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Istilah anestesi dimunculkan pertama kali oleh dokter Oliver Wendell Holmes

(1809-1894) berkebangsaan Amerika, diturunkan dari dua kata Yunani : An


berarti tidak, dan Aesthesis berarti rasa atau sensasi nyeri. Secara harfiah
berarti ketiadaan rasa atau sensasi nyeri. Dalam arti yang lebih luas,
anestesi berarti suatu keadaan hilangnya rasa terhadap suatu rangsangan.
Pemberian anestetikum dilakukan untuk mengurangi dan menghilangkan
rasa nyeri baik disertai atau tanpa disertai hilangnya kesadaran. Seringkali
anestesi dibutuhkan pada tindakan yang berkaitan dengan pembedahan.
Anestetikum yang diberikan pada hewan akan membuat hewan tidak peka
terhadap rasa nyeri sehingga hewan menjadi tenang, dengan demikian
tindakan diagnostik, terapeutik atau pembedahan dapat dilaksanakan lebih
aman dan lancar.

Secara garis besar Anestesi dapat dibagi menjadi dua kelompok yaitu
anestesia lokal dan anestesi umum.

Anestesi umum adalah keadaan hilangnya nyeri di seluruh tubuh dan


hilangnya kesadaran yang bersifat sementara yang dihasilkan melalui
penekanan sistem syaraf pusat karena adanya induksi secara farmakologi
atau penekanan sensori pada syaraf. Agen anestesi umum bekerja dengan
cara menekan sistem syaraf pusat (SSP) secara reversibel (Adams 2001).
Anestesi umum merupakan kondisi yang dikendalikan dengan
ketidaksadaran reversibel dan diperoleh melalui penggunaan obat-obatan
secara injeksi dan atau inhalasi yang ditandai dengan hilangnya respon rasa
nyeri (analgesia), hilangnya ingatan (amnesia), hilangnya respon terhadap
rangsangan atau refleks dan hilangnya gerak spontan (immobility), serta
hilangnya kesadaran (unconsciousness).Anestesi umum yang baik dan ideal
harus memenuhi kriteria : tiga komponen anestesi atau trias anestesi
(sedasi, analgesi, dan relaksasi), penekanan refleks, ketidaksadaran, aman
untuk sistem vital (sirkulasi dan respirasi), mudah diaplikasikan dan
ekonomis. Dengan demikian, tujuan utama dilakukan anestesi umum adalah
upaya untuk menciptakan kondisi sedasi, analgesi, relaksasi, dan penekanan
refleks yang optimal dan adekuat untuk dilakukan tindakan dan prosedur
diagnostik atau pembedahan tanpa menimbulkan gangguan hemodinamik,
respiratorik, dan metabolik yang dapat mengancamAgen anestesi umum
dapat digunakan melalui injeksi, inhalasi, atau melalui gabungan secara
injeksi dan inhalasi. Anestetikum dapat digabungkan atau dikombinasikan
antara beberapa anestetikum atau dengan zat lain sebagai preanestetikum
dalam sebuah teknik yang disebut balanced anesthesiauntuk mendapatkan
efek anestesi yang diinginkan dengan efek samping minimal
Anestesi lokal adalah obat yang merintangi secara reversibel penerusan
impuls saraf ke sistem saraf pusat pada kegunaan lokal dengan demikian
dapat menghilangkan rasa nyeri, gatal-gatal, panas atau dingin (Kartika Sari,
2013).

Masuke ke buku 1 2 3

(mirip 4) Local anesthetics interrupt neural conduction by inhibiting the influx


of sodium ions through chan-

nels or ionophores withi n neuronal membranes. Normally these channels


exist in a resting state, during whi ch sodi um ions are deni ed entry. When
the neuron is stimulated, the channel assumes an activated or open state, in
which sodium ions diffuse into the cell, initiating depolarization. Following
this sudden change in membrane voltage, the sodium channel assumes an
inactivated state, during which further influx is denied
whileactivetransportmechanismsreturnsodiumions to the exterior. Following
this repolarization, the channel assumes its normal resti ng state. An
appreciation of these sodium channel states helps to explain the preferenti al
sensitivity of local anestheti cs for various classes of neuronal fibers.

Local anesthetics have greater affinity for receptors within sodium channels
during their activated and inactivated states than when they are in their
resting states. i0003

Masuk ke procaine

Onset

25 minutes.a

Duration

11.5 hours.a c d

Distribution

Extent

Local anesthetics are distributed to some extent to all body tissues, with high
concentrations found in highly perfused organs (e.g., liver, lungs, heart,
brain).d
Local anesthetics generally cross blood-brain and placental barriers.b d

Elimination

Metabolism

Rapidly and almost completely hydrolyzed by plasma cholinesterase to p-


aminobenzoic acid and diethylaminoethanol.a c d

Elimination Route

Approximately 90% of p-aminobenzoic acid and its conjugates and 33% of


diethylaminoethanol are excreted in urine; <2% of administered dose is
excreted in urine as unchanged drug.d

SIDE EFFECT

Applies to procaine: parenteral injection

Side effects include:

Adverse CNS and cardiovascular effects, underventilation, apnea. (See CNS


Effects and also Cardiovascular Effects, under Cautions.)

Spinal anesthesia: Possible postspinal headache, meningismus, arachnoiditis,


palsies, spinal nerve paralysis, hypotension, respiratory impairment or
paralysis, nausea, vomiting.

