagmus (+)
5. Ventilasi (+)  Inj. Rocuronium  Sleep apnoe
6. Oksigen 3-5 menit
7. Insersi Ett No 4.0  cuff (+)
8. Cek suara nafas  Kanan=kiri  Fiksasi kuat
9. Cek ulang hemodinamik

Zahira/PR/7 bln/ 3.8 kg`

Persiapan alat
1. Stetoscope anak 1 unit
 2. Video Laringoscope set pediatric (Storch)
3. Tubes : Ett No.3.5;4.0;4,5 cuff dan non-cuff
4. Airway equipment : OPA, NPA, LMA ukuran bayi
5. Tapes : Hypafix 1 unit, 3M 1unit
6. Introducer : Stylet bayi 2 unit
7. Bogie bayi 1 unit
8. Connector : L&Y 2 Unit
9. Mesin Suction, Cannul suction
10. CVC no 4.0 (Arrow) Triple Lumen 3 set
11. Bag Valve Mask (Ambu) pediatric 2 set
12. USG 1 unit
13. Jelly
14. Handscoon Steril No. 6,0; 6,5 ; 7.0 ; 7.5 (masing – masing
2)
15. Handscoon On 1 Kotak
16. Manometer Invasif (Transducer) 2 lumen
17. Monitor Invasif 2 Unit
18. Infus Warmer 2 unit
19. Blanket Warmer 2 unit
20. Syringe pump 5 unit
21. Spuit 3 cc; 5cc; 10cc; 20cc; 50cc masing-masing 5 unit
22. Infus Pump 2 unit
23. Breathing Circuit Pediatric 1 Unit
24. Extention tube 4 unit
25. IV Catheter no.26;24;22;20;18 (TERUMO) masing-masing 4
unit
26. Softband 3 dan 5 inci masing-masing 2 unit
27. NGT no 8;10 silikon (TERUMO) masing-masing 2 unit
28. Blood Warmer 1 unit
Adrenaline dan Milrinone  Dipersiapkan di Syringepump