ETIKA DAN KOMUNIKASI PASIEN,

PERALATAN DAN MONITORING ANESTESI

PEDIATRI
dr. Anisa Fadhila Farid Sp.An

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 Etika & Komunikasi

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PEDIATRIK Clinicians should treat every child
and family with the grace and
consideration with which they would
want their own child and family
treated.
Taking the experience of children
seriously means involving interested
children in developmentally
appropriate decision making.

Bioethics helps motivated physicians

to identify and resolve ethical
dilemmas
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 Informed Consent

• The benefits and risks of the anesthetic

procedure must be presented in clear, easily
understood terms.
• it is important not to present this information
in a manner that unduly frightens the child or
parents.
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 COTE 6th

Peralatan

Patient Warming
Intubation Equipment
Airway Apparatus

Suction Devices
Anesthesia
E Workstation
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 Patient Warming

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 Airway Apparatus

MASK

Transparant disposable plastic (latex-free) fase masks

are available in a wide variety of sizez for the children of
all ages, to deliver oxygen as well as induce and
maintain inhalational anesthesia

COTE 6th AI

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Craig
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 Orophayngeal Airway

Oropharyngeal airways are hard, non-latex plastic that are preformed in different
sizes from 40 mm (infant) to 100 mm (large adult). Care should be taken to choose
an airway that is the correct size for the child because :
• Insertion of an undersized airway can push the tongue posteriorly and worsen
obstruction,
• while an oversized airway can impinge on the epiglottis or glottis and worsen
J obstruction or trigger coughing and laryngospasm.

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 Nasopharyngeal Airway
• A nasopharyngeal airway may be inserted
to restore patency of the obstructed upper
airway when the obstruction is suspected
to be at the level of the upper pharynx or
higher
• Latex-free nasal airways are available in
sizes from 12F to 36F. Care should be
taken when placing them in the nose as
they may injure the mucosa or dissect
adenoidal tissue free, causing bleeding

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 LMA / SGA

• SGAs are available for all age groups from

neonates and infants < 5Kg to children and
adolescents (>70 kg).
• When the LMA was first introduced, most
practitioners used it only in children who
breathed spontaneously. However, more
recently many have adopted the adult
practice of using low-pressure volume
support and positive end-expiratory
pressure (PEEP) with the LMA to minimize
the effect of the dead space contributed by
the LMA stem and the associated
hypercarbia.

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 Endotracheal Tube

Endotracheal tube (ETT) sizes are polyvinyl chloride in composition, implant tested
and non-reusable. ETT sizes range from 2 to 10 mm inner diameter (ID).

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 COTE 6th

• Uncuffed ETTs have been the standard in pediatric anesthesia in infants and children up to 8
years of age for decades,
• Although in the past 10 to 20 years, there has been a shift toward cuffed ETTs, accelerated
by the introduction of the Microcuff ETT (Halyard Health, Alpharetta, GA).
• The reasons behind this shift in practice include : the manufacturing of high-volume,
lowpressure cuffed ETTs, efforts to reduce OR contamination, to decrease anesthetic use
O with reduced fresh gas flow, to reduce the need to reintubate the airway to prevent a large
gas leak, and ICU studies documenting the safety of cuffed ETTs after prolonged tracheal
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 Cuffed vs Uncuffed

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 LARYNGOSCOPES

• Laryngoscopes A full range of straight (Miller) and curved (Macintosh or Mac) laryngoscope blades for
direct laryngoscopy should be available.
• It is quite possible in a typical pediatric anesthesia practice to use both a Miller 00 and a Mac 4 blade
in the same day.
• Both small and large laryngoscope handles are available to accommodate differences in body habitus
among children.
• The blade and handle combinations should be tested before anesthesia is induced. Backup blades
and handles should be immediately available; additional batteries and light bulbs should be in

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 SUCTION

• Suction catheters with a thumb-controlled side port in sizes from 6F to 14 F should

be available to suction ETTs.
• Yankauer suction devices should never be inserted into the mouth in the midline
(because the child may bite down on it and break or dislodge teeth).
• Rather, the devices should be inserted between the teeth and the inside of the cheek,
reaching the hypopharynx behind the molars or bicuspids.
• The small size Yankauer works well in infants, limiting damage to the oropharynx.

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 Monitoring COTE 6th

“Monitoring should be appropriate for the child's clinical condition and

the surgical procedure”
Basic monitors : Continuous monitoring : Additional monitoring :
• Eyes : observe a child's • Electrocardiogram, • Near-infrared
color to and chest • Temperature, spectroscopy
movements • Inspired oxygen • Invasive hemodynamic
• Ears : to listen for heart concentration, monitoring (direct
tones and breath • Oxygen saturation, arterial blood pressure,
sounds • Expired carbon dioxide, • central venous
• Hands : palpate the and pressure)
arterial pulse and • Serial blood pressure • Neuromuscular
temperature of the skin (NIBP) Transmission Monitor
F

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 TERIMA KASIH

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