Masuk ke lidocaine

Onset

More rapid onset of anesthesia compared with procaine hydrochloride (no


longer commercially available in the US).a

For dental anesthesia, onset <2 minutes following infiltration with 2%


solution (with or without epinephrine).213 Onset of 24 minutes following
nerve block with 2% solution (with or without epinephrine).213

Duration

Longer duration of anesthesia compared with procaine hydrochloride.a

Duration of about 100 minutes following lumbar epidural block with 2%


solution.a
Duration of about 75135 minutes following caudal block with 1 or 2%
solution.a

Following spinal block with 50 mg (1 mL) of 5% solution, duration of perineal


anesthesia is about 100 minutes; analgesic effects continue for another 40
minutes.214 Duration of surgical anesthesia is about 2 hours with 75100 mg
(1.52 mL) of 5% solution.214

Distribution

Extent

Crosses blood-brain and placental barriers.211 213 214

Plasma Protein Binding

Protein binding dependent upon drug concentration and concentration of -


1-acid glycoprotein; fraction bound decreases with increasing drug
concentration.211 213 214 At concentrations of 14 mcg/mL, 6080% of drug is
bound.211 213 214

Elimination

Metabolism

Systemically absorbed lidocaine is rapidly metabolized in the liver.211 213 214

Pharmacological or toxicological effects of metabolites are similar to but less


potent than those of parent drug.211 213 214

Elimination Route

Excreted principally in urine as metabolites (90%) and small amounts


(<10%) of unchanged drug.211 213 214

Half-life

1.52 hours following IV injection.211 213 214

SIDE EFFECT

General

Adverse reactions following administration of this drug are similar in nature


to those observed with other amide local anesthetic agents. The most
serious adverse reactions tend to be systemic in nature. In general, these
adverse reactions are dose-related and may result from high plasma levels
caused by excessive dosage, rapid absorption, or inadvertent intravascular
injection, or may result from a hypersensitivity, idiosyncrasy, or diminished
tolerance on the part of the patient.[Ref]

Cardiovascular

Frequency not reported: Bradycardia, hypotension, cardiovascular collapse,


cardiac arrest, circulatory collapse, hypertension, arrhythmia, maternal
hypotension, shock, tachycardia, ventricular fibrillation, heart block,
myocardial depression, peripheral vasodilation[Ref]

Nervous system

Frequency not reported: Lightheadedness, headache, dizziness, drowsiness,


cold/numbness, tremor, convulsions, unconsciousness, positional headache,
peripheral nerve symptoms, spinal cord deficit, paresthesia, speech slurred,
arachnoiditis, peripheral nerve injury, coma, paralysis of the lower
extremities, cauda equina syndrome, Horner's syndrome, hemiparesis,
circumoral paresthesia, nystagmus[Ref]

Gastrointestinal

Frequency not reported: Vomiting, nausea, bowel control loss, swallowing


difficult, numbness of tongue[Ref]

Psychiatric

Frequency not reported: Nervousness, apprehension, euphoria, confusion,


agitation, disorientation, psychosis, restlessness, excitement[Ref]

Hematologic

Frequency not reported: Methemoglobinemia[Ref]

Dermatologic

Frequency not reported: Urticaria, cutaneous lesion, dermatitis, rash,


angioedema, face edema[Ref]

Genitourinary

Frequency not reported: Bladder control loss, sexual function loss, perineal
sensation loss, urinary retention[Ref]

Immunologic
Frequency not reported: Allergic reaction, anaphylaxis/anaphylactoid
reaction[Ref]

Local

Frequency not reported: Persistent anesthesia[Ref]

Metabolic

Frequency not reported: Hypoglycemia[Ref]

Musculoskeletal

Frequency not reported: Twitching, backache, leg pain, buttock pain[Ref]

Ocular

Frequency not reported: Blurred/doubled vision, diplopia, transient


amaurosis, bilateral amaurosis[Ref]

Other

Frequency not reported: Tinnitus, feeling hot, edema, shiver, total spinal
block, hyperacusis, weakness, sphincter control loss[Ref]

Respiratory

Frequency not reported: Respiratory depression, respiratory arrest, dyspnea,


bronchospasm, hypoventilation, apnea, respiratory inadequacy, respiratory
failure, yawning[Ref]

MASUK ke Buku 6

Masuk ke JAICM conclude

Masuk anastegprog
masuk ke kontra indikasi anastesi, slide anastes

3. Tim dosen farmakologi. Petunjuk praktikum farmakologi kedokteran


angkatan 2015. Banjarmasin: bagian farmakologi program studi pendidikan
dokter fakultas kedokteran unlam; 2017
1. Calvey TN, Williams NE. Principles and practice of pharmacology for
anaesthetists . London; Blackwell Scientific Publications; 1982

2. S.M. Darto, Thaib R. Anestesi regional dalam Anestesiology. Jakarta :


FKUI ; 2009.

5. McEvoy GK. Procaine Hydrochloride. Bethesda, MD: American


Society of Health-System Pharmacists; 2011

6. McEvoy GK. Lidocaine Hydrochloride. Bethesda, MD: American


Society of Health-System Pharmacists; 2011

7. Mendona FT, Mariana CR, Jordana AA, Luse AC. Systemic Lidocaine
for Perioperative Analgesia: A Literature Review. J Anest & Inten Care Med.
2015 des 9; 1 (1)

8. Sisk AL. Vasoconstrictorsin Local Anesthesia for Dentsty. Georgia:


Anesth Prog; 1992

4. Becker DE, Kenneth LR. Local Anesthetics: Review of


Pharmacological Considerations. Miami: Anesth Prog; 201