Doso Sutiyono
Bagian Anestesiologi dan Terapi Intensif FK Undip/ RSUP Dr. Kariadi, Semarang

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PERBEDAAN TEKANAN DARAH PASCA ANESTESI SPINAL DENGAN PEMBERIAN PRELOAD DAN TANPA PEMBERIAN PRELOAD 20CC/KGBB RINGER ASETAT MALAT

MEDIA MEDIKA MUDA 2012:MMM VOLUME 1 NUMBER 1 YEAR 2012
Publisher : MEDIA MEDIKA MUDA

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ABSTRACTBackground : Hypotension is commonly occured in spinal anesthesia. Crystaloid preload before spinal anesthesia is one of commonly way to manage hypotension effect. Ringer acetat malate is one of isotonic crystalloid fluids.Aim : To determine the different of pasca anesthesia blood pressure between patient with preload 20 cc/kgBB Ringer Acetat Malat ( RAM ) and without preload ( TP ).Methods : This study is a randomized single blind experimental study with two-stage clinical trial method. Sample is selected with Consecutive Random Sampling and obtained 40 people. Group I ( n = 20 ) with preload Ringer Acetat Malat and group II ( n = 20 ) without preload. The measurement of blood pressure was taken before spinal anesthesia and after anesthesia every 3 minutes to 15 minutes. The number of ephedrin requirements if hypotension occured will be recorded for comparison on each group. Statistical test with paired t-test.Results : There were significant differences ( p <0,05 )of decrease in systolic blood pressure with preload 20cc/kgBB Ringer Acetat Malat and without preload in pra preload with 0’ pasca preload delta and 0’ pasca preload with minute 3’ pasca preload delta. The systolic blood pressure of pra preload (RAM = 129,917,2 ; TP = 147,021,8), 0’ pasca preload ( RAM = 130,217,4 ; TP = 141,519,9 ), and 3’ pasca preload ( RAM = 127,619,7 ; TP = 132,223,0 ). The number of patients who need ephedrin at group without preload ( 15: 20 ) were more prevalent than group with ringer acetat malat preload ( 11 : 20 ).Conclusion : There were significant differences of decrease in blood pressure between pasca spinal anesthesia patients who had 20 cc/kgBB Ringer Acetat Malat preload and who didn’t have 20 cc/kgBB Ringer Acetat Malat preload.Keywords : Spinal anesthesia, hypotension, preload, Ringer Acetat Malat.

PERBEDAAN PERUBAHAN KONSENTRASI NATRIUM PLASMA ANTARA PRELOAD 20CC/KGBB RINGER LAKTAT DIBANDINGKAN DENGAN PRELOAD 20CC/KGBB RINGER ASETAT MALAT

MEDIA MEDIKA MUDA 2012:MMM VOLUME 1 NUMBER 1 YEAR 2012
Publisher : MEDIA MEDIKA MUDA

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ABSTRACTBackground The use of fluid resuscitation in a large amount is an important factor which influences the balance of fluid and electrolytes in pathological patients. To give a large amount of fluid, the least affecting plasma osmolarity should be choosen and one of its parameter is sodium. Sodium is the biggest electrolyte ion component found in extracellular fluid. Ringer lactate and ringer acetate malate are crystalloid fluid types with different sodium concentrations. Ringer acetate malate has a higher sodium concentration and its osmolarity is closer to plasma osmolarity compared with ringer lactate. Therefore, it is considered more effective in fluid resuscitation.Aim To Analyze the difference of plasma sodium concentration modification between preload 20 cc/kgBody weight of ringer lactate and preload 20 cc/kgBody weight ringer acetate malate.Methodology This study is an experimental study with phase II clinical trial which was conducted randomly single-blind. The sample is 40 patients who underwent elective operations with spinal anesthetic at the Central Surgery Unit of dr.Kariadi Hospital Semarang who fulfilled inclusive and exclusive criteria to be divided into two groups. The choice of sample was made based on consecutive random sampling. The first group was given preload 20cc/kgBody weight ringer lactate and the second group was given preload 20 cc/kgBB ringer acetate malate. Before the giving of the preload, the patients’s blood sample was taken for the purpose of plasma sodium concentration examination. Next, after ten to fifteen minutes, another blood sample taking was conducted immediately in order to examine the plasma sodium concentration of electrolytes. Then, the results of the examination were compared with the basic data and were statistically tested. The data were analyzed and processed based on computer software program. The statistic test made used of t-test and p degree of significance=0,05. Finally, The results of the data analysis were presented in the form of tables and graphs.Results The mean value of the sodium before the giving of preload ringer lactate is=137,1±2,8 and after the giving of preload ringer lactate is=138,2±3,3 (p=0,021). The mean value of the sodium before the giving of preload ringer acetate malate is=137,2±1,8 and after the giving of preload ringer acetate malate is= 138,3±2,2 (p=0,013). However the difference is not statistically significant (p=0,880) at the use of preload 20cc /kgBody weight ringer lactate as compared with the use of preload 20 cc/kgBody weight ringer acetate malate.Conclusion There is no significant difference of sodium concentration modification in plasma in the use of preload 20 cc/kgBody weight ringer lactate compared with the use of preload 20 cc/kgBodyweight ringer acetate malate.Key Words: Sodium, Preload, Ringer lactate, Ringer acetate malate

