151898874 5 perioperative fluid therapy ppt

8/20/2019 151898874 5 Perioperative Fluid Therapy Ppt

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Terapi Cairan dan TransfusiTerapi Cairan dan Transfusi

dr. Imam Ghozali., SpAn.,MKesdr. Imam Ghozali., SpAn.,MKes

Department of Anesthesiology

Malahayati Uniersity


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Total !ody "ater #T!"$Total !ody "ater #T!"$

% &aries 'ith age, gender, (ody ha(itus&aries 'ith age, gender, (ody ha(itus

% ))* (ody 'eight in males))* (ody 'eight in males

% +)* (ody 'eight in females+)* (ody 'eight in females

% -* (ody 'eight in infants-* (ody 'eight in infants

% ess in o(ese/ fat 0ontains little 'ater ess in o(ese/ fat 0ontains little 'ater


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!ody "ater Compartments!ody "ater Compartments

% Intra0ellular 'ater/ 123 of T!"Intra0ellular 'ater/ 123 of T!"

% 45tra0ellular 'ater/ 623 T!"45tra0ellular 'ater/ 623 T!"

77 45traas0ular 'ater/ 32+ of e5tra0ellular 'ater 45traas0ular 'ater/ 32+ of e5tra0ellular 'ater

77 Intraas0ular 'ater/ 62+ of e5tra0ellular 'ater Intraas0ular 'ater/ 62+ of e5tra0ellular 'ater


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8luid and 4le0trolyte 9egulation8luid and 4le0trolyte 9egulation

% &olume 9egulation&olume 9egulation

7 Arginine7&asopressin #Antidiureti0 :ormone$Arginine7&asopressin #Antidiureti0 :ormone$

7 9enin2angiotensin2aldosterone system9enin2angiotensin2aldosterone system

7 !arore0eptors in 0arotid arteries and aorta!arore0eptors in 0arotid arteries and aorta

7 Stret0h re0eptors in atrium and ;u5taglomerularStret0h re0eptors in atrium and ;u5taglomerular

aparatusaparatus

7 CortisolCortisol


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8luid and 4le0trolyte 9egulation8luid and 4le0trolyte 9egulation

%


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=rthostati0 :ypotension=rthostati0 :ypotension

% Systoli0 (lood pressureSystoli0 (lood pressure decreasedecrease of greater thanof greater than

1-mm:g from supine to standing1-mm:g from supine to standing

% Indi0ates fluidIndi0ates fluid deficit deficit of @7* (ody 'eightof @7* (ody 'eight

77 :eart rate should in0rease as a 0ompensatory measure :eart rate should in0rease as a 0ompensatory measure

77 If no in0rease in heart rate, may indi0ate autonomi0If no in0rease in heart rate, may indi0ate autonomi0

dysfun0tion or antihypertensie drug therapydysfun0tion or antihypertensie drug therapy


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Maintenan0e 8luid 9euirementsMaintenan0e 8luid 9euirements

% Insensi(le losses su0h as eaporation of 'ater fromInsensi(le losses su0h as eaporation of 'ater fromrespiratory tra0t, s'eat, fe0es, urinary e50retion.respiratory tra0t, s'eat, fe0es, urinary e50retion. Occurs continuallyOccurs continually..

% Adults/ appro5imately 6.) ml2?g2hr Adults/ appro5imately 6.) ml2?g2hr

% +7176 9ule+7176 9ule77 + ml2?g2hr for the first 6- ?g of (ody 'eight + ml2?g2hr for the first 6- ?g of (ody 'eight

77 1 ml2?g2hr for the se0ond 6- ?g (ody 'eight 1 ml2?g2hr for the se0ond 6- ?g (ody 'eight

77 6 ml2?g2hr su(seuent ?g (ody 'eight 6 ml2?g2hr su(seuent ?g (ody 'eight

77 45tra fluid for feer, tra0heotomy, denuded surfa0es 45tra fluid for feer, tra0heotomy, denuded surfa0es


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B


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Third Spa0e ossesThird Spa0e osses

% Isotoni0 transfer of 4C8 fromIsotoni0 transfer of 4C8 from functional functional (ody (ody

fluid 0ompartments tofluid 0ompartments to non-functional non-functional

0ompartments.0ompartments.

% Depends on lo0ation and duration of surgi0alDepends on lo0ation and duration of surgi0al pro0edure, amount of tissue trauma, am(ient pro0edure, amount of tissue trauma, am(ient

temperature, room entilation.temperature, room entilation.


