SISTIM ANESTESI INHALASI

Dr.Elizeus Hanindito SpAnKIC

Dr. Arie Utariani, SpAn
Bag. Anestesi & Reanimasi
FK. UNAIR-RSUD dr.Soetomo
 ANESTESI
 ANESTESI LOKAL
 ANESTESI REGIONAL
 ANESTESI UMUM :
1. Parenteral – intramuskuler
intravena
2. Inhalasi
 ANESTESI INHALASI
 OKSIGEN (O2)
 NITROUS OXIDE (N2O)
 LIQUID – Ether
Halothane
Enflurane
Isoflurane
Sevoflurane
Desflurane
 Minimum Alveolar
Concentration
 Concentration of an anesthetic at 1 atm &
37 C that prevents movement in response to
an surgical stimulus in 50% of patients.
 Clinical experience – 1.2 to 1.3 MAC :
prevents patients movement.
 0.4-0.5 MAC prevents self-awareness.
 Many factors increase/decrease MAC.
Obat anestesi inhalasi ideal
 Bau menyenangkan
 Tidak iritasi
 Kelarutan didarah rendah
 Tidak toksik
 Efek pada nafas & kardiovaskuler <
 Efek pada SSP reversibel,tanpa aktivitas
stimulans
 Efektif jika diberikan bersama oksigen
 Blood : gas solubility
Agent Blood:gas partition
coefficient
Diethyl ether 12.1
Halothane 2.4
Enflurane 1.9
Isoflurane 1.4
Sevoflurane 0.59
Desflurane 0.42
Open drop
 SAFETY
 KONSENTRASI OKSIGEN
 ELIMINASI KARBONDIOKSIDA
 POLUSI KAMAR BEDAH
 SISTIM PENGAMANAN
Klasifikasi sistim anestesi inhalasi

 Sistim ‘rebreathing’
 Sistim ‘non-rebreathing’
 Sistim ‘non-rebreathing’

 Flow-controlled :
Mapleson A – F.
 Valve-controlled :
Ambu-Paedi system.
Valve-controlled non-rebreathing syst.
Non-rebreathing system
Mapleson A - F
 Aliran gas sistim ‘flow-
controlled nonrebreathing’
Nafas spontan Nafas buatan
Mapleson A 0.7 – 1 MV 2–3 MV
Mapleson B ,C 2 MV 2 MV
Mapleson D 1.5 MV 1 MV
Mapleson E 2 MV 2–3 MV
Mapleson F 1.5 MV 1–2 MV
Mapleson A
 Berat badan 50 kg.

 Volume nafas semenit (minute volume) :

Vt x frekwensi nafas
500 x 12 = 6000 ml
 Flow yg diperlukan untuk Mapleson A :
Spontan = 1 x 6000 = 6 liter/menit
Buatan = 2 x 6000 = 12 liter/menit
 Faktor yang mempengaruhi
‘rebreathing’
 Ventilasi semenit ( Vt x frekwensi nafas).
 Cara ventilasi (spontan atau buatan).
 Waktu inspirasi : waktu expirasi (I : E ratio)
 Lama pause expirasi.
 Volume reservoir
 Volume ‘breathing bag’
Mapleson A (Magill system)
Mapleson A (Magill system)
Valve controlled ‘non-rebreathing’
EMO + valve controlled non-rebreathing
Valve controlled ‘non-rebreathing’
Valve controlled ‘non-rebreathing’
Sistim ‘rebreathing’

 Sistim ‘to and fro’

 Sistim ‘Circle absorbtion’
‘To and fro’ system
Circle absorption system
 Rebreathing system
(Circle Absorber system)
Soda lime (CO2 absorbent)
 Aliran gas ‘circle absorption system’

Flow rate Aliran gas (ml/menit)

Metabolic flow 250
Minimal flow 250-500
Low flow 500-1000
Medium flow 1000-2000
High flow 2000-4000
 Karakteristik ‘circle system’
Keuntungan Kerugian

 Ekonomis.  Rancang bangun rumit

 Kelembaban ‘airway’  Koneksi2 > - potensi
 Tak kehilangan panas penyulit >
 Polusi kamar bedah <  Kebocoran >
 CO2 absorbent
 Gangguan katup >
 Tidak portabel
Pengamanan thd hipoxia
Pencegahan hipoxia & hiperkarbia

 Oxygen failure warning device

 Emergency oxygen flush
 Oxygen analyser (FiO2)
 Pulse oxymetry
 End tidal CO2
Oxygen supply failure alarm
Emergency oxygen flush
Oxygen concentration analyser
Oxygen concentration (FiO2) analyser
Pulse oximetry
Pencegahan hiperkarbia (etCO2)
Grafik SpO2 & etCO2
COLOR INDEX SYSTEM
COLOR INDEX SILINDER GAS
MEDIS
BODY SHOULDER

OXYGEN BLACK WHITE

N2O BLUE BLUE
CO2 GREY GRAY
AIR GREY WHITE/BLACK
PIN INDEX SYSTEM
PIN INDEX SYSTEM
PIN INDEX SYSTEM
Color Index
Medical Gas
Draw over vaporizer
Plenum vaporizer
Anesthesia workstation
Anesthesia workstation
 ‘Low-flow anaesthesia’
 Fresh-gas flow 0.5 - 1 L/mnt
 Fase initial 5 - 10 mnt :
High flow (4 - 8 L/mnt)
Denitrogenasi
Stadium pembedahan +
 Syarat :
Kebocoran –
Monitoring gas anestesi +
Intubasi atau LMA
 Keuntungan ‘low-flow’
 Ekonomis
 Polusi kamar bedah <
 Kehilangan suhu tubuh <
 Humidifikasi saluran nafas terjaga
 Rumus pemakaian
sevoflurane
 Fresh gas flow x 1/183 x vol% x waktu(mnt)
 30 det I = 6000 x 1/183 x 8% x 0.5 = 1.3 ml
 3 menit intubasi = 6000 x 1/183 x 2% x 3 = 1.9 ml
 3 mnt fase initial = 3000 x 1/183 x 2% x 3 = 1.2 ml
 3 mnt kedua = 1000 x 1/183 x 1% x 3 = 0.1 ml
 Op 2 jam = 1000 x 1/183 x 1% x 120 =6.5 ml

 Total pemakaian = 11 ml