PERBEDAAN TEKANAN DARAH PASCA ANESTESI SPINAL DENGAN PEMBERIAN PRELOAD DAN TANPA PEMBERIAN PRELOAD 20CC/KGBB RINGER LAKTAT

MEDIA MEDIKA MUDA 2012:MMM VOLUME 1 NUMBER 1 YEAR 2012
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Latar Belakang : Teknik anestesi spinal mempunyai efek samping seperti penurunan tekanan darah. Salah satu cara untuk mencegah penurunan tekanan darah tersebut adalah dengan pemberian preload. Ringer laktat banyak digunakan untuk preload karena mudah didapatkan dan harganya murah.Tujuan : Meneliti perbedaan tekanan darah pasca anestesi spinal dengan pemberian preload 20cc/kgBB ringer laktat(RL) dan tanpa pemberian preload(TP).Metode : Desain penelitian ini adalah experimental dengan uji klinik tahap II secara acak tersamar tunggal. Sampel terdiri atas 40 pasien yang akan menjalani anestesi spinal di Instalasi Bedah Sentral RSUP Dr. Kariadi Semarang yang telah memenuhi kriteria penelitian. Pasien dibagi menjadi 2 kelompok, kelompok 1 mendapat preload 20cc/kgBB ringer laktat dan kelompok 2 tidak mendapat preload. Dilakukan pemeriksaan tekanan darah meliputi tekanan darah sistolik, tekanan darah diastolik dan tekan arteri rerata pada sebelum anestesi spinal dan segera setelah anestesi spinal tiap 3 menit sampai 15 menit. Apabila terjadi penurunan tekanan darah sistolik lebih dari 25% akan diberi efedrin 10mg i.v diencerkan. Dinilai juga jumlah pasien dan total kebutuhan efedrin. Uji hipotesis yang digunakan adalah uji paired t-test. Nilai p=0,05 dinyatakan signifikan.Hasil : Terdapat perbedaan bermakna antara selisih kedua kelompok pada tekanan darah sistolik(p=0,005) dan tekanan arteri rerata(p=0,009) yang terjadi antara pra preload dengan menit ke-0 post anestesi spinal. Rerata perubahan tekanan darah sistolik pra preload(RL=137,6+18,4; TP=147+21,8), menit ke-0 (RL=138,9+19,6; TP=141,5+19,9), menit ke-3(RL=133,1+19,5; TP=132,2+23). Pada penggunaan efedrin, RL: 4 sampel dengan rata- rata 12,5mg efedrin dan TP: 15 sampel dengan rata- rata 10mg efedrin.Simpulan : Terdapat perbedaan penurunan tekanan darah yang bermakna antara pemberian preload dan tanpa pemberian preload ringer laktat 20cc/kgBB pasca anestesi spinal.Kata Kunci : Anestesi spinal, hipotensi, preload, ringer laktat

