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Obat Anestesi/Ike Mega Irawati/ 091.0039/ S1-2A


Posted Selasa, 11 Januari 2011 by Ike Mega Irawati
Efforts are made to reduce or eliminate pain with drug use in surgical procedures have been performed since ancient times, including the provision of ethanol and opium (opiate) orally. The first scientific demonstration of the use of anesthesia for surgery performed by William Morton in Boston in 1846 by using diethyl ether. While the term anesthesia was first proposed by OW Holmes which means no pain. Anesthesia is done first by the Egyptians to use narcotics, the Chinese people use cannabis Indica, and beating the head with a wooden stick to remove consciousness. Anesthesia is divided into two groups: (1) general anesthesia and (2) local anesthesia. The following will be explained on general anesthesia and local anesthesia. 


General anesthesia is missing pain accompanied loss of consciousness. Anesthesia used in surgery with the intention of achieving unconsciousness, hinder the stimulus of pain (analgesia), blocked the reflex response to surgical manipulation and creates pelemasan muscle (relaxation). General anesthesia are now available can not meet this goal as a whole, then in anesthesia for surgery is generally used in combination hipnotika, analgesics, and muscle relaksansia. 

Procedures on General Anesthesia 

General anesthesia can be given by inhalation or intravenous injection.
1. Inhalation anesthetics: halothane, enflurane, isofluran, sevoflurane, desflurane, and methoxyflurane is a volatile liquid. These drugs are given as vapor through the airways. The way of inhalation anesthetics: • Open the drop method: an anesthetic substance dripped on cotton placed under the noses of patients so that levels of a substance which is inhaled anesthetics is unknown and wasteful use as an anesthetic agent evaporates into the open air. • Semiopen drop method: in this manner nearly equal to open the drop, only to reduce the waste of anesthetic agents then used a mask. • Semiclosed method: given the same air that is inhaled oxygen levels can be determined. The advantage of this way is it an anesthetic can be adjusted by giving a certain degree of anesthetic agents and hypoxia can be avoided by giving O2. • Closed method: almost the same as semiclosed, only the expiratory air flow through the NaOH that can bind CO2, so that air containing the anesthetic can be used again. This method is more efficient, safer, and easier, but the price is quite expensive appliance. The types of first-generation inhaled anesthetics such as ether, cyclopropane, and chloroform are not used anymore in developed countries because of its flammable (such as ether and cyclopropane) and its toxicity to organs (chloroform). 
2. Intravenous Anesthesia. Some drugs are used intravenously (either alone or in combination with other drugs) to induce anesthesia, or as a component of balanced anesthesia (balanced anesthesia), or to soothe patients in emergency care units who require artificial breathing assistance for the long term.

Classification of General Anesthesia Drugs  

a. Inhalation Anesthesia Halothane, enflurane, isofluran, sevoflurane, desflurane, and methoxyflurane is a volatile liquid. 


 • Smell and taste do not sting,   
• Savor anestetisnya very strong but the efficacy and power analgetisnya mild muscle relaxation, the new adequate in anesthesia in  • halothane used in low doses and in combination with a relaksans bibs, like galamin or suksametonium.  • relatively low solubility in blood induction of slow, easy to use, does not stimulate the respiratory mucosa  • crushing, and laryngeal reflexes from Paring, bronkioli widen and reduce the secretion of saliva and secretions of the bronchi • Famakokinetik: partial dimetabolisasi inwardly bromide, inorganic chloride, and trifluoacetik acid. • Side effects: suppress breathing and heart activity, hypotension, if repeated use, it can cause liver damage. • Dose: 0.5 to 3 tracheal v%. Enflurane • strong inhalation anesthetics are used in various types of surgery, as well as analgetikum in childbirth. • Has the power and muscle relaxation analgetis good, relaxes uterine muscle • Not so pressing SSP • Resorpsinya after inhalation, rapid induction time of 2-3 minutes • Most is excreted through the lungs in one piece, and the rest is converted into free fluoride ion • Side effects: hypotension, respiratory pressure, aritmi, and stimulate the CNS. Post-surgery may arise hipotermi (shivering), and nausea and vomiting, can increase bleeding during childbirth, SC, and abortion.
Isofluran (Forane) • The smell bad • Includes a strong inhalation anesthesia with muscle relaxation properties and good analgetis • Power of work and its emphasis thdp SSP = enflurane • Side effects: hypotension, aritmi, chills, constriction bronkhi, increasing the number of leukocytes. Can arise after surgery nausea, vomiting, and the tense situation • Dosage: 3 to 3.5% Dlm isofluran O2; + NO2-O2 = induction; maintenance: 0.5% -3%

