The management of late obstructive ileus cases frequently culminates in poor postoperative outcomes that can even cause

sepsis if it is immediately untreated. It however frequently exist since general awareness regarding the necessity of early examination and evaluation is deprived, mo

ANESTHETIC MANAGEMENT IN EXPLORATORY LAPAROTOMY PATIENT IN THE

INDICATION OF OBSTRUCTIVE ILEUS POST RIGHT NEPHRECTOMY FOR THE
RIGHT KIDNEY TUMOR: A CASE REPORT

Ilham Anggito Aji 1, Jati Listyanto 2

1The Resident of Anesthesiology and Intensive Therapy, Diponegoro University / RSUP Dr. Kariadi
2 Medical Staff of Anesthesiology and Intensive Therapy, Diponegoro University / RSUP Dr. Kariadi

Introduction
The management of late obstructive ileus cases
frequently culminates in poor postoperative outcomes
that can even cause sepsis if it is immediately
untreated. It however frequently exist since general
awareness regarding the necessity of early examination
and evaluation is deprived, most of the people pursue
the treatment after experiencing unbearable pain and
had already attempted alternative treatments. The
anesthetic management in the patient undergoing In the operating theatre, in the supine position, the
exploratory laparotomy in indications of the obstructive preoxygenation carried out using 100% oxygen for three
ileus post right nephrectomy that indicated by the right minutes followed by slow coinduction of fentanyl 100
kidney tumors is a challenge because it requires careful mcg, the induction carried out using ketamine 100 mg iv
preparation and has a high risk during the perioperative slowly. Sellick maneuver was performed then fast-onset
and postoperative period. muscle relaxant rocuronium 40 mg iv was given. After
60 seconds, laryngoscopy-intubation was performed
with a no 7.5 endotracheal tube with the cuff

Case Report In the post-surgery period, it was decided not to do the

extubation, and the ventilation was remained controlled
A 41-year-old man came to the hospital with complaints by ventilators in the intensive care unit.
of pain throughout the abdomen since 1 day before
admission to the hospital. The patient complained of
severe pain so he could not carry out activities. The
patient also complained about nausea, vomiting, fever, Discussion
unable to defecate and having fart. There was no history
of systemic diseases like hypertension or diabetes. There In the RSUP DR. Kariadi Hospital, still often found
was no history of allergies. There was a surgical history ileus patients with sepsis. This patient was managed
of nephrectomy 7 days ago. under general anesthesia with breathing control. At the
The patient had a body weight of 60 kg and height of time of induction, it is substantial to prevent the risk of
164 cm, blood pressure 110/60 mmHg, respiration rate regurgitation, by fasting preparation, administration of
30x/minute, pulse rate 140x/minute, body temperature antacids, H2 blockers, and Sellick maneuver.
39.8 ° C. The results of the two positions abdominal x- Preoxygenation becomes essential to increase the
rays performed before the operation indicated a partial Functional Residual Capacity (FRC) with 100%
ileus image (suspiciously high position). oxygen, at least requires 3 minutes, this will increase
Electrocardiogram examination indicated sinus the patient's oxygen reserves during the apnea period.
tachycardia. Another problem is related to inadequate postoperative
ventilation. There have been reports of difficulties in
postoperative ventilation. In these patients postoperative
surgery is inadequate. Ones of the causes of inadequate
postoperative ventilation are sepsis and the mechanical
factors of the diaphragm and respiratory aids.
Postoperative pain is also mentioned to represent the
cause of inadequate ventilation.
Figure 1. sinus tachycardia After the laparotomy surgery, patients are treated in an
intensive room for 4 days implementing the
FASTHOGBID method. While in the ICU, Continuous
Renal Replacement Therapy (CRRT) is in addition done
twice.

Conclusions
Figure 2. Abdominal X-ray
Anesthetic management was carried out on a 41-year-
old male, weighing 60 kg, 164 cm tall. The patient was
In the preparation room, a managed under general anesthesia with the breathing
central venous catheter (in control. During the surgery, it is essential to prevent the
the left subclavian vein) risk of regurgitation, maintain the availability of
was installed for intravascular volume, prevent the intraoperative and
monitoring and for fluids postoperative hypothermia, and maintain adequate
administration. ventilation. CRRT in the intensive care unit is eminently
useful to help advance the recovery from sepsis then the
Figure 3. Left subclavian vein. mortality and morbidity can be reduced.

Contact References
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