The Comparison Of The Effect Of Etomidate And Propofol On Serum Cortisol Level

Jurnal Anestesiologi Indonesia Vol 3, No 3 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background: The choose of anesthetic agent not only based on primary effect as an ideal anesthetic for surgical procedure, but also took attention for their effect to various organ system. Etomidate is known as an ideal anesthetic agent because its hemodynamic stability, minimally respiratory effect and neuroprotection properties, but become not popular as it suppress cortisol synthesis although it significant clinical effect remain controversy.Purpose: To analyze the different effect etomidate and propofol on serum cortisol concentration in patient underwent elective surgery in general anesthesia.Method: This double blind, Randomized Controlled Trial with 34 subjects which divided into two groups (n=17), control group and treatment group which received either intravenous propofol 2,5mg/kgBW or etomidate 0,2mg/kgBW pre-operation respectively. Each group was then examined for serum cortisol concentration pre-anesthesia, 2 hours post induction, and 8 hours post induction. Wilcoxon Signed Rank Test and Paired T Test were performed to compare cortisol serum concentration in each group. Mann Whitney and Independent Sample T Test were used to compare between control and treatment group.Results: There were significant different of cortisol serum level between pre-anesthesia and 2 post induction in etomidate group [244,15(181,39-382,75)] vs [195,07(119,96-236,35)]. It showed that decrement of etomidate dosage into 0,2mg/kgBW still decrease cortisol serum production significantly from 2 to 8 hours. It proved that propofol did not decrease cortical synthesis. Compared with propofol, etomidate significantly suppress serum cortisol level at 2 hours post induction.Conclusion: Etomidate 0,2mg/kgBW decrease serum cortisol concentration at 2 hours post induction, but return to its normal level at 8 hours post induction. Propofol 2,5mg/kgBB did not decrease serum cortisol concentration.Keywords : Etomidate, Propofol, General anesthesia, CortisolABSTRAKLatar belakang penelitian: Pemilihan suatu obat anestesi tidak hanya didasarkan pada efek utamanya sebagai anestesi yang ideal untuk suatu prosedur pembedahan, melainkan turut pula mempertimbangkan efeknya terhadap berbagai sistem organ. Etomidat diketahui memiliki sifat obat anestesi yang ideal baik dari segi hemodinamik, respirasi, maupun neuroproteksi, akan tetapi menjadi kurang populer akibat efeknya terhadap fungsi adrenal meski konsekuensi klinis nyata dari efek hambatan ini masih kontroversi.Tujuan: Membuktikan adanya perbedaan pengaruh pemberian etomidat 0,2mg/kgBB intravena dan propofol 2,5mg/kgBB intravena terhadap penurunan kadar kortisol serum.Metode: Merupakan penelitian Randomized Clinical Control Trial pada 34 pasien yang menjalani anestesi umum, dibagi menjadi 2 kelompok (n=17), etomidat dan propofol. Masing-masing kelompok diperiksa kadar kortisol serum sebelum induksi, 2 dan 8 jam setelah induksi. Uji statistik Wilcoxon Signed Rank Test dan Paired T Test digunakan untuk membandingkan kadar kortisol di masing- masing kelompok. Sedangkan uji statistik Mann Whitney U Test dan Independent Sample T-Test digunakan untuk membandingkan antar kelompok perlakuan.Hasil: Terdapat perbedaan bermakna kadar kortisol sebelum dan 2 jam pasca induksi pada kelompok etomidat (mean 244,15 vs 195,07), tetapi tidak pada 8 jam pasca induksi. Hal ini menunjukkan bahwa pengurangan dosis etomidat sampai 0,2mg/kgBB masih menurunkan kadar kortisol secara signifikan sampai < 8 jam pasca induksi. Pada kelompok propofol terdapat peningkatan bermakna kadar kortisol 2 jam pasca induksi (p=0,013). Hal ini membuktikan bahwa propofol tidak memiliki efek menurunkan síntesis kortisol.Kesimpulan: Pemberian etomidat 0,2mg/kgBB menurunkan síntesis kortisol pada 2 jam pasca induksi namun kembali normal 8 jam pasca induks i. Pemberian propofol 2,5 mg/kgBB tidak menyebabkan penurunan kadar kortisol serum.

