MANAJEMEN PREOPERATIF KEHAMILAN EKTOPIK TERGANGGU DENGAN SYOK HIPOVOLEMIA

Had been reported a case of preoperative management for a woman 36 years old, G1P0A0, pregnant 11 weeks with ruptured ectopic pregnancy and run into hypovolemia shock. We assessed physic status patient as ASA (American Society of Anesthesia) 4E (emergency) with hypovolemia shock et causa internal bleeding and patient had been done relaparotomy. Patient had been refered from RSUD Wonosari and when she came to RSUP Sardjito, she feel pain and pale suspicious hypovolemia shock with internal bleeding then had been done laparatomy emergency surgery, dextra salphingectomy et causa ruptured ectopic pregnancy in IGD operation room for 2 hours and then she was observated in resusitation room for 6 hours and then she was transported to PACU.

When in PACU, her condition compos mentis, she feel pain and the hemodynamic is blood pressure 90/ 60 mmHg, pulse 165 times/ minutes, respiration rate 32 times/ minutes on NRM 8 liters/ minutes, spO2 99 – 100 %, temperature 36,8 °C and VAS 3 – 4. In abdominal assessment, we found decreased of peristaltic, distended (+), tenderness (+), wound dressing blood seeped (-) and capilarry re ll over 2 second and also radialis artery was not detected. We did evaluation to know internal bleeding, we did positive challange test with kristaloid 20 cc/ kg BB in 15 minutes and then in USG, we found free liquid intraabdomen and we planned emergency laparatomy in IGD operation room. Anesthetic technique that we used was general anesthesia. After surgery, patient was transported to ICU in sedation condition and was intubated.

Dilaporkan kasus manajemen preoperatif wanita 36 tahun, G1P0A0 hamil 11 minggu dengan kehamilan ektopik terganggu dan mengalami syok hipovolemia. Pasien dinilai status sik ASA 4E dengan syok hipovolemia disebabkan internal bleeding dan dilakukan relaparatomi eksplorasi. Pasien rujukan dari RSUD Wonosari dan saat datang di RSUP Sardjito, kondisi pasien tampak pucat serta kesakitan curiga syok hipovolemik dengan internal bleeding, dilakukan operasi laparatomi eksplorasi emergensi, salpingektomi dektra a.i kehamilan ektopik terganggu di ok IGD selama ± 2 jam kemudian diobservasi di rr ok IGD selama 6 jam kemudian pasien ditransport ke PACU.

Kondisi pasien saat di PACU compos mentis, tampak kesakitan dengan hemodinamik tekanan darah 90/ 60 mmHg, nadi 165 kali/ menit, respirasi 32 kali/ menit on NRM 8 liter/ menit, spO2 99 – 100 %, suhu 36,8 °C dan VAS 3 – 4. Pada pemeriksaan abdomen didapatkan bising usus menurun, distended (+), nyeri tekan (+), balut luka rembes darah (-) serta pengisian kapiler > 2 detik dan arteri radialis tidak teraba. Pasien dilakukan evaluasi internal bleeding, diberikan challange test dengan kristaloid 20 cc/kg BB dalam 15 menit didapatkan hasil (+) dan dilakukan USG cito, didapatkan cairan bebas intraabdomen kemudian direncanakan operasi relaparatomi emergensi di ok IGD. Teknik anestesi yang digunakan general anestesi dengan intubasi. Sesudah operasi, pasien ditransport ke ICU dalam kondisi tersedasi dan terintubasi.