b. Gas anesthesia 
1. Potential minor  
2. Difficult to dissolve in the blood  
3. N2O • achromatic gas, odorless, LBH BRT air dp, dg combined O2 • weak anesthetic potency, rapid induction • good analgesic effect (20% N2O) • the use of old: nausea, vomiting, slow build Included in this group adalh siklopropan. Siklopropan • Anesthesia gas is strong, specific smell, no color • More heavy than air and kept in the form of pressurized fluid. • Highly flammable and explosive, therefore, anesthetic gases used only in the closed method.

c. Intravenous Anesthesia 
 Included in this group are: barbiturates (thiopental, methothexital), benzodiazepines (midazolam, diazepam), opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil), propofol, ketamine, a compound that can cause a state arylcylohexylamine dissociative anesthesia and medications Other (droperianol, etomidate, dexmedetomidine).

1. Stimulation system blockade in the formation retikularis  
2. Respiratory inhibition in the medulla oblongata  
3. Inhibition of muscle contraction. heart, cardiac sensitization caused ill against ketekolamin  
4. Dose of anesthesia: excitatory CNS; doses> = CNS depression  
5. Dose: induction = 2 mg / kg (iv) in the 60 sec; maintenance = half dose induction o Na tiopental: • Induction: TGT BB dose, physical condition and eds • DWS: 2-4ml of 2.5% scr lar intermittent performance every 30-60 sec ad o Ketamine • the nature of analgesic, anesthetic, brief work kataleptik dg • strong analgesic for somatic system, weak for visceral system • relaxation o. Plain striated (-), rising tone • increase BP, pulse, bulk jtg • Hallucinations (+) Fentanyl and droperidol • Analgesic & anesthetic neuroleptics • Combination of fixed • Safe naturally given pd yg px hiperpireksia ok other general anesthesia • Fentanyl: short working period, the early rapid crimes • Droperidol: working lives long & slow early labor Diazepam • A benzodiazepine with the ability to relieve anxiety, muscle relaxing effect that works in a central, and when given intravenously to work as antikejang. Drug response lasted for 12-24 hours a real gift in 30-90 min stlah SCRA 15 min slah oral and intravenous injection. • Contraindications: Hypersensitivity to benzodiazepines, parenteral administration is contraindicated in patients with shock or coma • Cause of sleep and impairment of consciousness accompanied nistagmus, talk slow • Analgesics (-) • Sedation basalt in regional anesthesia, endoscopy, dental procedures, anesthesia induction pd cardiovascular patients • effects of anesthesia <ok job at first slow, long recovery period • To premedication (neurolepanalgesia) & convulsions ok overcome local anesthesia • Dimetab mjd active metabolite • T ½> with age • ESO: stopping the breath, phlebitis and thrombosis (+) (route IV) • Dose: induction = 0.1 to 0.5 mg / kg

Stages of Anesthesia  
1. Stage 1 (analgesia)
• Patients experiencing analgesia,  
• The pain disappeared,  
• Awareness is reduced
2. Stage II (delirium / excitation)  

• The patient was restless and lost consciousness 
• Patients experiencing movement that is not according to the will (laugh, scream, cry, sing)  
• Volume and speed of irregular breathing 
• nausea and vomiting may occur 
• incontinence of urine and defecation often occurs  
• Midriasis, hypertension  
3. Stage III (anesthesia, surgery / operation)  
• Breathing becomes shallow, rapid, and orderly, as in a state of sleep (belly breathing)  
• Eye movements and eye reflex loss / movement was not at the discretion of the eyeball  
• Muscles become weak, for example, the head can be moved to the right and left freely, arms raised and then released to fall freely without being detained
4. Stage IV (paralysis of the medulla oblongata)  

• cardiac and respiratory activity spontaneously stopped.  
• There was severe depression of respiratory center in the medulla oblongata and vasomotor center. Without the help of a respirator and circulation, the patient will quickly die. So this stage as far as possible be avoided.