Ketamin dan Meperidin Untuk Pencegahan Menggigil Pasca Anestesi Umum

Jurnal Anestesiologi Indonesia Vol 3, No 2 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Background: Post anesthesia shivering is common complication after anesthesia. It can causes uncomfortable situation and so many risk. Post anesthesia shivering must be prevented or treated. Most commonly drug that used is meperidine. Objective: The aim of this study is to proved that giving intra venous ketamine 0,25mg/kgBW as soon before the end of the surgery is more effective than intravenous meperidine 0.5mg /kgBW as soon before the end of the surgery to prevent shivering after general anesthesia. Methods: This experimental study was designed as randomized post test only controlled group of 72 patients underwent elective surgery with general anesthesia. Vital sign (diastolic and systolic blood pressure, mean arterial pressure, heart rate and SaO 2) were measured five minutes before induction. Induction procedure of standardized general anesthesia were done. Esophageal temperature was measured as soon as intubation done. Duration of operation was limited 2 - 3 hours. At the end of surgery, inhalation drugs were stopped. After adequate spontaneous breathing and laryngeal reflex shown, randomization was done. Patients divided into three groups, and received intravenously ketamine 0,25 mg/kgBW for group 1, meperidine 0.5 mg/kgBW for group 2 and NaCl 0,9 % for group 3. E xtubation was done 5 minutes after the drug was given. Vital sign were measured as soon as after extubation and every 5 minutes for 30 minutes long. Body temperature were measured as soon as and 15 minutes after extubation. After extubation patients were receiving oxygen 6L/minute face mask. Statistical analysis were performed by One-way Anova and chi-square, which were p-value < 0,05 was considered significant. Results : Basic data, clinical characteristic data before induction, were not significantly different (p>0.05). Vital sign after extubation between group 1 and group 3 were significantly different (p<0.05). Incidence of shivering on group 1 is 4 people (16.6%) consisted of 3 people suffer 1 st degree and 1 people suffer 2 nd degree, while at group 2 is 5 people (20.8%) consisted of 4 people suffer 1 st degree and 1 people suffer 2 nd degree, this matter statistically were not significantly different (p=0.500). Differences of body temperature between group 1 and group 2 were not significantly different (p>0.05). Side effects that developed on group 1 were 2 subjects had nausea, which group 2 were 7 subjects had nausea and 2 subjects had difficulty for breathing, this matter statistically were significantly different (p=0.012). Conclusions : Ketamine 0,25 mg/kgBW and meperidine 0.5 mg/kgBW have similar effectivity on the prevention of shivering after general anesthesia, but ketamine have lower side effect nausea than meperidine.Keywords : post anesthesia shivering, ketamine, meperidine.ABSTRAKLatar Belakang: Menggigil pasca anestesi merupakan komplikasi yang cukup sering terjadi. Menggigil menimbulkan keadaan yang tidak nyaman dan berbagai resiko. Karena itu menggigil harus segera dicegah atau diatasi. Sampai saat ini obat paling sering digunakan adalah meperidin. Tujuan: Membuktikan bahwa pemberian ketamin 0,25 mg/kgBB intra vena menjelang akhir operasi lebih efektif dari pada meperidin 0,5mg/kgBB intra vena menjelang akhir operasi untuk mencegah kejadian menggigil pasca anestesi umum. Metode: Merupakan penelitian eksperimental dengan desain “randomized post test only controlled group” pada 72 pasien dengan usia 16 – 60 tahun yang menjalani operasi dengan anestesia umum. Tanda vital ( Tekanan darah diastolik dan sistolik, tekanan arteri rerata, laju jantung dan SaO2 ) diukur 5 menit sebelum induksi. Prosedur induksi anestesi umum dilakukan sesuai standar. Temperatur esofagus diukur segera setelah induksi. Lama operasi dibatasi antara 2 -3 jam. Pada akhir operasi, obat inhalasi dihentikan. Setelah nafas spontan adekuat, reflek laringeal positif dilakukan randomisasi. Pasien dibagi menjadi tiga kelompok, dan mendapatkan secara intravena ketamin 0,25 mg/kgBB untuk kelompok 1, meperidin 0,5 mg/kgBB untuk kelompok 2 dan NaCI 0,9% untuk kelompok 3. Ekstubasi dilakukan 5 menit setelah perlakuan. Tanda vital di ukur dicatat segera setelah ekstubasi dan tiap lima menit selama 30 menit. Suhu tubuh diukur segera dan 15 menit setelah ekstubasi. Pasca ekstubasi pasien diberi oksigen 6L/menit. Uji statistik dilakukan dengan menggunakan One-way ANOVA dan Chi- kuadrat, dengan derajat kemaknaan yaitu p<0,005 Hasil : Data dasar dan data karakteristik klinis sebelum induksi, berbeda tidak bermakna (p>0,05). Terdapat perbedaan bermakna tanda vital antara kelompok 1 dengan kelompok 3 saat setelah ekstubasi. Kejadian menggigil pada grup 1 yaitu 4 orang (16,6%) terdiri dari 3 orang menderita derajat 1 dan 1 orang menderita derajat 2, sedangkan pada kelompok 2 terjadi pada 5 orang (20,8%) terdiri dari 4 orang derajat 1 dan 1 orang derajat 2, hal ini secara statistik berbeda tidak bermakna (p=0,500). Perbedaan suhu tubuh grup 1 dan grup 2 berbeda tidak bermakna (p>0,05). Efek samping obat yang timbul pada kelompok 1 sebanyak 1 penderita mengalami mual, sedangkan kelompok 2 sebanyak 7 penderita mengalami mual dan 2 penderita depresi nafas, berbeda bermakna (p=0,012). Kesimpulan: Ketamin 0,25 mg/kgBB dan meperidin 0,5 mg/kgBB mempunyai efektifitas yang sama dalam mencegah menggigil pasca anestesi umum, tetapi ketamin mempunyai efek samping mual yang lebih rendah dibandingkan meperidin.

