KEBUTUHAN CAIRAN PERIOPERATIF

The following factors must be taken into account:

1- Maintenance fluid requirements
2- NPO and other deficits: NG suction, bowel prep
3- Third space losses
4- Replacement of blood loss
5- Special additional losses: diarrhea
TUJUAN
HEMODYNAMIC GOALS
Maintain cardiac output
Maintain tissue blood flow
Maintain adequate oxygen delivery
 PREOPERATIVE CLINICAL ASSESSMENT

WATER DEPLETION
INTRAVASCULAR DEPLETION
- Thirst
- Hemodynamic effects :
- Hypernatremia
- BP, HR, JVP
- Cool extremities
ECF DEPLETION - Reduced sweating
- Skin turgor, sunken - Dry mucus membranes
eyeball
- Weight
- Hemodynamic effects
 INTRAOPERATIVE CLINICAL ASSESSMENT

1. Physical Assessment: Skin and mucous

membranes no dry; no thirst in an awake patient
2. Urine Output: at least 0.5 ml/kg/hr
3. Vital Signs: BP and HR normal
4. Invasive monitoring; CVP or PCWP may be used
as a guide
5. Laboratory tests: periodic monitoring of
hemoglobin and hematocrit
BUN 8.0 20 mg/dl
Kreatinin 0.5 1.5 mg/dl
Creatinine clearance >30 %
 URINE OUTPUT
- A monitor of renal perfusion only, urine
output is often used as a guide to adequacy
of cardiac output as the kidney receive 25%
of CO
- Renal prefusion adequate UO : > 0.5
ml/kg/jam
- UO < 0.5 ml/kg/jam low perfusion
 INVASIVE PRESSURE MONITORING

1. Central Venous Pressure (CVP)

2. Pulmonary Artery Catheters (PACs) and Pulmonary
Arteri Occlusion (Wedge) Pressure (PAOP)
3. Left Ventricular End-diastolic Pressure (LVEDP)
4. Systolic Pressure Variability (SPV)
5. Echocardiography
6. Transthoracic Echo (TTE)
7. Transesophageal Echocardiography (TEE)
8. Esophageal Doppler Monitoring (EDM)
THANKYOU !