Introduction

to
ANESTHESIA

Ainul Rofik Fakultas Kedokteran

UNUSA
Pengertian anestesi
• dari bahasa Yunani :
• an = tidak/tanpa
• aesthetos = persepsi/kemampuan

untuk ​merasa
• berarti suatu tindakan

menghilangkan rasa sakit ​ketika

melakukan pembedahan dan

berbagai prosedur lainnya yang

menimbulkan rasa sakit pada tubuh

Sejarah anestesi
Sejarah anestesi
• Jaman dulu : dokter bius di dalam
kamar operasi
• 16 Oktober 1846 : Willian TG

Morten (dentist), ​penggunaan ether

di Masachusetts Gen. Hosp.

• dr. Oliver Wendell Holmes : anestesia
• 1846-1920 : stagnan
• John Snow : anesthetist & bapak
epidemiologi
• James Young Simpson : obstetric
anestesia
• Colton : Nitrous Oksida (1863)
• Paul Berd (1887), Claude Bernard :
anestesi lokal
• Leonard Corning : epidural anestesi
• August Bier : spinal dan anestesi regional
intra vena
• di Indonesia : dirintis oleh Prof.
Muh. Kaelam
Sejarah anestesi
• Tehnik & alat anestesi :
• 1846-1850 : sapu tangan yg

ditetesi ​chloroform
• ether yg diberi dg handuk yg dilipat

kmdn ​ditutupkan di hidung px

Peran aktif anestesi
• Inpatient care
• Outpatient care
• Operating Room (preop and post
op care)
• Recovery Room
• Outpatients clinics (pain, acute
drug overdose)
• Outpatients surgery centers
• Intensive care units (ICU)
• Also : - ​medical research
- Administration of hospitals - National
organized medicine
Breadth of the Specialty

• Obstetric anesthesia
• Pediatric anesthesia
• Cardiothoracic anesthesia
• Neuroanesthesia
• Outpatient surgery
• Pain management
• Critical care medicine
• Pre anesthetic evaluation
Anesthesia care team

• Nurse anesthetists
• Physicians
• Medical students
• Non specialist physicians
• Other hospital workers
Tugas & Tanggung Jawab

• Tindakan anestesi adalah

tindakan ilmu kedokteran (bukan
perawatan) : hanya boleh
dilakukan oleh seorang dokter &
sebaiknya dr Spesialis Anestesi
• bila dilakukan oleh perawat anestesi
: atas instruksi dan tanggung jawab
dokter bedah
• Etika Pelayanan Anestesiologi
berdasarkan KODEKI (kode
etika kedokteran Indonesia)
• Di kamar operasi : dokter
anestesi adalah partner dokter
bedah
Tugas & Tanggung Jawab

• Dokter Bedah : menghilangkan

penyakit dan mengoreksi
kelainan anatomi px
• Dokter Anestesi :
• menghilangkan rasa nyeri dan
stress emosi selama pembedahan /
prosedur lain
• pengelolaan tindakan medik umum
kpd px, menjaga fungsi organ tubuh
• menciptakan kondisi operasi yg
sebaik mungkin
Preoperative evaluation

• Review data base

– Medical history (Allergies,

Medications, Past ​illness, Last meal,

Event) –
​ Consultations – Laboratory
and diagnostic studies
• Perform physical examination
directed at ​anesthetic conserns
(from head to toe)
• Develop anesthesia
management plan
• Obtain the patient’s informed
consent
• Establish doctor-patient
relationship
Premedications in
Anesthesia

• Memberi obat sebelum

anestesi dan operasi
• Tujuan : ​– Safety – Meningkatkan
kenyamanan / comfort px – Blunt
harmful reflexes – Mengurangi resiko
aspirasi isi lambung – Treat illness,
allergies, infections
Common problem
• Anxiety → benzodiazepines
• Amnesia → benzodiazepines,
Scopolamine
• Pain → opioids
• Salivation and airway secretions

→ ​glycopirolate, atropine
• Vagal reflexes → anticholinergic
/ ​atropine
• Hypertensive responses → α β

blockers, ​opioids, α2 sympathetic

agonis
• Seizures → anticonvulsant,

benzodiazepines
Common problem
• Aspirations of gastric contents →
fasting, gastric anti secretory
agents, antacida
• Nausea and vomiting →
antiemetic
• Infections → antibiotics
• Reactions to iv. contrast media
→ allergy, anaphylactic,
hypotension, bronchospasme,etc
• Latex allergy → severe
anaphylactic
• Continuation of preoperative
therapy → prevent serious acute
withdrawal syndrome
Treatment for anaphylactic
reactions
1. Discontinu iv. contrast media, latex,
other allergen ​exposure 2.
​ Monitor
ECG & blood pressure 3. Administer
supplemental O2 4. Administer fluid
as required to maintain BP 5. Iv drug
regimen : as needed
– Anticholinergics → atropin 0,5 mg iv –
Antihistamines → diphenhydramine 25-50 mg
iv – Methylxantines → aminophylline 5mg/kg

iv loading ​dose –
​ Steroids →
methylprednisolone up to 1g iv –
Catecholamines → epinephrine 3-5 μg/kg iv
bolus

1-4 μg/kg iv ​infusion 6.

