BASIC ANESTHESIA

Pontisomaya Parami
SMF Anestesi & Terapi Intensif
FKUNUD-RSUP Sanglah
Denpasar
 ANESTHESIA

 From Greek anaisthesis means ”not sensation”

 Listed in Bailey´s English Dictionary 1721.
 When the effect of ether was discovered”anesthesia”
used as a name for the new phenomenon.
BASIC PRINCIPLES OF ANESTHESIA

 Anesthesia defined as the abolition of sensation

 Analgesia defined as the abolition of pain
 “Triad of General Anesthesia”
 need for unconsciousness
 need for analgesia
 need for muscle relaxation
 HISTORY OF ANESTHESIA

 Ether synthesized in 1540

by Cordus
 Ether used as anesthetic in
1842 by Dr. Crawford W.
Long
 Ether publicized as
anesthetic in 1846 by Dr.
William Morton
 Chloroform used as
anesthetic in 1853 by Dr.
John Snow
 History of Anesthesia

 Endotracheal tube discovered in 1878

 Local anesthesia with cocaine in 1885
 Thiopental first used in 1934
 Curare first used in 1942 - opened the “Age of
Anesthesia”
PERIOPERATIVE ANESTHESIA CARE
Anesthesiologists melakukan tatalaksana anesthesia
pada pasien yang akan menjalani pembedahan, ruang
lingkupnya meliputi preoperative, intraoperative,
and postoperative.
Dimulai saat melakukan evaluasi preoperatif,
mempersiapkan rencana anestesia, mempersiapkan
ruang operasi, melakukan tatalaksana anestesia
durante operasi serta tatalaksana pasca operasi.
 PREOPERATIVE EVALUATION
Tujuan evaluasi preoperatif adalah melakukan evaluasi & menilai
resiko akibat penyakit penyerta (coexisting diseases),
meminimalkan resiko, melakukan inform consent kepada pasien,
serta melakukan diskusi tentang pilihan tatalaksana anesthesia.
Does the patient have Has the patient had
coexisting medical anesthesia before? Were
problems? Does the there any complication
surgery or anesthesia such as difficult airway
care plan need to be management? Does the
modified because of patient have risk factor
them? for difficult airway
management?
 PREOPERATIVE EVALUATION
What is the indication for the What are the inherent risk of this
proposed surgery? It is surgery?
elective or an emergency?
Setiap prosedur pembedahan
Indikasi pembedahan memiliki memiliki resiko yang berbeda.
implikasi anestesi yang Misalnya, pasien yang akan
berbeda. Misalnya, pasien dilakukan coronary artery
yang akan dilakukan bypass memiliki resiko yang
esophageal fundoplication signifikan untuk terjadinya ,
cenderung memiliki severe stroke, myocardial infarction
gastroesophageal reflux & kematian.
disease, yang memerlukan pasien yang akan dilakukan
modifikasi rencana anestesi ekstraksi katarak memiliki
(antara lain, preoperative non resiko kecil untuk terjadinya
particulate antacid, major organ damage.
intraoperative rapid sequence
induction of anesthesia).
 PREOPERATIVE EVALUATION

Menilai catatan medis pasien

Mengevaluasi diagnosis & data laboratorium misal
pemeriksaan darah, electrocardiogram, chest x-ray,
Verifikasi prosedur pembedahan,
Memeriksa pasien,
Diskusi pilihan anestesia & resikonya &
Memberikan premedikasi yang sesuai
 KLASIFIKASI STATUS FISIK
(PHYSICAL STATUS CLASSIFICATION)

 Oleh American Society of Anesthesiologist (ASA) dibuat klasifikasi

status fisik sebagai guidelines untuk anesthesiologist.
 It is an evaluation of anesthetic morbidity and mortality related to the
extent of systemic diseases, physiological dysfunction, and anatomic
abnormalities.
 Penyulit intraoperatif lebih sering terjadi pada pasien dengan status
fisik yang lebih buruk.
MEMPERSIAPKAN RENCANA ANESTHESIA

Setelah evaluasi preoperatif, rencana anesthesia dapat

dilengkapi. Rencana ini meliputi daftar obat dan dosis yang
akan dipergunakan secara detail termasuk antisipasi terhadap
masalah yang mungkin terjadi.
PERSIAPAN DI DALAM KAMAR OPERASI
 PILIHAN ANESTHESIA
 Pasien diharapkan mengerti dan dapat menentukan pilihan (dari
teknik anesthesia yang sesuai)
 Tergantung dari teknik & durasi prosedur pembedahan
 Tergantung kondisi & stabilitas psikologis pasien
 Tergantung penyakit penyerta & tingkat keparahannya
 Tergantung status mental & psikologis pasien.
 Pemulihan postoperatif berbeda pada tiap pilihan anesthesia
 Pilihan untuk tatalaksana nyeri postoperative
 Apakah ada permintaan spesifik dari surgeon
 There is major and minor surgery but only major anesthesia
 PILIHAN TEKNIK ANESTHESIA

