2. Dasar – Dasar Anestesia

7/25/2019 2. Dasar Dasar Anestesia

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DASAR DASARANESTESIA (II)


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FARMAKOLOGY

ANESTESI INHALASI


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ANESTESI UMUM INHALASI


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2a_Ventilation

O2 !ala"

!a#a$

%&'&

O2"a&' a#&

Al*eoli

+e", !a#a$ Kaile#

O2

!ala" al*eoli


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2a_Ventilation -

UDARA 20% O2 + 80% N2

pO2 150

ALVEOLI 16% O2 + 80% N2 + 4% CO2

pAO2 120

DARAHpaO2 100

Hypoxia = paO2 < 90 mmHg

Terapi Oksige ! "eigka#ka pAO2 $ega ara

"eigka#ka pO2 UDARA


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.a#a Ma&' Ga Aneteia Dala"

T&,&$ Man&ia

.a#a "a&' 2 Fae /

01 FASE +ULMONAR / In$alai a

aneteia "en%aai &at& 'onent#a3i al*eola# 4an %&'& &nt&' !i5&i

"elal&i "e",#an a#& !an 'e"&!ian

"en%aai !a#a$ a#te#iel1


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21 FASE SIRKULATOAR /

+enan'&tan 6at aneteia ole$

e#e!a#an !a#a$ 'e 7a#inan ota' !ano#an lain8 Konent#ai a!a 7a#inan

ota' a'$i#n4a e&ai !enan te'anan

a#tial &a aneteia !ala" &!a#aal*eola#1


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Mini"al Al*eola# .on%ent#ation (M1A1.1)

A!ala$ 'onent#ai "ini"al &aaneteia !ala" &!a#a al*eola#9 4an!aat "en$ail'an $ilann4a #ea'i

te#$a!a in%ii '&lit a!a :; !a#io,4e' 4an !iteliti1

M1A1.1


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FASE +ULMONAR/

+a!a a#&3a#& 4an e$at !i5&i

"elal&i "e",#an a#& ti!a' "e#&a3

'an 5a'to# en$a",at1

U"&"n4a te'anan !ala" !a#a$

a#te#iel a'an a"a !enan te'anan

!ala" al*eola#1


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Fa'to# 5a'to# 4an "e"ena#&$i

te'anan al*eola# /

Konsentrasi gas yang diinhalasi/

Konent#ai a te'anan

al*eola# te'anan !ala" !a#a$

a#te#iel in!&'i aneteia le,i$

%eat9 aal ti!a' te#7a!i e5e' ta$an

naa9 la#inoa"e ata& ,at&'3

,at&'1


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2. Ventilasi alveolar :

Konent#ai &!a#a al*eola# a"a

!enan 'onent#ai &!a#a 4an !i3

ini#ai !ala" ,e,e#aa 'ali ,e#na3

a a!a ite" non3#e,#eat$in

!an en!e#ita e$at9 e#l& =a't& > ?

"enit &nt&' "en%aai 'eei",anan1

In!&'i a'an le,i$ %eat a!a e#na3

aan !ala" @ iti" non 3 #e,#ea3

t$in9 tetai le,i$ la",at a!a ite"#e,#eat$in9 !e#ei e#naaan !an

o,t#&'i 7alan naa1


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3. Blood / gas partition coefficient :

Partition coefficienta!ala$ #atio

'eei",anan 'onent#ai 6atte#e,&t a!a 'e!&a ii !a#i"e",#an !i5&i

Blood gas partition coefficienta!ala$

a#tition %oe55i%ient 6at te#e,&t a!a"e",#an al*eola# a#&3a#&1

< G a#t1 .oe55/

B N2O :9C

B Halotan ?9-

B T#ilene 9:

B Met$o45lane 0?9:

B Et$e# 09:


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at aneteia !enan < G a#t1.oe55 in!&'i le,i$ la",at9 tetai

6at aneteia !enan < G a#t1.oe55 in!&'i le,i$ %eat1

Kela#&tan 6at !ala" !a#a$

'onent#ai al*eola# ti!a' "en%aai'eei",anan !enan 'onent#ai&!a#a ini#ai1 Ole$ 'a#ena !i5&i 6atte#e,&t e%a#a 'ontan !a#i al*eoli