Pengaruh Anestesi Epidural Terhadap Supresi Imun Yang Diinduksi Stres Operasi Selama Pembedahan

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Major surgery associated with dysfunction of the innate immune system. More recently, demonstrated that the stress of surgery can rapidly induce a temporary reduction of the blood response to endotoxin from 2 hours after incision and that plasma IL-10 increased during surgery, contributes to reducing the response. It has been reported that epidural anesthesia has beneficial effects on immune reactions and response to the stress of surgery. Some researchers have reported that epidural anesthesia maintains NK cell activity and reduced stress response in patients undergoing hysterectomy. Epidural block from T4 to S5 dermatomal segments, starting before surgery, to prevent an increase in cortisol and glucose concentrations in the hysterectomy. Regional anesthesia techniques for major surgery may reduce the release of cortisol, adrenaline (epinephrine) and other hormones, but has little effect on the cytokine response. Recent studies (Kawasaki et al., 2007) suggests that the innate immune system, such as phagocytosis, suppressed by the stress of surgery and that epidural anesthesia did not prevent this decline in immune responsiveness during upper abdominal surgery.ABSTRAKOperasi besar berhubungan dengan disfungsi sistem kekebalan tubuh bawaan. Baru-baru ini, dibuktikan bahwa stres akibat pembedahan dapat dengan cepat menginduksi penurunan respon sementara dari darah terhadap endotoksin sejak 2 jam setelah insisi dan bahwa IL-10 plasmayang meningkat selama pembedahan, berperan dalam penurunan respon ini. Telah dilaporkan bahwa anestesi epidural memiliki efek menguntungkan pada reaksi imunitas dan respon terhadap stres akibat pembedahan. Beberapa peneliti telah melaporkan bahwa anestesi epidural mempertahankan aktivitas sel NK dan mengurangi respon stres pada pasien yang menjalani histerektomi. Blok epidural dari segmen dermatom T4 sampai S5, dimulai sebelum pembedahan, mencegah peningkatan konsentrasi kortisol dan glukosa pada histerektomi. Teknik anestesi regional untuk operasi besar dapat mengurangi pelepasan kortisol, adrenalin (epinefrin) dan hormon lain, namun memiliki pengaruh kecil pada respon sitokin. Penelitian terbaru (kawasaki et al.,2007) menunjukkan bahwa sistem kekebalan tubuh bawaan, misalnya fagositosis, ditekan oleh stres akibat pembedahan dan bahwa anestesi epidural tidak mampu mencegah penurunan respon kekebalan tubuh ini selama operasi perut bagian atas.