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9epla0ing Third Spa0e osses9epla0ing Third Spa0e osses

% Superfi0ial surgi0al trauma/ 671 ml2?g2hr Superfi0ial surgi0al trauma/ 671 ml2?g2hr

% Minimal Surgi0al Trauma/ 37+ ml2?g2hr Minimal Surgi0al Trauma/ 37+ ml2?g2hr

77 head and ne0?, hernia, ?nee surgeryhead and ne0?, hernia, ?nee surgery

% Moderate Surgi0al Trauma/ )7@ ml2?g2hr Moderate Surgi0al Trauma/ )7@ ml2?g2hr

77 hystere0tomy, 0hest surgery hystere0tomy, 0hest surgery

% Seere surgi0al trauma/ 76- ml2?g2hr #or more$Seere surgi0al trauma/ 76- ml2?g2hr #or more$

77 AAA repair, nehpre0tomy AAA repair, nehpre0tomy


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!lood oss!lood oss

% 9epla0e9epla0e 3 cc3 cc of 0rystalloid solution per 00 ofof 0rystalloid solution per 00 of

(lood loss #0rystalloid solutions leae the (lood loss #0rystalloid solutions leae the

intraas0ular spa0e$intraas0ular spa0e$

% "hen using (lood produ0ts or 0olloids repla0e"hen using (lood produ0ts or 0olloids repla0e (lood loss olume per olume (lood loss olume per olume


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=ther fa0tors=ther fa0tors

% =ngoing fluid losses from other sites/=ngoing fluid losses from other sites/

77 gastri0 drainage gastri0 drainage

77 ostomy output ostomy output

77 diarrhea diarrhea% 9epla0e olume per olume 'ith 0rystalloid9epla0e olume per olume 'ith 0rystalloid

solutionssolutions


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45ample45ample

% @1 y2o male, - ?g, for hemi0ole0tomy@1 y2o male, - ?g, for hemi0ole0tomy

% B


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CrystalloidsCrystalloids

% Com(ination of 'ater and ele0trolytesCom(ination of 'ater and ele0trolytes

77 !alan0ed salt solution/ ele0trolyte 0omposition and!alan0ed salt solution/ ele0trolyte 0omposition and

osmolality similar to plasmaH e5ample/ la0tatedosmolality similar to plasmaH e5ample/ la0tated

9ingers,


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ColloidsColloids

% 8luids 0ontaining mole0ules suffi0iently large8luids 0ontaining mole0ules suffi0iently large

enough to preent transfer a0ross 0apillaryenough to preent transfer a0ross 0apillary

mem(ranes.mem(ranes.

% Solutions stay in the spa0e into 'hi0h they areSolutions stay in the spa0e into 'hi0h they areinfused.infused.

% 45amples/ hetastar0h #:espan$, al(umin, de5tran.45amples/ hetastar0h #:espan$, al(umin, de5tran.


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CompositionComposition


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CompositionComposition

Fluid Osmo-

lality

Na Cl K

D5W 253 0 0 00.9NS 308 154 154 0

LR 273 130 109 4.0

Plasma-lyte 294 140 98 5.0

Hespan 310 154 154 0

5% Albumin 308 145 145 0

3%Saline 1027 513 513 0

Cli i l 4 l ti f 8l idCli i l 4 l ti f 8l id


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Clini0al 4aluation of 8luidClini0al 4aluation of 8luid

9epla0ement9epla0ement

6. Urine =utput/ at least 6.- ml2?g2hr 6. Urine =utput/ at least 6.- ml2?g2hr

1. &ital Signs/ !< and :9 normal #:o' is the patient1. &ital Signs/ !< and :9 normal #:o' is the patientdoingF$doingF$

3.


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SummarySummary

% 8luid therapy is 0riti0ally important during the8luid therapy is 0riti0ally important during the

perioperatie period. perioperatie period.% The most important goal is to maintainThe most important goal is to maintain

hemodynami0 sta(ility and prote0t ital organshemodynami0 sta(ility and prote0t ital organsfrom hypoperfusion #heart, lier, (rain, ?idneys$.from hypoperfusion #heart, lier, (rain, ?idneys$.

% All sour0es of fluid losses must (e a00ounted for.All sour0es of fluid losses must (e a00ounted for.% Good fluid management goes a long 'ay to'ardGood fluid management goes a long 'ay to'ard

preenting pro(lems. preenting pro(lems.


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"hen is Transfusion Be0essaryF"hen is Transfusion Be0essaryF

%

Transfusion Trigger Transfusion Trigger / :g( leel at 'hi0h/ :g( leel at 'hi0htransfusion should (e gien.transfusion should (e gien.

