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CHECK LIST GA

N
O
1.
2.

NAMA

JML

CHEC
K

N
O

OBAT

JML

Propofol (potek)
Midazolam
(potek)
Fentanyl (potek)
Rocuronium
(potek)
Ketorolac
Tramadol
Dexamethasone

2
1

1.
2.

3.

Cuff (2 ukuran)
Laringoskope + 2
blade
ET (2 ukuran)

2

3.

4.

Guedel (2ukuran)

2

4.

5.
6.
7.

Stilet
Magil
Spuit
(3cc,5cc,10cc)
Gel

1
1
3

5.
6.
7.

1

8.

8.
9.
10
.
11
.
12
.
13
.

Lead EKG
Hypafix
Nasal canul

3
1
set
1

Sucction

1

Corigated

1

Diphenhindramin
e
9. Ondancentron
10. Metochlorpamid
e
11. Kalnex

N
O

NAMA

2
1

1.
2.

1

3.

1

4.

1
1
1

5.
6.

Infus Set (2)
Transfusi set
(1)
Abocath
18,20
Extention
Tube
3 way
Pek

1
1
1
2

CHEC
K

CEK

5. 9. NAMA KHUSUS SC JML CEK N O OBAT JML Lidocain 2% Bupivacain Spinal Catapres Fenthanyl Tegaderm/Hypafix 12x5 Betadine Semprotan Alkohol Bantal + Guling Tangan Bow 2 1 1 1 1 1. 12 . 7. 3. 2. Oksitosin 1 Jarum Spinal25(O). Ondancentron Midazolam Fenthanyl Cefazolim Metergin 1 1 1 1 1 1 1 1 2 1 6.CHECK LIST SPINAL N O 1. 14 . 4. 27(P) Handskun steril 2 ukuran Kasa Steril 1 Mangkok Cina 1 2 1 CHEC K . 13 . 6. 4. 10 . 8. 5. 2. 3. 11 .

2.15 .5cc 3 CHECK LIST EPIDURAL N O NAMA JML 1. 5. 9.9% Betadine Handskun Steril 4 1 1 1 1 1 1 8. 7. 6. Spuit 1cc. 3.3cc. 10 1 1 2 CEK . Lidocain 2% Pehacaine Test Dose (spuit 3cc) Morfin Catapres Hypafix Semprotan Alkohol 70% NaCl 0. 4.

15 Needle 18 .. 18 Bow . 2ukuran 11 Bantal + Guling . *test dose : lidocain 1. 17 Tangan . NAMA OBAT PENGENCERAN DOSIS Midazolam Rocuronium Tidak diencerkan 1cc + Aquadest jadi ---2mg/ml . 12 Mangkok Cina .8cc + 1 1 1 3 1 1 2 1 1 pehacain 1. 16 Epidural Set .2cc PENGENCERAN OBAT GA PADA ANAK N O 1. 14 Spuit 1cc. 13 Kasa Steril .20cc .3cc. 19 Transporter . 2.

SA 5.3. Fentanyl 6. Ketamin 7.05mg/ ml 10ug/ml Aquadest jadi 10ug/ml Aquadest jadi 2mg/ml . Tramadol 4. Propofol 5cc 1cc + 5cc 1cc + 5cc 1cc + 5cc 1cc + 10cc 2cc + 10cc Aquadest jadi 10mg/ml Aquadest jadi Aquadest jadi 0.