Ovamelia Julio – 2014.061.

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 Anestesi Amino-amida
◦ Durasi lama
◦ Stabil
◦ Jarang menimbulkan reaksi alergi
 Blok sensorik > motorik
 Sediaan : 0.25%, 0.5%, 0.75%
 Dosis Maksimum : 3mg/kg
 BUPIVACAINE

Kanal Induksi
Stimul Ion Na Influx Depola /kondu
us terbuk Na risasi ksi
a impuls
Nerve Membrane
Local Anesthetics (acid) + Na Intracell
HCO3  Neutral base Form Conduction Block

 Local Anesthetics (acid ) = Ionized fraction

> non-ionized fraction
 pKa  pH di mana fraksi terionisasi dan
tidak terionisasi dalam keadaan seimbang
◦ Menentukan onset kerja
 Onset :
◦ Administration route
> proximity to nerve, > onset
◦ Concentration
 Absorption and Duration:
◦ High Affinity of protein binding
◦ Vascular uptake at injection site
◦ Vasoconstrictors
 Distribution
◦ Rapid phase  highly perfused tissue e.g:
lung
◦ Slow phase
 Metabolism
◦ Biotransformation in liver
◦ Excreted by renal
 Additives
◦ Adrenergic agents block prolongation &
intensify
◦ α2 adrenergic agonist
 Block prolongation
 Reduce local anesthetics requirement
◦ Opioids
 Prolong analgesia effect
◦ Ketamine
 Prolong analgesia in epidural
 Shorten onset and decrease duration in spinal
 Sistem Saraf Pusat
◦ Kesemutan, pusing, tinitus, penglihatan terganggu, agitasi,
gugup, dsb
 Respirasi
◦ Apneu, paralisis nervus interkostalis, depresi pusat napas
 Kardiovaskuler (Kardiotoksik)
◦ ↓ automatisasi miokard (konduksi dan kontraktilitas)
◦ Aritmia, ↓kontraktilitas ventrikel, hipotensi, cardiac arrest
 Benzodiazepine  profilaksis kejang
 Anti konvulsan  diazepam atau propofol
 Hipotensi dan bradikardi  cairan intravena,
kronotropik, inotropik, dan agen vasoaktif
 Cardiovascular collapse  Lipid emulsion infusion