Mekanisme Kerja Obat Anestesi Lokal

Jurnal Anestesiologi Indonesia Vol 3, No 1 (2011): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Regional anesthesia is growing and expanding its use, given the variety of benefits offered, such as relatively cheap, minimal systemic effects, produce adequate analgesia and the ability to prevent the stress response is more perfect. Local anesthetic drug is chemically divided into two major categories, namely the class of Amide and ester groups. These chemical differences are reflected in differences in the metabolism of the place, where the ester group is mainly metabolized by the enzyme pseudo-cholinesterase in the plasma while the Amide groups mainly through enzymatic degradation in the liver. This difference is also related to the magnitude of the possibility of allergies, in which the ester group derived from p-amino-benzoic acid has a greater frequency of allergic tendencies. Local anesthetic commonly used in our country for the class of esters are procaine, whereas the Amide groups are lidocaine and bupivacaine. Mechanism of action of local anesthetic drugs to prevent transmission of nerve impulses (conduction blockade) by inhibiting the delivery of sodium ions through selective sodium ion gates in neuronal membranes. Failure of the sodium ion permeability of the gate to increase the speed of depolarization of the slowdown as a potential threshold was not reached so that action potentials are not propagated. Local anesthetic did not alter the resting potential or transmembrane potential threshold. Pharmacokinetics of the drug include absorption, distribution, metabolism and excretion. Complications of local anesthetic is a local side effects can occur at the injection site hematoma and abscess while systemic side effects such as neurological in the central nervous, respiratory, cardiovascular, immunological, musculoskeletal, and hematologic Some local anesthetic drug interactions include coadministration may increase the potency of each drug. decreased metabolism of local anesthetics as well as increase the potential for intoxication.ABSTRAKAnestesi regional semakin berkembang dan meluas pemakaiannya, mengingat berbagai keuntungan yang ditawarkan, diantaranya relatif lebih murah, pengaruh sistemik yang minimal, menghasilkan analgesi yang adekuat dan kemampuan mencegah respon stress secara lebih sempurna. Secara kimiawi obat anestesi lokal dibagi dalam dua golongan besar, yaitu golongan ester dan golongan amide. Perbedaan kimia ini direfleksikan dalam perbedaan tempat metabolisme, dimana golongan ester terutama dimetabolisme oleh enzim pseudo-kolinesterase di plasma sedangkan golongan amide terutama melalui degradasi enzimatis di hati. Perbedaan ini juga berkaitan dengan besarnya kemungkinan terjadinya alergi, dimana golongan ester turunan dari p-amino-benzoic acid memiliki frekwensi kecenderungan alergi lebih besar. Obat anestesi lokal yang lazim dipakai di negara kita untuk golongan ester adalah prokain, sedangkan golongan amide adalah lidokain dan bupivakain. Mekanisme kerja obat anestesi local mencegah transmisi impuls saraf (blokade konduksi) dengan menghambat pengiriman ion natrium melalui gerbang ion natrium selektif pada membrane saraf. Kegagalan permeabilitas gerbang ion natrium untuk meningkatkan perlambatan kecepatan depolarisasi seperti ambang batas potensial tidak tercapai sehingga potensial aksi tidak disebarkan. Obat anestesi lokal tidak mengubah potensial istirahat transmembran atau ambang batas potensial. Farmakokinetik obat meliputi absorpsi, distribusi, metabolisme dan ekskresi. Komplikasi obat anestesi lokal yaitu efek samping lokal pada tempat suntikan dapat timbul hematom dan abses sedangkan efek samping sistemik antara lain neurologis pada Susunan Saraf Pusat, respirasi, kardiovaskuler, imunologi ,muskuloskeletal dan hematologi Beberapa interaksi obat anestesi lokal antara lain pemberian bersamaan dapat meningkatkan potensi masing-masing obat. penurunan metabolisme dari anestesi lokal serta meningkatkan potensi intoksikasi. 

