Introduction to

ANESTHESIA
Ainul Rofik
Fakultas Kedokteran UNUSA
 D
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
W
Sejarah anestesi
• Tehnik & alat anestesi :
• 1846-1850 : sapu tangan yg ditetesi
Praktikum
chloroform
*
• ether yg diberi dg handuk yg dilipat kmdn
ditutupkan di hidung px
Kelvar ujian Peran aktif anestesi
-
• Inpatient care

E
• Outpatient care
• Operating Room (preop and post op care)
• Recovery Room
• Outpatients clinics (pain, acute drug overdose)
-

• Outpatients surgery centers

•
•antr ->
Intensive care units (ICU)
Also : - medical research
- Administration of hospitals
- National organized medicine
Free
·

↳msi

Witdrawal
 Breadth of the Specialty
⑳
-
Obstetric anesthesia ->
•
-
Pediatric anesthesia
• SC, kuret
-

• Cardiothoracic anesthesia
• Neuroanesthesia
Outpatient surgery
•
•
-h
Pain management
• Critical care medicine
• Pre anesthetic evaluation
⑦
Anesthesia care team
• Nurse anesthetists
• Physicians
• Medical students
• Non specialist physicians
• Other hospital workers

Milichann
 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

1 ↳sam
• 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
•&

E
Tujuan :
– Safety
– Meningkatkan kenyamanan / comfort px
– Blunt harmful reflexes
– Mengurangi resiko aspirasi isi lambung
– Treat illness, allergies, infections
 Depresent
-> Common problem
• -h
Anxiety → benzodiazepines
• Amnesia → benzodiazepines, Scopolamine
• R
Pain → opioids -> VAS scale
• Salivation and airway secretions →
glycopirolate, atropine
--
• Vagal reflexes → anticholinergic /
atropine

->
con
• Hypertensive responses → α β blockers,
opioids, α2 sympathetic agonis
• Seizures → anticonvulsant,
>benzodiazepines
Seizure -> Hejang
·
General (Selvruhtrbuh)
·Parsial (Sebagian
P ertamaKali
Obat
kejang -> Benzodiazepin

spinaprost
Parson
Atropinisasi
atropin lig
Dosis
0.25mg/1Amp
-

- Sediaan

·
Dosis minimal
maklimalaya
tiap
g
3-5 menit
·
Dilahrhan
· Boleh diulang 3x
VAS Scale!!!
NSAID (Paracetamol,
0-3
Auprofenl/ Asmet
Ketorolak (n)
4-6
tramadol
7 - 9 Drip
+ Tramadol
10 Ketorolah
 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
ReaksiAlergi
·
Antihistamin ins

STEROID (Deksame)
tason

ext Antihistamin
is
hidramine
Loratadin
1
Amp
=
Rabeprazol 20 My
20 My
Omeprazole
ansoprazol
30
mg
E meprazol 40 my

Payprazol 40 my

tik
 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 Sierrard,
0,5 mg iv
so
t
– 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
(syoh Cardiogenic infusion
1-4 µg/kg iv

6. Be prepared for resuscitation

 Den
syok
- ↑
Cardiogenic.
Epinefrin
3
lihat
·

·
Dubutamin Nadinya
·
Dopamin
nadi
>100 -> Epinefrin
<100-owerDopa
↓
WhatAkralnya
Dingin: Hangat
Doa (bU-Hangat -> Dubu
Doa Bapak - Dingin - Dopa
 Pharmacologic principles
• Pharmacokinetics -> Perjalanan
– Absorption obat
– Distribution
– Elimination # metabolism
# excretion
> Respodbat
•
->
Pharmacodynamics : interaction of that
drug with the target cell
-

– Dose-response relationships (potency, slope,

efficacy, individual variation)

Futi
– Choosing the dose # titration
## loading dose
 Trias of anesthesia
1. Sedation
→ inhalation A

Ern
→ intra vena

E
→ intra muscular
2. Analgesia
→ inhalation Kelvar
→ intra vena
→ intra muscular
3. Relaxant
-

→ inhalation
-

→ intra vena
-
 Type of anesthesia
>
1. General anesthesia ->
Inhalation
0
2. Local anesthesia

-
3.-

Ot
Regional anesthesia
4. Combine

SC Lidokain
 1. general anesthesia
• Anestesi Umum : mati Suri
• 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 :

> S tase
• Inhaled anesthetics
-

• Intra venous
-

• Intra muscular
-
Hous
• Per-oral
-
-

• Per-rectal
-
Kewar Ujian Inhaled anesthetics
• History :
–
–
Nitrous Oxide (1844)
Diethyl ether (1846)
E
– Chloroform (1847)
-

– Cyclopropane (1929)
– Trichloroethylene (1934)
BP]S

#
– Fluroxene (1954)
– Methoxyflurane (1959)
• Now : N2O, -halothane, isoflurane,
enflurane, desflurane, and sevoflurane
--
X
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 Nyeri
c) Muscle relaxant
- AESANS
 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

– Acute offset
-
• Depolarizing : succinylcholine
M
– Redistribution and metabolism by pseudocholinesterase
– SE : malignant hyperthermia, masseter spasm,
cardiovascular, hyperK, myalgia, ↑ IOP, IGP, ICP
• Non depolarizing=>
: Acuanium
– Brief duration : mivacurium
– Intermediate : atracurium, vecuronium, rocuronium
– Prolonged : pancuronium, D-tubocuranium,
metocurine, doxacurium, pipecuronium
• Antagonism of neuromuscular blockade: reversal
 dikebankern.
Disa 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)
-
 nice to know
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 : gene
– Ester-derived → cocaine, procaine,
chloroprocaine, tetracaine
– Amide →> lidocaine, mepivacaine,
prilocaine, bupivacaine, etidocaine,
ropivacaine
 3. regional anesthesia

-
• Spinal anesthesia -> S
• 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.