DASAR-DASAR DASAR-DASAR ANESTESIANESTESI

GENERAL ANESTESIGENERAL ANESTESI MANAGEMEN OBAT ANESTESIMANAGEMEN OBAT ANESTESI MONITORINGMONITORING KOMPLIKASI ANESTESIKOMPLIKASI ANESTESI

General AnaesthesiaGeneral AnaesthesiaNunn JF. General AnaesthesiaNunn JF. General Anaesthesia

Sri Sunarmiasih Sri Sunarmiasih

IntroductionIntroduction

AnaesthesiaAnaesthesia

derived from the greek, meaning derived from the greek, meaning insensible or without feelinginsensible or without feeling

DefinitionDefinition General AnaesthesiaGeneral Anaesthesia

Definition : a condition induced by pharmacological Definition : a condition induced by pharmacological or other means which results in all of the of the or other means which results in all of the of the following effectsfollowing effects

1.1. Loss of awarenessLoss of awareness2.2. No recall of events at the conscious level, although No recall of events at the conscious level, although

it is possible that events may still be retained in it is possible that events may still be retained in the subconscious, from which they may be recalled the subconscious, from which they may be recalled under certain circumstancesunder certain circumstances

3.3. Lack of overt muscular response to surgical Lack of overt muscular response to surgical stimulation, as in the definition of the minimal stimulation, as in the definition of the minimal alveolar concentration required for anaesthesia. An alveolar concentration required for anaesthesia. An exception is the respiratory musculature, which exception is the respiratory musculature, which usually responds to surgical stimulation by an usually responds to surgical stimulation by an increase in pulmonary minute volume, even in increase in pulmonary minute volume, even in deep anaesthesiadeep anaesthesia

4.4. Minimal autonomic response to surgical Minimal autonomic response to surgical stimulation, although this can not be totally stimulation, although this can not be totally abolishedabolished

5.5. The process should be reversible The process should be reversible

Methods of Production Methods of Production

of General Anaesthesiaof General Anaesthesia Inhalational anaesthesiaInhalational anaesthesia Injectable anaesthesiaInjectable anaesthesia Other methods : hypnosisOther methods : hypnosis

Choice of AnaesthesiaChoice of Anaesthesia

Rational selection is based on :Rational selection is based on :

1.1. safest for the patientsafest for the patient

2.2. requirements of the anticipated requirements of the anticipated surgical interventionsurgical intervention

3.3. preference of the patient preference of the patient

Inhalational Inhalational AnaesthesiaAnaesthesia

ApparatusApparatus1. gas sources1. gas sources2. gas delivery2. gas delivery3. flow meters3. flow meters4. high flow oxygen flush4. high flow oxygen flush5. vaporizers5. vaporizers6. anaeshtetic breathing system 6. anaeshtetic breathing system (tubing, reservoir bags(tubing, reservoir bags

- semi closed system (Mapleson)- semi closed system (Mapleson)- circle system - circle system

- chemical CO- chemical CO22 absorber absorber

Anaesthetic machineAnaesthetic machine

Gas Sources Flow Meter

Vaporizer

Y-piece / circle system

Carbo Absorber

GA Inhalasi dengan Intubasi GA Inhalasi dengan Intubasi ETTETT

Induksi :Induksi :propofolpropofolpenthotalpenthotalmidazolammidazolamketaminketamin

Muscle relaxantMuscle relaxantsuccinylcholinesuccinylcholinerocuronium bromide, vecuronium, atracurium, rocuronium bromide, vecuronium, atracurium, pancuroniumpancuronium

Maintenance :Maintenance :halothane, ethrane, isoflurane, sevofluranehalothane, ethrane, isoflurane, sevofluraneOxygen, nitrous oxideOxygen, nitrous oxide

Intubasi ETTIntubasi ETT

General Anesthesia w/ Face General Anesthesia w/ Face MaskMask

Injectable AnaesthesiaInjectable Anaesthesia

IntermittentIntermittent ContinuousContinuous

TOTAL INTRAVENOUS ANAESTHESIATOTAL INTRAVENOUS ANAESTHESIA