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Anesthesia

Management of BiliarAtresia

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Neonatal surgical disease

• Congenital Diaphragmatic Hernia

• Esophageal Atresia & TracheoesophagealFistula

• Abdominal all Defects ! "mphalocele &

#astroschisis• Hirschsprung$s Disease

• Anorectal Malformations

• %yloric tenosis

• Necroti'ing Enterocolitis

• Biliary Atresia (EHBA)

ur(i(a• *+, -

• 0 122

• .2, -

32,

• Deathof a

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Neonatal Cholestasis

• Cholestatic 4aundice 5 1 ! +/22 infants 6East Asia• Biliary atresia +/ 5 9/ ,

• #enetic disorders +/,

• Metabolic diseases +2,

• :1-antitrypsin de;ciency 12,

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Biliary Atresia

• "bliteration<discontinuity =e>trahepatic biliary sy biliary system obstruction?

• @elainan lain ! malrotasi usus7 situs in(ersus7polysplenia<aspenia?

• Early surgical inter(ention is critical?

• *2-/2, ! li(er transplantation

@ombinasi pembedahanhepatoenterostomy dan transplantasili(er meningatan / years sur(i(al

rate hingga 32,

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@elainan yang menyertai EHBA

• @elainan lain menyertai +2, EHBA• Biliary Atresia plenic Malformation yndrome !ntestinal malrotation%roduodenal portal (ein%olysplenia

itus in(ersusAbsent inferior (ena ca(aCardiac defectAnomalous hepatic artery supply

• Memperburu prognosa

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Masalah Anestesi Neonatus

• %rematuritas7 malnutrisi7 sepsis7 hipogliemia?• %eralatan yg sesuai7 DM ompeten7 er4asama

multidisiplin?

• "ptimalisasi preoperatif?

• %engelolaan cairan dan transfusi?

• @ontrol suhu ! pre(ensi hipotermi<hipertermi?

• Analgesia pasca bedah?

• %eraatan intensif pascabedah?

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urgical site infection &hypothermia

0

4

8

12

16

Wound Infection (%)

Hypothermic Normothermic

P =0.001

Normothermia is

more effective

than antibiotics! Melling et al 

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%ersiapan prabedah

• i @ 1 mg selama * hari?• Antibiotia oral sehari sebelum pembedahan?

• Hb dan fator pembeuan 5 platelet 122?222 d 1?/ ! 1?

• iap darah 1 unit 6ecuali prosedur re(isi8?

• Clear liGuid terahir * 4am sebelum anestesi?

• nfus lancar 6(ena sulit rn sering diinfus87 p inf(?4ugularis e>t?

• %remediasi Atropin 2?21 5 22+ mg<g dan antib

intra(ena?

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Anestesi prosedur @asai

• =tandard of care$ dari BA? ebainya dilauan usia -I minggu?

• 9 tahap ! mobilisasi li(er 5 persiapan )ou>-en-J l 4e4unum 5 anastomosis loop e porta hepatis?

• %ertahanan eu(olemia7 euthermia7 euglycemia

• Anestesi & analgesia adeat?• Esplorasi li(er  ining (?ca(a inferior  hipot

• Brody$s eKect?

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Brody$s eKect

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@asai %orto-Enterostomy

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Anestesi prosedur @asai

• Matras penghangat 7 selimut hangat 7 infus & gas aneshangat?

• E@# 7 NB% 7 pulse o>imeter 7 etC"+7 stetosop preordrectal temp7 C%?

• Ner(e stimulator?

• ) 7 indusi inhalasi 6se(oLurane8 NMB?

• Anestesi inhalasi 6soLurane7 DesLurane8 7 Fi"+ *2,?

• Hindari N+"?

• %asang N# tube?

• NMB Atracurium?

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Body Temperature

Hypothermia 6core body temperature8 !• N")MA ! 9?/ to 9.?9OC• Cold tress ! 9?2 to 9?*OC

• Be careful

• Moderate hypothermia ! 9+ 59/?3OC• Danger

• e(ere hypothermia ! belo 9+OC• Fatal - silled care urgently needed PP

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%erioperati(e Thermoregulation

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Efe anestesi inhalasi

Parameter(bloodow*)

Halothae !so"rae #e$o"rae De

Hepaticarterial *

Portal*

%otalhepatic*

#plachic*

&olatile

id"cedhe atitis

%"r"

%"r"

%"r"

High ris 

%etapt"r"

%"r"

%"r"

%etap

+ow ris 

%eta

Nai

%"r"

,edi"m ris 

%etap

&e

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ntraoperati(e Transfusion Trigg

Ma>imum Alloable Blood oss

  Normal Acceptable EBV  (%) (%) (ml/kg)

Premature 40 – 45 35 90 – 100

Nebor! 45 – "5 30 – 35 #0 – 90

3 $o!t& 30 – 4' '5

4 ear 34 – 4' '0 – '5 0 – #0

" ear& 35 – 43 '0 – '5 0

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CONTOH :

 Anak 10 kg , Hct 42%.

Berapa ‘maximal all!a"le "l# l$$ &ika #i'arapkan Hct terren#

*B+ -0 mlkg -00 ml

/AB

  2( ml

anti per#ara'an : 23 x kri$tali# ata5 1 x kli#al"5min (%6ika per#ara'an 7 /AB ata5 Hct 8 target : "eri 9C.

-00 x ;42 < 2(=

42

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%asca bedah

• Tida perlu respirator?• %emantauan E@# 7 suhu 7 p"+ 7 NB% 7 sala nye

sor sedasi?

• Analgetia morphine loading 2?2/ mg<g md o-2 Qg<g<4

• Cairan de;sit 7 rumatan 7 on going loss?• Antibiotia / hari?

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