'e e",&l&$ !a#a$ &l"ona# te'1at !ala" al*eola# Te'1 Dala"!a#a$ a#te#ial In!&'i la",at1


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Kela#&tan 6at !ala" !a#a$

'onent#ai al*eola# ei",an

!enan 'onent#ai &!a#a ini#ai

te'1 Al*eola# te'1 Da#a$ a#te#iel

in!&'i %eat1

4. Tekanan partial obat anestesia

dala darah yang kebali ke par!"

par! :Te'anan 4an tini a!a

!a#a$ A1 +&l"ona# (Da#a$ Veno&) Menin'at'an 'onent#ai al*eola#1


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#. P!lonary Blood $lo% :+&l"ona#4,loo! 5lo= "enan'&t o,at

aneteia !ala" 'ea!aan no#"al&l"ona#4 ,loo! 5lo= a"a !enan%a#!ia% o&t&t1

&. 'ebran alveolar :+a!a o#ane$at ti!a' a!a "aala$9 tetai a!aen!e#ita !enan en4a'it ee#tioe!e" &l"o9 5i,#oi &l"o !i5&i

"elal&i "e",#an te#$a",at1(. )!b!ngan ventilasi * perf!si :


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Fae Si#'&latoa# /

+!rah ,ant!ng -+ardiac !tp!t /+..:

Dala" 'ea!aan ,aal > : ; .1 O(> ; ,e#at ,a!an) e#i 'e ota'9

7ant&n9 $ea# @ in7al Dala" $alini > 0C ; .1 O1 e#i 'e ota'1

Sela"a in!&'i #elati5 7a#inan ota'"en!aat ,aian .1 O1 le,i$,an4a' (!ala" 'ea!aan ,aal)1


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Dala" 'ea!aan ti!a' ,aal ee#ti

a'ti*ita otot9 t#e9 'eta'&tan9

ti#oto'i'oi9 ota' "ene#i"a ,aian.1 O1 le,i$ 'an in!&'i

aneteia "en7a!i la",at1

Dala" 'ea!aan 4o'9 !e$i!#ai9 !lli#'&lai e#i5e# ,e#'an9 ota'

"ene#i"a ,aian .1 O1 le,i$ ,an4a'

in!&'i aneteia 7a!i %eat1


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2. 0liran darah serebral -cerebral blood flo% /

+B$1.


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3. at!rasi ,aringan t!b!h sek!nder :

Ota' "&la3"&la "ene#i"a ,aian 4an

,ea# !a#i o,at aneteia9 tetai 'e"&!ian

te#7a!i #e!it#i,&i o,at9 e$ina te#7a!i

'eei",anan !enan 7a#inan37a#inan

t&,&$ e%a#a 'eel&$an1

Sela"a in!&'i #elati5 !ie#l&'an o,ataneteia !ala" 7&"la$ 4an ,ea#9 e,a,

te#7a!i #ei#'&lai !a#i o,at 'e 7a#inan lain

!a#i ota' etela$ te"at te"at ini

7en&$ $an4a 7&"la$ e!i'it !a#i o,ataneteia 4an !ie#l&'an &nt&'

"e"e#ta$an'an ta!i&" aneteia 4an

!iinin'an ("aintenan%e)1


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Sta!i&" ta!i&" aneteia


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Sta!i&" ta!i&" aneteia

Sta!i&" ta!i&" ini $an4a 7ela

te#li$at a!a Volatile Anaet$eti%

Aent9 te#&ta"a et$e#1

tadi! : tadi! analgesia

-disorientasi :"&lai in!&'i a"ai

$ilann4a 'ea!a#an (#e5le' ,&l&

"ata 3 )


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tadi! : tadi! 5citeent :

