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Heru DJ., Bagian / SMF Anestesiologi FK-UNDIP/RSDK Semarang
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16.750 Children in PACU 10 Arrest 43 %
Claims Respiratory System
25 %PostOP 2000
Incidents
10 % Infants & Children
Isabelle SS,Walid H,Pediatric Anesthesia 2002;661-675
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DISCHARGE FORM RR
Modified Aldrete Score
Color Oxygen Saturation
Five Function
Activity
Respiration
Circulation
ConsiousnessOxygen Saturation
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ASSESMENT OPEN ADMISSION
INTO RR Airway Potency & O2 Saturation Administration of
Suplemental O2
Basic Vital Sign, BP, Pilse, RR & t Position of The
Patient
Condition of Dressing or Wound if Evident
Type of Chateters and Drainage Tube
Location of Lines, Tipe & Amount of Fluid Infusion
Level of Consciousness
Muscular Strenght & Response
Level of Pain
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PROBLEM in
RECOVERY ROOM
Emergence DeliriumPainNausea & Vomiting
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Emergence Delirium = Emergence Agitation
A Disturbance in a childs awareness of end
attention to his or her environment withdisorientation &
perceptual alteration includinghipersensitivity to stimuli &
hyperactive motorbehavior in the immediate post anesthesia
periode
Sikick & Lerman, Anesthesiology
2004 ; 100 : 1138 - 45
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INCIDENCE
Pediatric 10 % to 80 %
Vlojokovik Sindehic
Anesthesiology 2007; 104J: 84 91
Adult 3% to 4 %
Lepord et al. BJA 2006; 96 (6)
: 747 - 753
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Risk Factors
2. Parent AnxietyMaternal heart variability just before
surgerysignificantly correlated with emergence behavior ofchildren
under going general anesthesia
Arai et al. Pediatric Anethesia 2008; 18: 167- 171
1. Patient AnxietyPre OP Patient anxiety Increases the risk of
postop Emergence delirium
Kain et al. Anesthesia Anelgetic 2006; 99(6) :1648-1659
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MANAGEMENT
Non Pharmacolic
- Quiet Environment- Comforting by Parent
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Pharmacologic
MidazolamFentanyl
Morphin
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PAIN
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PAEDIATRIC RECOVERY ROOM
PAIN CONTROL
DRUG DOSE ROUTE
Fentanyl 0,35 0 0,70 g/kg IV
Alfentanyl 2 4 g/kg IV
Acetaminofen 60 mg/yr PO
Acetaminofen 120 mg,Codein 12 mg ( elixir 5 ml)
5 -10 ml PO
Mepheridin 0,5 mg/kg IM
Codein 1 1,5 mg/kg IM
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Dorsal Nerve Block
Topical Anesthesia Lidocain Spray/Jelly
Caudal Block
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NAUSEA & VOMITING
Risk Factors
Narcotic Analgetic drug
Anaesthetic Technic
Operative Procedure
History of Motion Sickness
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ANTI EMETICS
Metoclopramide
Droperidol
Ondansetron
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Effect of Ondansentron on the Incidence of Vomiting
associated with Ketamine sedation in Children : A
Double
Blind, Randomized, Placebo Control Trial
An Emergency Medician. 2008; 52:30 -34
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e
Family Centered Pediatric PerioperativeCare
Most hospitals allow parents in the recovery roomafter their
childrens surgeries
Jill Mac laren, Zeev NK.Anesthesiology 2010,112:751-5
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Thank YouFor YourAttention
