LAPAROTOMI

PREOPERATIVE  Sebelum ke ruang operasi bedah ditandai dengan kerjasama pasien dengan ahli bedah operasi untuk memastikan operasi  yang benar. Pasien dengan hati-hati diposisikan di meja operasi sementara mempertimbangkan kebutuhan untuk peralatan khusus seperti bantalan pemanas, piring landasan elektrokauter, stoking kompresi sekuensial, dan perangkat monitoring anestesi. Lengan dapat diposisikan di samping atau di sudut kanan pada papan lengan, yang memungkinkan akses yang lebih baik untuk anestesi infus dan perangkat pemantauan lainnya. Adalah penting bahwa pasien diposisikan tanpa tekanan atas siku, tumit, atau prominences tulang lainnya, tidak harus bahu ditarik di hyperabduction. Lengan, dada bagian atas, dan kaki ditutupi dengan selimut termal. Pembatasan kain sederhana loop dapat ditempatkan longgar tentang pergelangan tangan, sedangkan sabuk pengaman biasanya melewati paha dan di sekitar meja operasi. Perut Seluruh dicukur dengan gunting, seperti dada rendah bila prosedur perut bagian atas yang direncanakan. Pada individu hirsutisme, paha juga mungkin memerlukan penghapusan rambut dengan gunting untuk aplikasi yang efektif dari sebuah pad landasan elektrokauter. Pad grounding tidak boleh ditempatkan di wilayah implan ortopedi logam atau alat pacu jantung. Rambut lepas dapat diambil dengan pita perekat, dan umbilikus mungkin memerlukan membersihkan dengan kapas aplikator berujung. Para scrub asisten pertama, memakai sarung tangan steril, dan kemudian menempatkan handuk steril jauh melampaui batas atas dan bawah dari bidang operasi sehingga dinding dari daerah steril. Asisten keras membersihkan lapangan perut dengan spons kasa jenuh dengan larutan antiseptik . Beberapa memilih solusi iodinasi untuk persiapan kulit. Antibiotik profilaksis diberikan secara intravena dengan dalam 1 jam sayatan.

Sayatan harus hati-hati direncanakan sebelum landmark anatomi yang disembunyikan oleh tirai steril. Meskipun pertimbangan kosmetik dapat mendikte menempatkan sayatan di garis belahan kulit (garis Langer) dalam upaya untuk meminimalkan bekas luka berikutnya, faktor lain yang lebih penting. Sayatan harus bervariasi agar sesuai dengan kontur anatomi pasien. Ini harus memberikan paparan maksimum untuk prosedur teknis dan dari patologi yang diantisipasi, sekaligus menciptakan cedera minimal untuk dinding perut, terutama di hadapan satu atau lebih bekas luka dari prosedur bedah sebelumnya. Sayatan yang paling umum digunakan adalah satu garis tengah yang berlangsung antara kedua otot rektus abdominis, sekitar umbilikus, dan melalui alba linea (gambar 1). Untuk prosedur dalam panggul, sayatan diperluas ke pubis, sedangkan untuk operasi perut bagian atas, sayatan dapat memperpanjang ke atas dan melewati Xifoid tersebut. Setelah persiapan, perut tidak aktif berdinding dengan handuk steril ditempatkan melintang di Xifoid dan pubis dan longitudinal tentang baik otot rektus. Beberapa ahli bedah lebih suka lebih lanjut untuk menutup lapangan dengan menggantungkan plastik perekat yang dapat diresapi dengan larutan antiseptik. 

Teknik ini sangat berguna pada pasien yang telah ada sebelumnya stoma usus, tabung, atau proses lain yang dapat mencemari bidang operasi.