77 &aries 'ith patients and pro0edures &aries 'ith patients and pro0edures

% Toleran0e of a0ute anemia depends on/Toleran0e of a0ute anemia depends on/

77 Maintenan0e of intraas0ular olume Maintenan0e of intraas0ular olume77 A(ility to in0rease 0ardia0 outputA(ility to in0rease 0ardia0 output

77 In0reases in 1,37D


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=5ygen Deliery=5ygen Deliery

% =5ygen Deliery #D==5ygen Deliery #D=11$ is the o5ygen that is$ is the o5ygen that is

deliered to the tissuesdeliered to the tissues

% D=D=11E Cardia0 =utput #C=$ 5 =5ygen Content #Ca=E Cardia0 =utput #C=$ 5 =5ygen Content #Ca=11$$

% Cardia0 =utput #C=$ E :9 5 S&Cardia0 =utput #C=$ E :9 5 S&

% =5ygen Content #Ca==5ygen Content #Ca=11$/$/

77 # #HgbHgb 5 6.3$=5 6.3$=11 saturation


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=5ygen Deliery #0ont.$=5ygen Deliery #0ont.$

% Therefore/ D=Therefore/ D=11 E :9 5 S& 5 Ca=E :9 5 S& 5 Ca=11% If :9 or S& are una(le to 0ompensate, :g( is theIf :9 or S& are una(le to 0ompensate, :g( is the

ma;or deterimant fa0tor in =ma;or deterimant fa0tor in =11 delierydeliery

% :ealthy patients hae e50ellent 0ompensatory:ealthy patients hae e50ellent 0ompensatoryme0hanisms and 0an tolerate :g( leels of Jme0hanisms and 0an tolerate :g( leels of Jgm2d.gm2d.

% Compromised patients may reuire :g( leelsCompromised patients may reuire :g( leelsa(oe 6- gm2d.a(oe 6- gm2d.

l d


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!lood Groups!lood Groups

Antigen onAntigen on


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Type and S0reenType and S0reen

% Donated (lood that has (een tested for A!=29hDonated (lood that has (een tested for A!=29h

antigens and s0reened for 0ommon anti(odies #notantigens and s0reened for 0ommon anti(odies #not

mi5ed 'ith re0ipient (lood$.mi5ed 'ith re0ipient (lood$.

77 Used 'hen usage of (lood is unli?ely, (ut needs to (eUsed 'hen usage of (lood is unli?ely, (ut needs to (eaaila(le #hystere0tomy$.aaila(le #hystere0tomy$.

77 Allo's (lood to aaila(le for other patients. Allo's (lood to aaila(le for other patients.

77 Chan0e of hemolyti0 rea0tion/ 6/6-,---. Chan0e of hemolyti0 rea0tion/ 6/6-,---.

C t ThC t Th


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Component TherapyComponent Therapy

% A unit of 'hole (lood is diided into 0omponentsH Allo'sA unit of 'hole (lood is diided into 0omponentsH Allo's

prolonged storage and spe0ifi0 treatment of underlying pro(lem prolonged storage and spe0ifi0 treatment of underlying pro(lem'ith in0reased effi0ien0y/'ith in0reased effi0ien0y/7 pa0?ed red (lood 0ells #p9!Cs$ pa0?ed red (lood 0ells #p9!Cs$

7 platelet 0on0entrate platelet 0on0entrate

7 fresh frozen plasma #0ontains all 0lotting fa0tors$fresh frozen plasma #0ontains all 0lotting fa0tors$

7 0ryopre0ipitate #0ontains fa0tors &III and fi(rinogenH used in &on0ryopre0ipitate #0ontains fa0tors &III and fi(rinogenH used in &on

"ille(rands disease$"ille(rands disease$7 al(uminal(umin

7 plasma protein fra0tion plasma protein fra0tion

7 leu?o0yte poor (loodleu?o0yte poor (lood

7 fa0tor &IIIfa0tor &III

7 anti(ody 0on0entratesanti(ody 0on0entrates


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8resh 8rozen


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Compli0ations of !lood TherapyCompli0ations of !lood Therapy

% Transfusion 9ea0tions/Transfusion 9ea0tions/

77 8e(rile8e(rileH most 0ommon, usually 0ontrolled (y slo'ingH most 0ommon, usually 0ontrolled (y slo'ing

infusion and giing antipyreti0sinfusion and giing antipyreti0s

77

Allergi0Aller gi0

H in0reased (ody temp., pruritis, urti0aria. 95/H in0reased (ody temp., pruritis, urti0aria. 95/

antihistamine,dis0ontinuation. 45amination of plasmaantihistamine,dis0ontinuation. 45amination of plasma

and urine for free hemoglo(in helps rule out hemolyti0and urine for free hemoglo(in helps rule out hemolyti0

rea0tions.rea0tions.



