General Anaesthetic During ORIF

in Fracture Os. Radius Distal

Dextra

Donna Eveline Prisca Panduu

1061050030
Pembimbing: dr. Karyadi Prayanangga, Sp.An
KEPANITERAAN KLINIK ILMU ANESTESI
PERIODE 7 NOVEMBER 10 DESEMBER 2016
FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN INDONESIA
RSUD TARAKAN
2016

IDENTITY
Date
: December 7th, 2016
Name
: Mr. S
Age
: 62 yo
Weigh
: 43 kg
Height
: 149 cm
Gender : Male
Diagnosis
: Fracture os. Radius distal dextra
Surgery : ORIF
Operator
: dr. Nugroho, Sp. OT
Anesthesiologist : dr. Karyadi, Sp.An

ANAMNESIS

Mr. S. 62 years old presented to Emergency Room of RSUD

Tarakan with pain in the right wirst since 1 day before came to the
hospital. Patient admit that he fell with his right hand as a pedestal.
Patient also admit the pain worsening when he moves his right
hand. Patient didnt take any medicine and see other doctor. No
open wounded.

Patient was diagnosed with Fracture os. Radius distal dextra

History of surgery (-), HT (-), DM (-), Allergy (-), Asthma (-), Fasting
>6 hours, smoking (+), alcohol (-), dentures (-), ricket teeth (-)

Physical Exam.
B1: Composmentis, GCS 15, temp: 36C, pupil isokor, Direct reflex +/+
B2: Spontanious, vesiculare, ronchi (-), wheezing (-), RR 21x/m,
malampati 2, free neck mobilization
B3: BP 100/60 mmHg, HR 78x/m, HS I-II regulare, murmur (-), gallop (-)
B4: Abdominal Distensi (-), Pain (-), timpani (+), Peristaltic 4x/m,
NGT
(-), fasting > 6 hour
B5: Dower catheter (-)
B6: Warm, CRT <2, oedema (+) at the right hand, deformitas (+)

Lab Exam.
Normal
WBC

9.000 /uL

4000 12000 /uL

HGB

16.1 g/dl

14 18 g/dl

HCT

46%

40 48%

PLT

191.000 uL

150.000 - 450.000 uL

BT

2 minutes

< 3 minutes

CT

4 minutes

2 6 minutes

ORIF (Open Reduction and

Internal Fixation)

DEFINITION

Internal fixation with open surgery to rest the fracture

and put plate, screw and pen into the fracture site for
strengthen / binding parts of the fractured bone
together.

INDICATION

Fractures that cannot be reduced except by operation.

Fractures that are inherently unstable and prone tore-displace after reduction
(e.g. mid-shaft fractures of the forearm and some displaced ankle fractures).
Also included are those fractures liable to be pulled apart by muscle action
(e.g. Transverse fracture of the patella or olecranon).
Fractures that unite poorly and slowly, principally fractures of the femoral neck.
Pathological fractures in which bone disease may prevent healing.
Multiple fractures where early fixation (by either internal or external fixation)
reduces the risk of general complications and late multisystem organ failure
(Pape et al., 2005; Roberts et al., 2005).
Fractures in patients who present nursing difficulties (paraplegics, those with
multiple injuries and the very elderly).

GENERAL ANAESTHESIA

DEFINITION

General anesthesia (GA) is the state produced when a

patient receives medications for amnesia, analgesia,
muscle paralysis, and sedation.

ADVANTAGES

Reduces intraoperative patient awareness and recall

Allows proper muscle relaxation for prolonged periods of time
Facilitates complete control of the airway, breathing, and
circulation
Can be used in cases of sensitivity to local anesthetic agent
Can be administered without moving the patient from the supine
position
Can be adapted easily to procedures of unpredictable duration
or extent
Can be administered rapidly and is reversible

Pre Operative Room

STATICS

Intra Operative

Premed: Miloz (Midazolam) 3 mg, fentanyl

50 mcg
Muscle relaxant : Induct : Recofol (Propofol) 200 mg, sevoflurance 3%
Intubate : LMA no. 4
Maintanance : O2 4 lpm + Sevoflurance
Other drugs : Amikaccin 1 gr, cefazolin 2 gr,
dexamethasone, ondancetron 4
mg, ketorolac 30 mg

MABL (maximal allowable blood loss)

MABL=(initial Ht-target Ht) /
initial HT x EBV
MABL=[(46-21)/46] x (75 x
43)
MABL=0,76 x 3.225 =
2.4510 cc

Blood loss = + 50 cc

Fasting
2 x 43kg x 6 hours =516 cc
Stress op
43 kg x 3 = 129 cc
Bleeding= 50 cc
EBV=75 x 43kg = 3.225 cc
Blood loss= 50/3.225 x100%
= 1.6%

Replaced with crystalloid

3 x 50 = 150 cc
Total fluid needed
150+516+129=795cc

Pre op = 265 cc RL
Durante op = 265 cc RL
Post op = 265 cc RL

Fluid Resuscitation

VITAL SIGN
Jam

BP

HR

SpO2

10.20

160/64 mmHg

80

100%

10.35

138/82 mmHg

62

100%

10.50

110/78 mmHg

65

100%

11.05

120/80 mmHg

70

100%

11.20

124/75 mmHg

68

100%

11.35

122/78 mmHg

72

100%

11.45

120/60 mmHg

78

100%

Operation duration: 1 hours 25 minutes

BP: 120/60 mmHg, HR: 80x/m, spontanious and
adequate respiration, RR: 17x/m, SpO2 100%
Deep extubation
Transfer to Ward

THANK YOU