Regional Anesthesia (anesthesia

General Anesthesia (anesthesia umum) regional)
 Reversible, kondisi tidak  Injeksi agen anestesi lokal
sadar disertai amnesia untuk memblokade /
(sleep, hypnosis or basal menimbulkan anestesi
narcosis), analgesia pada saraf tepi (pleksus
(freedom from pain) saraf/ serat saraf)
penekanan terhadap refleks,
relaksasi otot.  Termasuk neuraxial block
 Dibuat tertidur yang dilakukan oleh
anesthesiologist (spinal,
epidural, caudal)
TYPES OF ANESTHESIA CARE
Monitered Anesthesia Care
(MAC) Local Anesthesia

 Infiltrasi lokasi opeasi  Untuk prosedur bedah

dengan agen anestesi lokal ringan dimana lokasi
oleh surgeon. operasi infiltrasi dengan
 Anasthesiologist agen anestesi lokal
memberikan suplemen obat (lidocaine or bupivacaine)
intravena (analgesi, sedasi,
mengurasi respon
autonomic nervous system)
 PREMEDIKASI

– Anticemas, sedasi
– Analgesia apabila preoperasi disertai nyeri
– Induksi lebih halus
– Mengurangi dosis obat anesthesia
– Mencegah reflek vagus
– Mengurangi sekresi saliva
 MONITOR DURANTE ANESTHESIA
• HEART RATE
– Saraf Pusat
precordial /esophagel (GCS,reflek &diameter
stethoscope pupil)
– Respirasi (Respirasi
• BLOOD PRESSURE rate, saturasi O2 &
CO2)
• EKG – Sirkulasi (ECG, BP,
• OXYGENATION with CVP)
pulse oxymeter – Urogenital (produksi
urine)
• TEMPERATURE – Otot rangka (tonus)
 GENERAL ANESTHESIA
1. Monitor
2. Preoxygenation
3. Induction (intravenous & inhalation)
4. Muscle relaxants
5. Mask ventilation
6. Intubation & ETT position confirmation
7. Maintenance
8. Emergence
 GENERAL ANESTHESIA
ANESTESI INHALASI (GAS) ANESTESI INTRAVENA (IV)

Halothane, isoflurane,  Propofol

sevoflurane, desflurane  Pentothal
(agen anestesi inhalasi),  Ketamine
N2O, air
 Etomidat
All inhalation anesthetics,  Opioid based
except N20, can trigger
malignant hyperthermia in
susceptible patient
 REGIONAL ANESTHESIA
Didefinisikan sebagai “hilangnya sensasi yang
reversibel pada area spesifik tubuh”

Spinal anesthesia
Epidural anesthesia
IV Regional Blocks
Peripheral Nerve Blocks
 REGIONAL ANESTHESIA
Spinal Anesthesia
 Obat anestesi lokal
(lidocaine, tetracaine or
bupivacaine) dimasukkan
ke ruang subarachnoid.
 Spinal anesthesia is also
known as a subarachnoid
block

 Menghambat saraf
sensoris dan motoris,
menyebabkan hilangnya
sensasi dan paralisis yang
temporary.
 REGIONAL ANESTHESIA
Epidural Anesthesia
 Local anesthetic agent is
injected through an
intervertebral space into
the epidural space.

 May be administered as a
one-time dose, or as a
continuous epidural, with
a catheter inserted into the
epidural space to
administer anesthetic drug
 REGIONAL ANESTHESIA
IV Regional Blocks
 Also known as a Bier  After a pneumatic
Block tourniquet is applied to
 Used on surgery of the extremity, Lidocaine is
upper extremities injected through the IV.
 Patient must have an IV
inserted in the operative  Anesthesia lasts until the
extremity tourniquet is deflated at
the end of the case.
 IMPORTANT- to prevent
an overdose of lidocaine it
is important not to deflate
the tourniquet quickly at
the end of the procedure.
 REGIONAL ANESTHESIA
Peripheral Nerve Blocks
 Injection of local anesthetic around a
peripheral nerve

 Can be used for anesthesia during surgery or

for post-op pain relief

 Examples: ankle block for foot surgery,

supraclavicular block for post-op pain control
after shoulder surgery
 Monitored Anesthesia Care (MAC)

 Generally used for short, minor procedures

done under local anesthesia
 Anesthesia provider monitors the patient and
may provide supplemental IV sedation if
indicated
 POSTOPERATIVE
• Post-anesthesia care unit (PACU)
- Oxygen supplement
- Pain control
- Nausea and vomiting
- Hypertension and hypotension
- Agitation
• Surgical intensive care unit (SICU)
- Mechanical ventilation
- Hemodynamic monitoring
 SKOR ALDRETE

SKOR 2 1 0

KESADARAN SADAR RANGSANG(+) TAK SADAR

RESPIRASI SPONTAN TAK ADEKUAT TAK NAFAS

TEK DARAH = PREOP 20%</>PREOP 50%</>PREOP

WARNA KULIT NORMAL PUCAT SIANOTIK

AKTIVITAS NORMAL RANGSANG(+) DIAM

KRITERIA PENGELUARAN PASIEN

• PASIEN BOLEH KEMBALI KE RUANGAN

APABILA :

– SKOR ALDRETE : 9 - 10
– TIDAK ADA PERDARAHAN LUKA OPERASI
– SETELAH 30 MENIT PEMBERIAN OPIAT
TERAKHIR
– TIDAK ADA PENYULIT YANG MENGANCAM
– TIDAK MEMERLUKAN TINDAKAN/TERAPI
KHUSUS
TERIMA KASIH