​ Be prepared for
resuscitation
Pharmacologic principles
• Pharmacokinetics
– Absorption – Distribution –
Elimination # metabolism
# excretion
• Pharmacodynamics :
interaction of that ​drug with the

target cell –​ Dose-response

relationships (potency, slope,

efficacy, individual variation) –

​
Choosing the dose # titration
# loading dose
Trias of anesthesia
1. Sedation ​→ inhalation → intra vena
→ intra muscular ​2. Analgesia
→ inhalation → intra vena → intra muscular
3. Relaxant ​→ inhalation → intra vena
Type of anesthesia
1. General anesthesia 2.
Local anesthesia 3. Regional
anesthesia 4. Combine
1. general anesthesia
• Anestesi Umum :
• obat yg dapat menimbulkan
anastesia atau narkosa
(yunan=tanpa, aesthesis=perasaan),
suatu keadaan depresi umum dari
pelbagai pusat di SSP yg bersifat
reversible, dimana seluruh perasaan
dan kesadaran ditiadakan (mirip
pingsan)
• px sepenuhnya tidak sadar dan
tidak sakit selama operasi
1. general anesthesia

• Cara pemberian :
• Inhaled anesthetics
• Intra venous
• Intra muscular
• Per-oral
• Per-rectal
Inhaled anesthetics

• History :
– Nitrous Oxide (1844) – Diethyl ether
(1846) – Chloroform (1847) – Cyclopropane
(1929) – Trichloroethylene (1934) –
Fluroxene (1954) – Methoxyflurane (1959)

• Now : N2O, halothane,

isoflurane, enflurane,
desflurane, and sevoflurane
Inhaled anesthetics

• The uptake & elimination

depending on equilibrium
between the gas and blood
across the alveolar membrane
→ Central nervous system and
other sites
• Across the pulmonary
blood-alveolar gas interface →
pulmonary capillar → body
tissues → ellimination
(ventilation, metabolism,
percutaneus diffusion)
• MAC (minimum alveolar
concentration) → standard
measure of the potency
Intra venous anesthetics

• Ideal iv : rapid onset, no pain,

no muscular twitching/
excitement, safe, short acting,
metabolism and excretion rapid
and complete, amnesia
• Anesthetics drugs :
a) Non opioid b) Opioid c) Muscle
relaxant
a) non opioid

• Benzodiazepines (midazolam,

diazepam, ​lorazepam)
• Barbiturates
➢ ​Thiopental : ​- water soluble
- alkaline solution

• Others
➢ ​Ketamine : ​- water soluble
- dissosiative anesthesia ​➢ ​Propofol : ​-
aques emulsion of soy bean oil, glycerol,

egg
- pain on iv injection ​➢ ​Etomidate : ​-
water soluble
b) opioid

• Action :
- analgesia - GI effects - cardiovascular
effects - sedation - ventilatory depression -
motor effects - tolerance, dependence,
addiction - miosis

• Agents :
- morphine - meperidine - fentanyl -
heroin - sufentanil - methadone -
alfentanil - hydromorphone (Dilaudid) -
nalorphine - naloxone
c) muscle relaxant

• Depolarizing : succinylcholine
– Acute offset – Redistribution and
metabolism by pseudocholinesterase –
SE : malignant hyperthermia, masseter
spasm,
cardiovascular, hyperK, myalgia, ↑ IOP,
IGP, ICP
• Non depolarizing :
– Brief duration : mivacurium –
Intermediate : atracurium, vecuronium,
rocuronium – Prolonged : pancuronium,

D-tubocuranium, ​metocurine,

doxacurium, pipecuronium
• Antagonism of neuromuscular
blockade: reversal
Stadium of anesthesia
• Guedel (1920) : anestesi umum
(Ether) dlm 4 stadium
• 1= analgesi (pemberian obat s/d
hilangnya kesadaran)
• 2= delirium/eksitasi/hiperrefleksi
(hilangnya kesadaran dan refleks
bulu mata s/d pernapasan kembali
teratur)
• 3= pembedahan (teraturnya
pernapasan s/d pernapasan spontan
hilang)
• 4= paralisis medula oblongata (ttu,
ttb/cardiac arrest, kematian)
Stadium of anesthesia
• Stadium 3 :
• plana 1= pernapasan teratur, spontan,
dada & perut seimbang, gerakan bola
mata, pupil midriasis, RC+, lakrimasi ,
refleks faring & muntah-, tonus otot
mulai
• plana 2= bola mata tdk bergerak, RC ,
relaksasi otot sedang, refleks laring
hilang
• plana 3= pernapasan perut, otot
interkostal mulai paralisis, lakrimasi-,
relaksasi otot lurik hampir sempurna
• plana 4= pernapasan tidak teratur,
pupil midriasis+ +, RC-,refleks sfingter
ani & kelj mata-, relaksasi otot lurik
sempurna
2. local anesthesia

• Mechanism of nerve conduction

:
– Sodium channel blockade –
Membrane expansion – Neural
blockade
• Pharmacology :
– Lipid solubility - intrinsic vascular
activity – Protein binding
• Agents :
– Ester-derived ​→ ​cocaine, procaine,

​ Amide ​→
chloroprocaine, tetracaine –
lidocaine, mepivacaine, ​prilocaine,

bupivacaine, etidocaine, ropivacaine

3. regional anesthesia

• Spinal anesthesia
• Epidural anesthesia
• Caudal anesthesia

• Nerve blok
4. combine

• CSEA (combine spinal

epidural anesthesia)
• General – epidural
• General – local
• General – nerve blockade
Terima Kasih

Wassalamualaikum Wr. Wb.