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http://slidepdf.com/reader/full/hap-pv 1/22

By. Dr. Ihsan Affandi

Inhaled Anesthetics

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y

• The discovery of the anesthetic properties of nitrous oxide,

diethyl ether, and chloroform in the 1840s

•

1951, fluroxene, was used clinically for several years beforeits voluntary withdrawal from the market due to its potential

flammability and increasing evidence that this drug could

cause organ toxicity

• Halothane was synthesized in 1951 and introduced for clinical

use in 1956

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Enflurrane, the next methyl ethyl ether derivative, was

introduced for clinical use in 1973 In search of a drug with fewer side effects, isoflurane, the

isomer of enflurane, was introduced in 1981

Methoxyflurane, a methyl ethyl ether, being introduced for

clinical use in 1960

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•Desflurane, a totally fluorinated methyl ethyl ether, was introduced in 1992

•Followed in 1994 by the totally fluorinated methyl isopropyl ether,

sevoflurane

•

The low solubility in blood of these newest anesthetics was desirable•Facilitate the rapid induction of anesthesia, permit precise control of

anesthetic concentrations during maintenance of anesthesia

•Favor prompt recovery at the end of anesthesia independent of the duration of

administration

•Desflurane and sevoflurane reflects in large part the impact of market forces

more than an improved pharmacologic profile on various organ systems as

compared will isoflurane

Inhaled Anesthetics for the Present & Future

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•Commonly administered include the inorganic gas nitrous oxide and the

volatile liquids isoflurane, desflurane, and sevoflurane

•Halothane and enflurane are administered Infrequently but are included in the

discussion of the comparative pharmacology of volatile anesthetics since

halothane in particular has been studied extensively

•Available but rarely administered inhaled anesthetics include the volatile

liquids methoxyflurane and diethyl ether and the cyclic hydrocarbon gas

cyclopropane

•Xenon is an inert gas with anesthetic properties, but its clinical use is hindered

by its high cost

CLINICALLY USEFUL INHALED ANESTHETICS

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PHYSICAL AND CHEMICAL PROPERTIES OF INHALED

ANASTHETICS

Nitrous

Oxide Halothane Enflurane Isoflurane Desflurane Sevoflurane Molecular weight Boiling point (OC) Vapor pressure (mmHg;20

O

C) Odor Preservative necesarry Stability in soda lime (40OC) Blood: gas partition coefficient MAC (37OC, 30 to 55years old, PB 760 mmHg) (%)

44 Gas Sweet

No Yes 0.46 104

197 55.5 172 Ethernal

No Yes 1.90 1.63

184 56.5 172 Ethernal

No Yes 1.90 1.63

184 48.5 240 Ethernal

No Yes 1.46 1.17

168 22.8 669 Ethernal

No Yes 0.42 6.6

200 58.5 170 Ethernal

No Yes 0.69 1.80

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Riwayat Keluarga

Tidak ada keluarga pasien yang sakit seperti ini

Riwayat perkawinan : 1 x tahun 1998

Riwayat kehamilan / abortus / persalinan : 4/0/3

PEMERIKSAAN FISIK

KU : sedang Sianosis : -

Kes : sadar Ikterik : -

TD : 120/80 mmHg pucat : -

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Nadi : 96 x/menit

Nafas : 22 x/menit

T : 37 C

Mata : tidak anemis, tidak ikterik, pupil isokor ki=ka

Telinga, hidung dan tenggorokan : tak ada kelainan

Leher : KGB tidak membesar

Dada : paru dan jantung dalam batas normal

Ekstremitas : akral hangat, edema -/-

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STATUS OBSTETRI

Abdomen :

Inspeksi: tampak membuncit sesuai usia kehamilan aterm

Palpasi :

L I : FUT 3 jari bpx, teraba massa besar, lunak, noduler

L II : teraba tahanan terbesar di kiri

L III : teraba massa bulat, keras, floating

L IV : tidak dilakukan

Taksiran berat anak : 2945 gr, TFU : 32 cm, Hiss (-)

Perkusi : timpani

Auskultasi : BU (+) normal ; BJA : -

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Genitalia : Inspeksi U/V tenangInspekulo : darah (+) warna merah segar, stosel (+)menutupi portio, laserasi (-)

