ANESTESIOLOGI

Departemen Anestesi dan Terapi Intensif

Fakultas Kedokteran Universitas Cenderawasih
 PERI-OPERATIF
PRE-OPERATIF
EVALUASI PREMEDIKASI

INTRA-OPERATIF
INDUKSI MONITORING

POST-OPERATIF
PULIH SADAR NYERI POST OP
 Sasaran evaluasi pre-op

• Riwayat penyakit dahulu dan pengobatan yang pernah dijalani

• Asesment dan melakukan optimalisasi kondisi pasien (misal

pasien dengan darah tinggi yang belum terkontrol dilakukan
konsultasi ke dokter penyakit dalam)

• Menilai risiko anestesi dan operasi

• Mengantisipasi kemungkinan komplikasi yang terjadi

 Airway Management
“LEMON” Mnemonic
• L : Look externally
• E : Evaluate 3-3-2 rule
• M : Mallampati score
• O : Obesity
• N : Neck mobility
3-3-2 rule
3-3-2 rule
Mallampati score
 Physical Status ASA
American Society of Anesthesiologists
ASA 1 A normal healthy patient Healthy, non-smoking, no or minimal alcohol use
ASA 2 A patient with mild systemic disease Mild diseases only without substantive functional limitations.
Examples include (but not limited to): current smoker, social
alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-
controlled DM/HTN, mild lung disease
ASA 3 A patient with severe systemic disease Substantive functional limitations; One or more moderate to
severe diseases. Examples include (but not limited to):
poorly controlled DM or HTN, COPD, morbid obesity (BMI
≥40), active hepatitis, alcohol dependence or abuse,
implanted pacemaker, moderate reduction of ejection
fraction, ESRD undergoing regularly scheduled dialysis,
premature infant PCA < 60 weeks, history (>3 months) of MI,
CVA, TIA, or CAD/stents.
 Physical Status ASA lanjutan
American Society of Anesthesiologists

ASA 4 A patient with severe systemic disease
that is a constant threat to life
ASA 5 A moribund patient who is not expected Examples include (but not limited to): ruptured
to survive without the operation
ASA 6 A declared brain-dead patient whose
organs are being removed for donor
purposes
Examples include (but not limited to): recent ( < 3 months)
MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or
severe valve dysfunction, severe reduction of ejection
fraction, sepsis, DIC, ARD or ESRD not undergoing regularly
scheduled dialysis
abdominal/thoracic aneurysm, massive trauma, intracranial
bleed with mass effect, ischemic bowel in the face of
significant cardiac pathology or multiple organ/system
dysfunction
 • General Anesthesia
Rencana • Regional Anesthesia
anestesi

• Bedah
• Anestesi
Consent
 Induksi Anestesi
• Pemberian obat anestesi
• Airway Management
– Intubasi Endotracheal Tube (ETT)
– Insersi Laryngeal Mask Airway (LMA)
– Penggunaan mesin anestesi
• Rumatan obat anestesi (inhalasi atau intravena)
 Monitoring

• Airway patency
• Blood Pressure, Heart Rate, Respiratory Rate, Temperature
• ECG
• O2 Saturation
• End Tidal CO2 (ET CO2)
• Anesthesia agent
• Urinary output
• Operative Bleeding
 PULIH SADAR

• Diawasi di ruangan pulih sadar/ Recovery

Room
• Dilakukan observasi dan dilakukan sampai
dinilai pasien layak untuk pindah ruangan
• Skor yang dipakai adalah Aldrete Score
(dewasa)
Nyeri post-op
TRIAS ANESTESI

Hipnotik-
Analgesi
sedasi

Relaksasi
 HIPNOTIK-SEDASI
• Barbiturat
• Benzodiazepin
• Propofol
• Ketamine
• Dexmedetomidine
Barbiturat
Benzodiazepin
• Flumazenil (an imidazobenzodiazepine) is a specific
benzodiazepine–receptor antagonist that eff ectively reverses
most of the central nervous system eff ects of benzodiazepines
• Gradual titration of flumazenil is usually accomplished by
intravenous administration of 0.2 mg/min until reaching the
desired degree of reversal. The usual total dose is 0.6–1.0 mg.
 Ketamine

• Ketamine has been demonstrated to be an N -methyl- d-aspartate

(NMDA) receptor (a subtype of the glutamate receptor) antagonist.
• The state of dissociative anesthesia may cause the patient to
appear conscious (eg, eye opening, swallowing, muscle
contracture) but unable to process or respond to sensory input.
• Dosis ketamin : Induksi IV 1-2 mg/Kg; IM 3-5 mg/Kg
Sedasi IV 2.5–15 mcg/kg/min
 Propofol
• Propofol induction of general anesthesia may involve facilitation of
inhibitory neurotransmission mediated by GABA receptor binding
A

• Globally used by anesthesiologist to perform anesthesia in induction and

maintenance
• Dose of propofol
– Induction IV 1-2.5 mg/Kg
– Maintenance Infusion 50-200 mcg/Kg/min
– Maintenance sedation 10-100 mcg/Kg/min
 Etomidate
• Etomidate has minimal eff ects on the cardiovascular system.
• Myocardial contractility and cardiac output are usually unchanged
• Even in large doses, Etomidate produces relatively light anesthesia
for laryngoscopy, and marked increases in heart rate and blood
pressure may be recorded when etomidate provides the only
anesthetic depth for intubation.
• Dose of etomidate: induction IV 0,2 mg/Kg