Working Mechanism  
a. Inhalation anesthesia
Inhaled anesthetics work pressure and evoke spontaneous neuronal activity in the brain areas. As an inhalation anesthetic gases and liquids used in flying, each very different in the speed of induction, activity, nature relaxes the muscles and relieve pain. To get the quickest response, this drug at the beginning should be given in high doses, which is then reduced to simply maintain a balance between giving and spending. Advantages compared with inhalation anesthesia intravenous anesthesia is likely to be able to more quickly change the depth of anesthesia by reducing the concentration of gas / vapor inhaled.
b. Intravenous Anesthesia

Intravenous medications such as thiopental, etomidate, and propofol have first anesthetist working faster compared to the most recent inhalation gas compound, such as desflurane and sevoflurane. The compound is commonly used for intravenous induction of anesthesia. The speed of recovery in most of the compounds intravenously is also very fast.


The depth of anesthesia is determined by the concentration of anesthetic in the central nervous system. The speed at which an effective brain concentrations (speed induction of anesthesia) depends on how much influence the pharmacokinetics of uptake and spread of anesthesia. These factors determine the difference in transfer speed of inhalation anesthetics from the lungs to the blood and from blood to the brain and other tissues. These factors also affect the anesthesia recovery period after anesthesia was stopped. Influenced / tek partial anesthetic substance Dlm brain. Determinants of partial pressure: 
 1. Partial pressure of inspired anesthetic gas • To accelerate the induction: the inspired gas levels should be higher than the expected partial pressure in the network • Once reached, reduced to maintain anesthesia  
2. Pulmonary ventilation • Hyperventilation to hasten the entry of an anesthetic gas into the circulation and tissue • soluble substances in the blood: halothan  
3. The transfer of anesthetic gas into the flow drh dr alveoli • Membrane alveoli easily bypassed by the diffusion of anesthetic gas from the alveoli into the blood is flow 
4. Transfer of anesthetic gas from Dareh flow to tissue cells • Networks that have a rapid blood flow, the equilibrium partial pressure is more easily achieved so that the anesthetic gas is easier to move.

Inhaled anesthetics work pressure and evoke spontaneous neuronal activity in the brain areas. To get a reaction as soon as possible, these drugs at the beginning should be given in high doses. The compound is commonly used for intravenous induction of anesthesia. The speed of recovery in most of the compounds intravenously is also very fast.
Side effects  

Almost all inhaled anesthetics which resulted in a number of side effects and most importantly: 
 1. Suppress respiration in anesthesia in mainly caused by halothane, enflurane and isofluran. This effect is the lightest on N2O and ether. 
 2. Pressing the cardiovascular system, especially by halothane, enflurane and isofluran. This effect is also caused by the ether, but because the ether also stimulate the sympathetic nervous system, then the overall effect becomes lighter. 
 3. Damage the liver and kidneys, particularly chlorine compounds, such as chloroform. 
 4. Oliguric (reversible) due to reduced drainage of blood in the kidneys, so patients need to dihidratasi taste.  
5. Pressing temperature regulation system, which raised the feeling of chills (shivering) post-surgery.


Posted by Ike Mega Irawati
Definition: drugs which inhibit the delivery of nerve reversible when applied locally scr pd jar adequate levels of nerve dgWork on each part of the nervous system which intervened 

First drug: cocaine, Erythroxylon coca leaf alkaloids  

Nature:- Not irritating & non-permanent damage to jar the nerves scr- At a brief work, long working period- Wide safety margin- Water Soluble- Stable in solution- Can be sterilized without changing its


The basic structure of local anesthetics in general consists of three parts, namely a hydrophilic amino group linked by an ester bond (alcohol) or amide with an aromatic group lipofil. The longer the alcohol group, the greater their power anestetiknya, but also increases toxicity.Local anesthesia can be chemically classified into several groups as follows:

a. Ester compound: cocaine and PABA ester (benzocaine, procaine, oksibuprokain, tetrakain) 

b. Amide compounds: lidocaine and prilokain, mepivakain, bupivacaine, and cinchokain 
c. Others: phenol, benzialkohol and ethyl chloride.