Jarum Spinal dan Pengaruh Yang Mungkin Terjadi

Jurnal Anestesiologi Indonesia Vol 1, No 3 (2009): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Technical success rate of spinal anesthesia is determined by manyfactors, including : drug dose, volume, position the patient and the complications that may arise. The effects can be associated with pharmacological drugs, the physiology of the body, and technical equipment used, especially the spinal needle. Side effects include spinal anesthesia, hypotension, bradycardia, hematome, where puncture wounds, bleeding, infection, trauma to the spinal cord and the incidence of headache after spinal anesthesia. Development of the spinal needle started long ago to the present, it is due to the spread of drugs that might happen, ease of deployment medicine, tissue tearing Subarachnoid, the release of CSF and the incidence of post dural headeche punctu m (PDPH). Along with the development progress of spinal needle type, has been much corrected all deficiencies to give the spinal anesthesia technique better.Keywords : -ABSTRAKTingkat keberhasilan teknik spinal anestesi ditentukan oleh banyak faktor, diantaranya : dosis obat, volume, posisi pasien serta komplikasi yang mungkin ditimbulkan. Efek yang ditimbulkan bisa berkaitan dengan farmakologis obat, fisiologi tubuh, teknis dan peralatan yang digunakan, terutama jarum spinal. Efek samping spinal anestesi diantaranya, hipotensi, bradikardi, hematome, luka tempat tusukan, perdarahan, infeksi, trauma medula spinalis dan kejadian nyeri kepala pasca anestesi spinal. Perkembangan penggunaan jarum spinal dimulai sejak lama sampai sekarang, hal ini berkaitan dengan penyebaran obat yang dimungkinkan terjadi, kemudahan penyebaran obat, robeknya jaringan subarakhnoid, keluarnya LCS dan kejadian post dural punctum headeche (PDPH). Seiring perkembangan kemajuan jenis jarum spinal, telah banyak dikoreksi segala kekurangan untuk memberikan hasil teknik spinal anestesi yang lebih baik.Kata kunci : -

Pengelolaan Intoksikasi Bupivakain

Jurnal Anestesiologi Indonesia Vol 1, No 3 (2009): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Bupivacaine intoxication is a complication of the use of local anesthesia of the most feared , because the handling is difficult. Bupivacaine intoxication management begins with recognizing the symptoms early, the early recognition of symptoms and the sooner done the management will give a better prognosis . Bupivacaine intoxication management includes control of the airway to prevent hypoxia and acidosis, which would aggravate intoxication, ACLS standards for circulation intact, and the use of lipid emulsion to eliminate the toxic effects of bupivacaine.Keywords : -ABSTRAKIntoksikasi bupivakain merupakan komplikasi pemakaian anestesi lokal yang paling ditakuti, karena penanganannya yang sulit. Pengelolaan intoksikasi bupivakain dimulai dengan mengenali gejala awalnya, semakin awal gejala dikenali dan semakin cepat dilakukan pengelolaan akan memberikan prognosa yang lebih baik. Pengelolaan intoksikasi bupivakain meliputi penguasaan jalan nafas untuk menghindari hipoksia dan asidosis yang akan memperberat intoksikasi, standar ACLS agar sirkulasi tetap berjalan dan pemakaian emulsi lipid untuk mengeliminasi efek toksik dari bupivakain.Kata kunci : -

Perbandingan Antara Anestesi Regional Dan Umum Pada Operasi Caesar

Jurnal Anestesiologi Indonesia Vol 1, No 3 (2009): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif

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Abstract

Spinal anesthesia and epidural blocks causing a decrease in blood pressure, which may affect both mother and fetus. There is no evidence suggest that RA is superior to GA in relation to mother and baby. A follow-up literature review or research to evaluate neonatal morbidity and maternal outcomes, such as relationship satisfaction with anesthesia techniques, it would be useful tofound the best techniques for sectio caesarea.Keywords : -ABSTRAKSpinal dan epidural anestesi menyebabkan penurunan substansial dari tekanan darah ibu, yang dapat mempengaruhi ibu dan janin . Tidak ada bukti dari tulisan ini yang menunjukkan bahwa RA lebih unggul GA dalam kaitannya dengan ibu dan bayi. Lanjutan tinjauan pustaka ataupun penelitian untuk mengevaluasi morbiditas neonatal dan hasil ibu, seperti hubungan kepuasan dengan teknik anestesi, akan berguna untuk mengungkap teknik terbaik untuk sectio caesarea.Kata kunci : -