Laboratorium : Hb : 10,7 g/dl Hematokrit : 35 %CT : 3’ BT : 4’

Leu : 12400 mm³ Trombosit : 178000/mm³

Diagnosis Kerja : G4P3A0H3 gravid aterm 38-39mgg + HAP ec susp placenta previa + susp IUFD

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Terapi

O2 3 liter/’

IVFD RL tetesan cepatKONSUL SpOG

• Kontrol KU, VS, perdarahan pervaginam

•

Pasang kateter urine• Ceftriaxone inj 1 x1 gr iv

• Persiapkan contoh darah untuk crossmatch

•

Rencana sectio sesarea sito

Diagnosis BandingHAP ec solusio placenta

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Laporan Operasi

Dilakukan SCTPP ai HAP ec placenta previa,lahir seorang bayi perempuan dengan BB :

2700 gr, PB : 47 cm, A/S : - (IUFD), sisa ketubanhijau kental, placenta lahir lengkap 1 buah,berat 500 gr, perdarahan selama tindakan 300

cc, BAK lancar via cateter 100cc/sewaktu

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FOLLOW UP POST OP

Pukul 18.00 WIB

S / Demam (-), BAK (+) terpasang kateter

0 / Ku : sedang Kes : sadar

Nfs : 20 x/’ TD : 120/80 mmHg T: afebris Nadi : 82 x/’

Abdomen, I : tampak sedikit membuncit,

luka operasi tertutup verbanPa : FUT 2 jari bawah pusat

kontraksi uterus baik

NT (-), NL (-), defans muscular (-)

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Genitalia : V/U tenang, PPV (+)↓ A/ P4A0H3 Post SCTPP ai placenta previa, ibu dalamperawatan + anak meninggalP /Awasi KU, VS, PPV post SCTPPDiet TKTPMobilisasi bertahap

IVFD RL 20 tetes/’ Ceftriaxon inj 1 x 1 gr ivMetronidazole infus/8 jamInvitex/ 4 jam suppositoria 2 x pemberian

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Pukul 23.00 WIB

Hb post op : 8,1 gr/dlRencana : transfusi darah, namun keluargabelum mendapatkan pendonor

Tanggal 5-10-2010 S / Demam (-), BAK (+) terpasang kateter

BAB (+), PPV (-)0 / Ku : sedang TD 120/100 mmHgKes : sadar Nfs : 20 x/’ T: afebris Nadi : 80 x/’

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Abdomen, I : tidak tampak membuncitluka operasi tertutup verban

Pa : FUT 2 jari bawah pusat

kontraksi uterus baikNT (-), NL (-), defans muscular (-)Genitalia : V/U tenang, PPV (-)Kesan : perbaikan

A/ P4A0H3 Post SCTPP ai placenta previa, ibu dalamperawatan + anak meninggal + Nifas hari ke-1

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P /Breast careMobilisasi bertahap

IVFD RL 20 tetes/’ Transfusi darah 2 kolf pukul 13.00 dan 22.00Ceftriaxon inj 1 x 1 gr ivCiprofloxacin 2 x1 po

Metronidazole aff ganti oral 3 x 1 tabViliron 1 x1 poAsam mefenamat 3 x 1 poLinoral 3 x 1 po

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Tanggal 6-10-2010

S / Demam (-), BAK (+), BAB (+), PPV (-)0 / Ku : sedang TD 120/100 mmHgKes : sadar Nfs : 20 x/’T: afebris Nadi : 80 x/’

Abdomen, I : tidak tampak membuncitluka operasi tertutup verban

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Tanggal 7-10-2010

S / Demam (-), BAK (+), BAB (+), PPV (-)0 / Ku : sedang TD 120/100 mmHg

Kes : sadar Nfs : 20 x/’T: afebris Ndi : 80 x/’ Abdomen I : tidak tampak membuncit

luka operasi tertutup verbanPa : FUT 2 jari bpst

kontraksi uterus baikNT (-), NL (-), defans muscular (-)

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Genitalia : V/U tenang, PPV (-)A/ P4A0H3 Post SCTPP ai placenta previa, ibudalam perawatan + anak meninggal + Nifashari ke-3P / Terapi lanjut

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TERIMA KASIH

hap pv

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