Perawatan Pascaanestesi pada Resipien Transplantasi Ginjal
Renal transplantation is a principal therapy for end stage renal disease. Renal transplantation can decrease mortality and improve recipient quality of life substantially. However, immunosuppressant therapy and comorbid disease in those patients make perioperative management challenging. A good urine output is a usual sign of good allograft function. Postoperatively, recipient should have a slight positive fluid balance and higher blood pressures to maintenance adequate posttransplanted organ perfusion. Fluid replacement should consider urine output, insensible water loss dan volume status of the recipient. Goal of the management is to reduce fluid replacement gradually while maintain hemodynamic stability.
Transplantasi ginjal adalah terapi pilihan pada pasien dengan penyakit ginjal stadium akhir (end stage renal transplantation/ ESRD). Transplantasi tidak hanya menurunkan mortalitas, tetapi secara substansial juga memperbaiki kualitas hidup pada hampir semua resipien. Namun begitu, penggunaan imunosupresan dan adanya beberapa komorbid medis pada pasien ini membuat manajemen perioperasi yang sangat menantang, termasuk manajemen pascaoperasi yang tidak mudah. Urine output yang baik adalah tanda yang paling sering dari fungsi allograft yang baik.
Pada periode pascaoperasi, resipien seharusnya memiliki balance cairan yang sedikit positif, dengan tekanan darah yang lebih tinggi (target tekanan darah sistolik ≥ 150 mmHg dan tekanan darah diastolik ≥ 80 mmHg) untuk membantu mempertahankan perfusi yang adekuat dari organ yang baru saja ditransplantasikan. Penggantian cairan seharusnya diperhitungkan berdasarkan urine output, kehilangan cairan yang tidak disadari, dan status volume. Perawatan harus dilakukan untuk mengurangi jumlah penggantian cairan secara bertahap, dengan tetap mempertahankan stabilitas hemodinamik, karena penggantian cairan penuh yang konstan hanya mengakibatkan diuresis yang lebih banyak.
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