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#0ont.$#0ont.$

% :emolyti0/:emolyti0/7 "rong (lood type administered #oops$."rong (lood type administered #oops$.

7 A0tiation of 0omplement system leads to intraas0ularA0tiation of 0omplement system leads to intraas0ular

hemolysis, spontaneous hemorrhage.hemolysis, spontaneous hemorrhage.

7 Signs/ hypotension,feer, 0hills, dyspnea, s?in flushing,Signs/ hypotension,feer, 0hills, dyspnea, s?in flushing,su(sternal pain. Signs are easily mas?ed (y general anesthesia.su(sternal pain. Signs are easily mas?ed (y general anesthesia.

7 8ree :g( in plasma or urine8ree :g( in plasma or urine

7 A0ute renal failureA0ute renal failure

7

Disseminated Intraas0ular Coagulation #DIC$Disseminated Intraas0ular Coagulation #DIC$

T t t f A t : l tiT t t f A t : l ti


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Treatment of A0ute :emolyti0Treatment of A0ute :emolyti0

9ea0tions9ea0tions

% Immediate dis0ontinuation of (lood produ0tsImmediate dis0ontinuation of (lood produ0ts

% Maintenan0e of urine output 'ith 0rystalloidMaintenan0e of urine output 'ith 0rystalloid

infusionsinfusions% Administration of mannitol or 8urosemide forAdministration of mannitol or 8urosemide for

diureti0 effe0tdiureti0 effe0t


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Compli0ations #0ont.$Compli0ations #0ont.$

%

Transmission of &iral Diseases/Transmission of &iral Diseases/7 :epatitis CH 6/3-,--- per unit:epatitis CH 6/3-,--- per unit

7 :epatitis !H 6/1--,--- per unit:epatitis !H 6/1--,--- per unit

7 :I&H 6/+)-,---76/@--,--- per unit:I&H 6/+)-,---76/@--,--- per unit

7 11 day 'indo' for :I& infe0tion and test dete0tion11 day 'indo' for :I& infe0tion and test dete0tion

7 CM& may (e the most 0ommon agent transmitted, (utCM& may (e the most 0ommon agent transmitted, (ut

only effe0ts immuno0ompromised patientsonly effe0ts immuno0ompromised patients

7


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=ther Compli0ations=ther Compli0ations

7 De0reased 1,37D


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Autologous !loodAutologous !lood

%


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Administering !lood


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Alternaties to !lood


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AutotransfusionAutotransfusion

% Commonly ?no'n as Cell7saerCommonly ?no'n as Cell7saer

% Allo's 0olle0tion of (lood during surgery for re7Allo's 0olle0tion of (lood during surgery for re7

administrationadministration

% 9!Cs 0entrifuged from plasma9!Cs 0entrifuged from plasma

% 4ffe0tie 'hen L 6---ml are 0olle0ted4ffe0tie 'hen L 6---ml are 0olle0ted

!l d S ( i!l d S ( i


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!lood Su(stitutes!lood Su(stitutes

% 45perimental o5ygen70arrying solutions/ deeloped to45perimental o5ygen70arrying solutions/ deeloped to

de0rease dependen0e on human (lood produ0tsde0rease dependen0e on human (lood produ0ts

% Military (attlefield usage initial goalMilitary (attlefield usage initial goal

% Multiple approa0hes/Multiple approa0hes/

7 =utdated human :g( re0onstituted in solution=utdated human :g( re0onstituted in solution

7 Geneti0ally engineered2(oine :g( in solutionGeneti0ally engineered2(oine :g( in solution

7 iposome7en0apsulated :g(iposome7en0apsulated :g(

7


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!l d S ( tit t # t $!l d S ( tit t # t $


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!lood Su(stitutes #0ont.$!lood Su(stitutes #0ont.$

%


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Transfusion Therapy SummaryTransfusion Therapy Summary

% De0ision to transfuse inoles many fa0torsDe0ision to transfuse inoles many fa0tors

% Aaila(ility of 0omponent fa0tors allo'sAaila(ility of 0omponent fa0tors allo's

treatment of spe0ifi0 defi0ien0ytreatment of spe0ifi0 defi0ien0y

% 9is?s of transfusion must (e understood and9is?s of transfusion must (e understood ande5plained to patientse5plained to patients

% &igilan0e ne0essary 'hen transfusing any (lood&igilan0e ne0essary 'hen transfusing any (lood

produ0t produ0t

151898874 5 perioperative fluid therapy ppt

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