Pediatric Ambulatory

I Putu Kurniyanta
 Pediatric Ambulatory

• Approximately 53 million ambulatory procedures

were performed in the USA in 2006, with 57.3% of
those taking place in hospitals, 42.7% in clinic
• The percentage in clinic is growing rapidly.
• Driven by economic factors, by surgeon and patient
• More efficiently, reduce the time patients spend
away from home undergoing surgery, and they lower
exposure to hospital‐acquired infections.
 Pediatric Ambulatory

• The increase in ambulatory surgery has been

facilitated by development of short acting
anesthetics and by advances in antiemetic and
analgesic agents, including multimodal
analgesics and especially the development
and use of regional anesthesia.
• Multimodal analgesia uses different classes of
analgesics with different sites of action
 Indication

• Patient with ASA 1 and 2

• Minimal/short surgery
 Kontra Indikasi

• Bayi aterm kurang dari 1 bln

• Bayi prematur
• Penderita dgn kelainan saluran nafas (BPD,
difficult airway, OSA)
• Kelainan metabolik, diabetes, obesitas
• Kelainan jantung
• Infeksi akut

PNPK Anestesiologi&Terapi Intensif

2015
 Indication

Diagnostic Procedures
• Upper and lower endoscopy
• Flexible bronchoscopy
• Auditory evoked response
 Indication

Urology
• Hernioraphy/Hydrocelectomy
• Hypospadius repair
• Orchiopexy
• Cystoscopy for stent change or deflux injection
• Circumcision
• Cordaee repair
• Meatotomy
 Indication
Otorhinolaryngology
• Examination under anesthesia
• Myringotomy tubes
• Adenoidectomy
• Adentonsillectomy
• Direct laryngoscopy/bronchoscopy ± laser ablation, typically for
papillomatosis
Dental
• Extractions and restorations
Plastic Surgery
• Excision of superficial lesions
• Placement of tissue expanders for congenital nevus
• Otoplasty
 Indication

Orthopedic Surgery
• Syndactyly Release/Polydactyly removal
• Hardware removal
• Anterior cruciate ligament repair
• Minor tendon releases
• Arthroscopy
 Indication
General Surgery
• Hernioraphy/Hydrocelectomy
• Umbilical/Periumbilical hernia repair
• Excision of superficial lesions/masses
• Abscess incision and drainage
• Removal of hardware after pectus repair
Ophthalmology
• Examination under anesthesia
• Strabismus repair
• Cataract removal, placement of intraocular lens
• Lacrimal duct probing ± stenting
• Glaucoma procedures: goniotomy, trabeculotomy
• Excision of cysts
 Pre Op

• Evaluasi ulang
Tanda Infeksi pernafasan
Puasa
Inform consent orang tua
 Persiapan

• Pasien
Puasa Cairan jernih, air putih,
the, juice buah tanpa
2 jam

ampas

ASI 4 jam
Susu formula 6 jam
Makanan padat 6 jam

Inform consent
• Obat & alat anestesi
 Anesthesia

• Premedikasi: midazolam, H2 antagonis,

antacide
• Induksi: propofol, inhalasi
• Pelumpuh otot: atracurium
• Analgesia : fentanyl, NSAID, caudal analgesia
Anesthesia

• Stress/cemas/takut
• Sakit
• Lingkungan
• Peran orang tua
 Post Op

• Monitoring
• Analgesia
Paracetamol 10-15 mg/kgbb
Ibuprofen 5-10 mg/kgbb
• Mual muntah
Ondancentron 0,1 mg/kgbb
Post Op

• Monitoring (telp,
distance to hospital,
pain, complication, ..)
Discharge
 Discharge
0 1 2

Vital Sign 40% of preop 20%-40% of preop 20% of preop value

value value

Ambulation None/dizzines With assistance Steady gait

Nausea/vomiting severe Moderate Minimal

Pain severe Moderate Minimal

Surgical bleeding severe Moderate minimal

Kriteria > 9 pasien boleh dipindahkan/dipulangkan

 Discharge

• Monitoring
• Telp call/hospital/clinic
• Voiding?
TERIMA KASIH