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Laparoskopi nefrektomi pada pasien dengan gangguan jantung dan paru



Abstract

Laparoscopy is a minimally invasive surgical procedure by inserting CO2 gas into the peritoneal cavity. Laparoscopy provides an advantage during surgery and shorten the hospital length of stay. The combination of nephrectomy in laparoscopy is the first step performed at Sanglah Hospital, Denpasar, this action presents different challenges in the management of anesthesia. Reported cases of women, 57 years old, with left staghorn stones, sinus pyohydronefrosis and post left nefrostomy with ASA III physical status (patients with LVH and decreased grade I of LV diastolic function and severe moderate restriction in the lungs), performed laparoscopic nephrectomy with anesthesia ASA III status, general anesthesia and endotracheal intubation. The duration of the surgery was 8 hours 15 minutes. Significant hemodynamic fluctuations occurred during the operation, however with good preparation of anesthesia, a good recovery outcome was obtained. Laparoscopy provides post-operative advantages, including: minimally traumatized, minimal pain, fewer pulmonary dysfunction, a faster recovery period, and shorten the hospital length of stay. During the laparoscopic procedure, performed a pneumoperitoneum will cause cardiorespiratory changes. The development of knowledge about pathophysiology, hemodynamic changes and respiration will determine the progress of the management of anesthesia in laparoscopy.

 

Laparoskopi merupakan suatu prosedur pembedahan minimal invasif dengan memasukkan gas CO2 ke dalam rongga peritoneum. Laparoskopi memberi keuntungan dalam durante operasi dan lama rawat yang singkat. Kombinasi tindakan nefrektomi dalam laparoskopi merupakan tindakan yang baru pertama kali dikerjakan di Rumah Sakit Umum Pusat Sanglah Denpasar, tindakan ini memberi tantangan berbeda dalam manajemen anestesi. Dilaporkan kasus perempuan, 57 tahun, dengan batu staghorn sinistra, pyohydronefrosis sinistra dan post nefrostomy sinistra dengan status fisik ASA III (pasien dengan left ventricle hypertrophy dan penurunan fungsi diastolik ventrikel kiri grade I dan restriksi sedang berat pada paru-paru), dilakukan tindakan laparoskopi nefrektomi dengan anestesi umum dan intubasi endotrakea. Durasi operasi selama 8 jam 15 menit. Terjadi fluktuasi hemodinamik signifikan selama durante operasi, namun dengan persiapan anestesi yang baik diperoleh luaran pemulihan yang baik. Laparoskopi memberikan keuntungan pasca operasi, diantaranya: trauma yang lebih minimal, nyeri minimal, gangguan fungsi paru yang sedikit, masa pemulihan yang lebih cepat, sehingga masa rawat inap di rumah sakit juga lebih singkat. Selama tindakan laparoskopi dilakukan pneumoperitoneum yang akan menimbulkan perubahan kardiorespirasi. Perkembangan pengetahuan tentang patofisiologi, perubahan hemodinamik dan respirasi sangat menentukan kemajuan penanganan anestesi pada tindakan laparoskopi.

Keywords: gangguan jantung dan paru laparoskopinefrektomi teknik anestesi

References

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How to Cite

Yudi, I. N. T. W., Senapathi, T. G. A., Ryalino, C., & Pradhana, A. P. (2020). Laparoskopi nefrektomi pada pasien dengan gangguan jantung dan paru. Medicina, 51(2). https://doi.org/10.15562/medicina.v51i2.988
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I Nyoman Trisna Wirakusuma Yudi
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Tjokorda Gde Agung Senapathi
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Christopher Ryalino
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Adinda Putra Pradhana
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