Mechanism of action
* Prevent the occurrence of nerve impulse conduction and
* Place of work mainly in cell membranes
* Inhibition of Na + ion membrane permeability due to membrane depolarization increased excitatory threshold makes
* Excitability <<& smoothness constraints hampered
* Binds to receptors dg yg pd tdpt Na ion channels, the blockade so that the inhibition occurs via membrane ion motion

1. Resorpsinya of skin and mucus membranes can take place very quickly and well, for example on cocaine, lidocaine, prilokain, and tetrakain. Distribusinyapun progress rapidly to all organs and tissues. Conversely, procaine resorption in kult bad. The speed and duration of labor power is determined by lipofilitas, pKa, degree of binding to proteins and the degree vasodilatasinya. 
2. Need to avoid the use of local anesthesia in patients with liver damage.    

3. Toxicity of local anesthetic depends on the balance between resorption rate and speed of degradation. The speed of resorption and also its toxicity can be minimized by giving vasoconstrictor. Another advantage of vasoconstrictor is renewed labor power and reduced blood loss in the surgical wound. Vasoconstrictor that is used is epineprin and norepineprin.
4. The combination of norepineprin epineprin and should not be used on certain body parts (finger hand / foot, nose, ears, penis) because of the likelihood of ischemia and gangrena (tissue death).


1. In SSPdapat stimulate CNS became agitated and tremor and clonic convulsions and depression and lead to death (paralysis breath
2. In muscle and ganglion nerve connections can influence the transmission at the neuromuscular connection is reduced muscle response on nerve stimulation
3. In the cardiovascular system: myocardial caused the decrease in excitability, Kec conduction & contraction strength (high KDR Dlm plasma); arteriolar vasodilatation
4. Pd smooth muscle: Unresponsive spasmolytic berhub dg anesthetic effect
5. Onset, intensity, and duration of nerve blockade is determined by the size and anatomical location of nerve.
6. Na + channel is important in muscle cells that can be excited like heart. The effect of cardiac Na + channels is the basis of local anesthetic therapy in the treatment of certain aritmi.
7. Local anesthesia is generally less effective in infected tissue than normal tissue, usually because of local infection resulting in metabolic acidosis

Profile of drug 

1. Procaine
 a. Pharmacodynamic
* Dose 100-800 mg: mild analgesic, 10-20 max effect ', missing timeout 60'
* Dhidrolisis mjd PABA (para amino benzoic acid) to inhibition of sulfonamide
b. PharmacokineticEsterase
* Absorption fast PABA + dietilaminoetanolHydrolysis* PABA excreted urine Dlm (Btk intact and conjugated)
c. Indication

* Infiltration anesthesia, nerve blocks, epidural, caudal and spinal
* Geriatric: improve sexual activity & FGS kel endocrine (conflicted)
d. Preparations
* 1-2% procaine hydrochloride is an anesthetic infiltrates, 5-20%; spinal anesthesia

2. Lidocaine

 a. Pharmacodynamic
* Local anesthesia strong. Tjd faster, stronger LBH, LBH LBH long & extensive procaine dp
* Lar 0.5% lidocaine is an anesthetic infiltrates, 1-2%; block and topical anesthesia
* Effective when without a vasoconstrictor, Kec absorption & tox, years of LBH short
b. Pharmacokinetic
* Easily absorbed dr tmpt injection
* It can penetrate the blood brain barrier
* Metab: liver; ex: urine
c. Indication
* Injection: infiltration anesthesia, nerve blocks, epidural anest, anest caudal, anest mucosa
* Anest infiltrates: 0.25 to 0.50% dg lar or without adrenaline
* Vizard teeth: lar Lido 1-2% adrenaline dg
* Anest surface, anest corneas (lidocaine 2% + adrenaline)
* Reduces heart irritability

3. Dibukain

* Local Anest strong PLG, PLG toxic, long working period
* 15x LBH strong & toxic dg LBH 3x long period of procaine dp
* KDR 0.05 to 0.1%: anest injection; anest urethra from 0.05 to 0.2%; anest spinal: 7.5 to 10 mg

4. Mepivakain HCl

* Similar to lidocaine
* Anest infiltra, regional nerve blockade, spinal anest
* Dosage: Injection is a solution of 1%, 1.5%, 2%

5. Piperakain HCl
* I.v: toks 3x procaine
* Strength anest = procaine
* Use topical: 2% lar to the cornea, 4% for eye ointment; nerve blockade: lar 0.5-1%