M&lai $ilann4a 'ea!a#an a"ai

"&lain4a e#naaan 7a!i te#at+a!a ta!i&" ini en!e#ita ,ia

,e#onta'9 ta$an naa9 "&nta$9

,at&'9 !ll1

tadi! : tadi! !rgical

0naesthesia :M&lain4a e#naaan

te#at a"ai a#alie e#naaan1

Sta!i&" III ini te#,ai lai !ala" C

+lane /


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Plane 6: Da#i "&lain4a e#naaante#at a"ai e#e#a'an ,ola "ata

te#$enti1Plane 2: Da#i e#e#a'an ,ola "ata

te#$enti a"ai "&lain4a a#aliee#naaan inte#'otal1

Plane 3: Da#i "&lain4a a#aliea"ai 'o"lit a#alie e#naaaninte#'otal1

Plane 4: Da#i 'o"lit a#aliee#naaan inte#'otal a"aia#alie !ia5#a"a1


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tadi! V : tadi! overdosis :Da#i

"&lain4a a#alie !ia5#a"a a"ai

an&9 !an en!e#ita "eninal1


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Re5le' #e5le' 4an entin&nt&' "enent&'an ta!i&" aneteia

Refleks bulu mata (Eyelash Reflex) :

Sent&$an e%a#a elan elan a!a ,&l&

"ata9 a'an "en4e,a,'an 'ont#a'i 'eloa'

"ata Re5le' ini $ilan a!a =a't& "a&'

Sta!i&" II

Refleks kelopak mata (Eyelid Reflex) :

Ji'a 'eloa' "ata ,aian ata !ian'at

elan elan9 a'an "en4e,a,'an

'ont#a'i

'eloa' "ata Re5le' ini $ilan a!a

=a't& "a&' ta!i&" III


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Refleks Conjunctiva (Conjunctival Reflex) :

Sent&$an e%a#a elan elan a!a%on7&n%ti*a ale,#a9 a'an "en4e,a,'an#e5le' "ene7a'an "ata Re5le' ini $ilana!a a'$i# ta!i&" III lane 0

Refleks Cornea (Corneal Reflex) : Sent&$an e%a#a $ati $ati a!a %o#nea9a'an "en4e,a,'an 'ont#a'i 'eloa' "ata Re5le' ini $ilan a!a e#tena$an lane 2

ta!i&" III


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Refleks Cahaya (Light Reflex) :

Denan "e",e#i'an %a$a4a 4an '&at a!a"ata9 a'an "en4e,a,'an &il "enala"i'ont#i'i ("ioi) Re5le' ini $ilana!a e#tena$an lane ? ta!i&" III

Refleks Lakrimasi :

Te#7a!i la'#i"ai le,i$ !a#i no#"al a!a lane0 !an lane 2 9 ta!i&" III

Refleks enelan :

Te#li$at e,el&" lane 09 4ait& a=al ta!i&"III


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Refleks untah :Te#li$at a!a a'$i# ta!i&" II (a!a =a't& #e%o*e3#49 #e5le' ini te#li$at aat e#ali$an !a#i ta!i&" III'e ta!i&" II)

Refleks Carina :

Rananan a!a %a#ina ole$ en!ot#a%$eal 3 t&,e9,#on%$o%oe9 ata& &%tion %at$ete#9 a'an "en4e3

,a,'an ,at&' ,at&' a!a e"&a ta!i&" e,e3l&" ta!i&" IV


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Refleks !phincter "ni :


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Refleks $ulit (!kin Reflex) :Rananan a!a '&lit a'an "ena'i,at'anen!e3#ita ,e#naa !ala" ata& "ene#a''an'a'i Re5le' ini $ilan a!a lane 2ta!i&" III

Refleks %arings &osterior :

Rananan a!a "&'oa 'e#on'onan

!enan len!i#9 !a#a$9 "&nta$an9 !ll9 a'an"ena'i,at'an ,at&' ,at&' Re5le' ini$ilan a!a a'$i# lane 0 ta!i&" III


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Refleks Larings :Rananan a!a la#in !an eiloti a'an"en3a'i,at'an ,at&' 3 ,at&' !an a!!&'iita &a#a (a"e) Re5le' ini $ilana!a a=al ta!i&" III lane 2

#racheal #ug :

Te#7a!i e#e#a'an 4an ta7a" !a#i la#in

!an t#a'ea 'ea#a$ ,a=a$ Re5le' inite#li$at a!a ta!i&" III lane ? ata& lane C


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2. Dasar – Dasar Anestesia