Pencegahan Hipotermia Intraoperatif selama Laparoskopi Apendiks pada Pasien Anak di IBS RSA UGM: Studi Kasus

https://doi.org/10.22146/jkkk.98512

Qory Nurulita Andayani(1*), Arifin Triyanto(2), Anita Ruswanti(3)

(1) Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(2) Departemen Keperawatan Medikal Bedah, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(3) Instalasi Bedah Sentral, Rumah Sakit Akademik Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Background: Children have a higher risk in experiencing intraoperative hypothermia (a body temperature below 36 ºC) compared to adults. This is due to an ineffective thermoregulation system, higher surface area compared to volume, and limited subcutaneous fat reserves.
Objective: To determine effective management to prevent intraoperative hypothermia in pediatric patients.
Case report: Pediatric patient A, 7 year old female with a diagnosis of acute appendicitis underwent appendix laparoscopy procedure. The patient's preoperative temperature was 36,9 ºC, the procedure took around 55 minutes, and the operating room temperature was between 18 - 20 ºC. Nurse gave active and passive mechanisms to prevent intraoperative hypothermia. The active mechanism was done by using a warming blanket with a temperature of 39 ºC. Passive management involved the use of 4 sterile draping, the draping process was carried out quickly to minimize the time patient's body was exposed to the cold air of the operating room, and in addition, blanket was applied over patient’s body while mobilized from the reception room to the pick-up room.
Outcome: After intervention using active and passive mechanisms, it was found that the child did not shiver, the temperature was 36 ºC post-operatively, and no acral cyanosis was found.
Conclusion: The application of active mechanisms in the form of using warming blankets and passive mechanisms using blankets and draping is effective in preventing intraoperative hypothermia in children.

INTISARI

Latar belakang: Anak memiliki risiko lebih tinggi mengalami hipotermia intraoperatif (keadaan temperatur tubuh di bawah 36ºC) dibandingkan dewasa. Hal tersebut karena anak memiliki sistem termoregulasi yang belum efektif, luas permukaan tubuh yang lebih tinggi dibandingkan dengan volume, dan cadangan lemak subkutan yang terbatas.
Tujuan: Mengetahui manajemen yang efektif untuk mencegah hipotermia intraoperatif pada pasien anak.
Laporan kasus: Pasien An. A, anak perempuan berusia 7 tahun dengan diagnosis apendisitis akut dilakukan laparoskopi apendiks. Suhu pre-operatif pasien yaitu 36,9ºC, tindakan berlangsung sekitar 55 menit, dengan suhu kamar operasi antara 18 - 20 ºC. Perawat melakukan mekanisme aktif dan pasif untuk mencegah hipotermia intraoperatif. Mekanisme aktif dilakukan melalui penggunaan warming blanket dengan suhu 39 ºC. Manajemen pasif melalui penggunaan draping dengan 4 duk steril, proses draping dilakukan dengan cepat untuk meminimalkan waktu tubuh pasien terpapar udara dingin kamar operasi dan ditambah dengan penggunaan selimut pada tubuh pasien, saat dipindahkan mulai dari ruang penerimaan sampai dengan ruang penjemputan.

Hasil: Setelah dilakukan intervensi aplikasi mekanisme aktif dan pasif pencegahan hipotermia intraoperatif, didapatkan hasil pasien anak tidak menggigil, suhu post-operatif 36 ºC, dan tidak ditemukan sianosis pada akral.
Simpulan: Penerapan mekanisme aktif berupa penggunaan warming blanket dan mekanisme pasif dengan penggunaan selimut serta draping, terbukti efektif untuk mencegah terjadinya hipotermia intraoperatif pada anak.


Keywords


anak; hipotermia intraoperatif; warming blanket

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DOI: https://doi.org/10.22146/jkkk.98512

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