6. Tetrakain

* PABA derivatives
* It is a local anesthetic that penetrates the cornea and conjunctiva, the drug is effective after topical administration to the eyes in 30 sec and anesthesia lasted for min. 15 min
* I.v = active & LBH LBH 10x toxic procaine dp
* Dosage and administration: in the eyes of 1 or 2 drops of a solution of 0.5%; ENT: lar 2%
* Contraindications: known the hipersensitiv against tetrakain, ocular inflammation or infection
* Precautions: teranestesi eyes must be protected from dust and bacteriological contamination samapai sensation of a full recovery. Use the old can cause opacity of the cornea
* Adverse effects: local burning feeling can arise and, more rarely is lakrimasi and photophobia
* Storage: Tetrakain eye drops should be stored in tightly closed containers protected from light and do not cooled

7. Prilokain HCL

* Securities fkologi lidocaine mrp
* At & long working long LBH lidocaine dp
* Dosage: KDR 1,2,3%

8. Bupivacaine

 This substance inhibits the initiation and transmission of nerve impul in place to stabilize the membrane of nerve. This compound is metabolized in the liver. Anesthesia and usually work for 2-4 hours

* Anesthesia infiltration
* Block of peripheral nerve and sympathetic
* Dental Anesthesia
* Spinal Anesthesia
* Epidural and caudal anesthesia
* Bupivacaine is not suitable for intravenous regional anesthesia or the use of topical

* Skin infections are adjacent to the injection site or any abnormal bleeding tendency
* Severe anemia
* Heart disease
* Local and epidural anesthesia was not performed in patients with dehydration and hypovolemia
* High levels of bupivacaine in the blood should be avoided in patients with hepatic disorders

Side effects
* The side effects are a result of the depressant effects on CNS and cardio-depresifnya effect (suppressing the function of the heart) with symptoms of inhibition of respiration and blood circulation. Local Anestetika can also cause a reaction that is often a exantema hipersensitasi, urticaria and allergic until sometimes shock bronchospasme anafilaktis which can be deadly. The famous dal; am this are substances procaine and tetrakain ester groups, which therefore is not used anymore in local stocks. Hipersensitasi reaction was caused by PABA (para amino benzoic acid), which is formed through hydrolysis. PABA can negate the effects of sulfonamide antibakteriil. Therefore, therapy with a sulfa should not be combined with the use of these esters.
* CNS effects: depression, stimulation, depending on the neural pathways affected by local anesthesia
* Overdose of local anesthetics can cause:
* Decrease the transmission of impulses in neuromuscular junctions and synapses ganglion
* Causes muscle weakness and paralysis

Provision of Local Anesthesia Techniques 

1. Surface anesthesia
2. Infiltration anesthesia 
3. Block anesthesia

* Spinal Anesthesia
* Epidurals
* Anesthesia caudal


1. In parenteral local anesthetic often used in surgery. 
Type of local anesthesia of the most widely used as an injection is as follows:
a. Infiltration anesthesiaSome injections are given at or around a network that will dianestetisir, resulting in loss of sensation in the skin and the tissue that lies deeper, for example in the practice of ENT (Ear, Nose, Throat) or gum (in a tooth extraction). 

b. Conduction anesthesia (peripheral nerve block ade), the injection in the spine at a gathering place for many nerves, especially on the operating arm or leg, and shoulder. It is also used to block the intense pain. 
c. Spinal anesthesia (intrathecal), also called the dorsal injection. Drugs injected in the spine that contains cerebrospinal fluid. Thus injection across the outer membranes of the medulla (duramater), usually between the lumbar vertebra to the third and fourth. Thus, anesthesia of the foot / lower body to the breastbone can be reached within a few minutes. 
d. Epidurals also ternasuk back injection. Drugs injected in the epidural space, the space between the outer medulla membranes. Injections are given at different locations, such as lumbar for delivery (SC), obstetrics and lower abdominal surgery. In cervical to reach the lost feeling in the neck; in torakal for cuts in the lung and upper abdomen. This method is feasible to use for a long time for surgery or for postoperative pain management. 
e. Surface anesthesiaAs injection is widely used as pain by a dentist to pull teeth or for minor surgery such as suturing the skin. Surface anesthesia is also used as a preparation for diagnostic procedures such as bronchoscopy, gastroscopy and sitoskopi.

2.Other UsageLocal anesthesia is used orally as a solution to pain in the mouth or suction tablets (sore throat). Also in the form of eye drops to measure the intraocular pressure or remove foreign objects, as well as ointments for itching or pain of burns.Ester compounds often cause allergic skin reactions, then you should use an amide compound which is more rarely result in hipersensitasi.

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