GENERAL SURGERY SERIES : ROUTINE SCREENING FOR PATIENTS PREOPERATIVE GUIDELINES

Chapter I

INTRODUCTION

I.1. Background

Once we know the importance of routine examination screnning preoperative for smooth operation and to control costs in the hospital. Therefore here I downloaded on the official website of the Ministry of Health  hopefully useful to all colleagues, especially colleagues Surgical and anesthesia. Preoperative routine examination, either on the basis of appropriate clinical indications patient or not, has become part of clinical practice for many years. The purpose of the investigation is to identify conditions unexpected that may require treatment prior to surgery or changes in the management of perioperative surgery or anesthesia; assess previously known diseases, disorders, or medical therapy alternatives that may affect perioperative anesthetic; estimate postoperative complications; as the consideration for the reference next; examination screening. (1)     

Last literature recommends not adequately about assessment of clinical benefit or harm preoperative routine examination. At the time found abnormal or positive results, the percentage of patients who changes in its management varies. (1)

Termination of the word "routine" is unclear and requires clarification. One sense of routine checks are carried out all examinations based on existing regulations, these regulations have never changed by clinicians. In the assessment of a routine examination by the unit preoperative HTA English, understanding the inspection routine is intended for healthy indiviuals, asymptomatic, with no specific clinical indication, to know the condition is not detected by clinical history and physical examination. Based on the understanding that, if a patient found to have specific clinical features with the consideration that examination may be useful, it is defined that the examination The indications are not on the basis of examination routine. (1)

On the other hand has been agreed by the consultant and member of the American Society of Anesthesiologists (ASA) that the examination should not prabedah done routinely. Pre operation examination can be done selectively for optimizing the perioperative implementation. Indication does examination should be based on information gathered from the records medical, anamnesis, physical examination, the type and level of invasive surgery planned and should note. (2)

Several studies have shown that in the absence of clinical indications, the likelihood of finding significant abnormal results on examlaboratory, electrocardiography and chest X-ray small. Abnormal results are procedure is not expected to affect operation. (3)

I.2. problems

From the clinical history and physical examination can be determined from healthy patients who appropriate for surgery, and selecting the examination pre operation necessary. The reason why the doctors still perform
prabedah is chosen well without them believing that history clinical and physical examination are not sensitive and may be a routine pre operation  can protect them from medikolegal issue. Each inspection  pre opertion  to do with good reason so as to bring benefits to patients and avoid side effects potential. The benefits include the execution time of anesthesia or the use of sources that can improve the safety and effectiveness process of anesthesia during and after surgery. Potential side effects can occur, including interventions that can cause injury, uncomfort, delays or expenses that are not comparable with benefits.



     



I.3. purpose

Realization of scientific studies as the basis of government recommendations to establish policies in preparation for elective pre operation so as to reduce the cost of expenses for patients who do not have the disorder.

Chapter II

ASSESSMENT METHODOLOGY

II.1. The literature search strategy

Search articles through Medline, New England Journal of Medicine, British Medical Journal, Anesthesiology, Annals of Internal Medicine, Canadian Journal of Anesthesia, British Journal of Anaesthesia, and BioMedicalCenter Anesthesiology, Surgery, Pediatrics, Anaesthesia, America Journal of Surgery, Journal of Clinical Anesthesia, Academy of Emergency Medicine, Mayo Clinic Proceedings, Anesthesia and Anesthesia, Anesthesia in the last 25 years (1978-2003). Information was also obtained from the guideline include a structured by ASA, American College of Cardiology (ACC), American Heart Association (AHA), National Institute of Clinical Excellence (NICE) and the Institute for Clinical Systems Improvement (ICSI) and the results of HTA studies from several countries, among Another England in 1997 on Routine Preoperative Testing. The keywords used were preoperative evaluation, preoperative examination, preoperative assessment, preoperative testing, guidelines, routine, Electrocardiography (ECG), fasting, chest X-ray, hemostatic screening, urinalysis, pulmonary function tests, laboratory tests, elective surgery, pediatric Patients, Patients elderly.

II.2. Level of Evidence and Level Recommendations

Any literature which gained critical assessment (critical appraisal) based on the rules of evidence based medicine, then the specified level. The recommendations are set to be determined level of recommendation. Level of evidence and the recommendations are classified according to the definition of Scottish Intercollegiate Guidelines Network, originating from the U.S. Agency for Health Care Policy and Research.

Level of evidence:

Ia.  Meta-analysis of randomized controlled trials.

Ib.  At least one randomized controlled trials.

IIa.  At least one non-randomized controlled trials.

IIb.  Cohort studies and / or case-control study

IIIa. Cross-sectional study

IIIb. Case series and case reports

IV.   Consensus and expert opinion

Recommendation:

A. Evidence included in the level he or lb.

B. Evidence included in level IIa or II b

C. Evidence included in level IIIa, IIIb or IV