Perkembangan Anestesi

Jajang Hadianto

Anestesiologi
- cabang / disiplin ilmu kedokteran - ruang lingkup 1. Pendidikan : - perawat - mahasiswa kedokteran - dokter spesialis - dokter spesialis lain - dokter spesialis anestesi super spesialis - awam 2. Penelitian & Pengembangan 3. Pelayanan Anestesiologi - Anestesia & Analgesia - Resusitasi - Intensive Care Unit Intensive Care Medicine - Terapi inhalasi - Penanggulangan nyeri

ANESTESI SENSASI RASA PANAS-DINGIN PERABAAN KEDUDUKAN TUBUH

HILANGNYA KESADARAN

NARKOSE

ANESTESI + ANALGESI

ANESTESIOLOGI
Pemberian anestesi + analgesi Cabang ilmu kedokteran Mengawasi menunjang faal-faal penderita dari stres operasi Dan lain-lain

PRINSIP BLOKADE ANESTESIA DAN ANALGESIA LOKASI BLOK 1,2,3 : - REGIONAL BLOCK

- GENERAL ANESTESI

IMPULS PATHWAY

SEJARAH
2250 SM : Babilonia, Hyoscyamus Niger Gigi 1500 Sm : Troya Opium

Herodotus : Cannabis Indica (Mariuana)

Abad 13 : Theodorico Dr.Borgogni Slaap Spons Spons Tidur Nicolaas Praerositus : Ypnoticon Opium China Yunani Assyria Abad 19 : Hashish (C. Indica) Beladona Alkaloid Mencekik Tidak Sadar Sirkumsisi Alkohol

Abad 17-18 : Morphin, Scopolamin

16 Oktober 1846

William Thomas Green Morton Drg demonstrasi Ether di Massachusetts General Hospital Boston-USA ruang Ether Dome . Dr. Crawford W. Long 1842 (tidak diumumkan) Georgia Penderita James M. Venable Ether operasi tumor di leher

Drg. Horace Wells N2O zat gelak dilakukan oleh Colton demonstrasi di Harvard Med School + Prof. John Collins gagal hadir Charles J. Jackson (ahli kimia) + Morton

Demonstrasi ahli bedah : - Morton + Jackson - Waren - Henry J. Bigelow Ether Berhasil

21 Nop 1846 : Oliver Wendell Holmes

Istilah Anestesi

Kongres Amerika :

sulit menentukan siapa pemenang hadiah penemu anestesi tsb.

Akhirnya : - Long - Wells - Morton - Jackson

meninggal mendadak bunuh diri + - Apoplexia gila

Morton

Tugas Anestesiologi
1. Mengelola

menghilangkan :

Rasa sakit / nyeri, rasa takut pada persalinan, pembedahan dan tindakan medik lainnya, baik sebelum, selama dan sesudahnya.
2. Mengawasi

dan menunjang fungsi-fungsi vital penderita yang

mengalami stres pembedahan dan pemberian anestesi.

3. Mengelola 4. Mengelola 5. Mengelola 6. Mengelola 7. Mengelola

penderita tidak sadar oleh karena sebab apapun. penderita yang mengidap masalah nyeri masalah resusitasi. terapi pernapasan. berbagai gangguan cairan, elektrolit dan metabolit.

Table 1-1 Definition of the practice of anesthesiology

1. Assesment, consultation and preparation of patients for anesthesia. 2. Rendering patients insensible to pain during surgical, obstetric, therapeutic and diagnostic procedures. 3. Monitoring and restoring homeostasis in perioperative and critically ill patients. 4. Diagnosing and treating painful syndromes. 5. Management and teaching of cardiac and pulmonary resuscitation. 6. Evaluating respiratoryfunction and applying respiratory therapy. 7. Teaching, supervising and evaluating the performance of medical and paramedical personel involved in anesthesia, respiratory care and critical care. 8. Conducting research at the basic and clinical science levels to explain and improve the care of patients in terms of physiologic function and drug response. 9. Involvement in the administration of hospitals, medical schools and outpatient facilities necessary to implement these responsibilities.
Adapted from the revised definition of the American Board of Anesthesiology, 1989

Risiko tindakan
Praktek anestesi Bukan pengobatan

Memberi fasilitas
Tidak sakit Relaksasi Tidur tidak sadar

Risiko tindakan

Risiko Praktek anestesi

meliputi : 1. Pemberian berbagai Obat yang sangat poten ( kuat ) 2. Mengerjakan tindakan yang memerlukan Kemampuan tehnik ketrampilan 3. Memakai berbagai Alat Anestesi 4. Memakai berbagai Alat monitor memantau

Risiko Karena :
1. Berhubungan dengan status fisik penderita 2. Pembedahan : rasa sakit, gangguan nafas, trombosis, emboli, dll 3. Pemakaian obat-obatan 4. Prosedur Anestesi 5. Pemakaian alat

Table 1-9. Risks of Anesthesia

Resiko Ringan

Mual dan Muntah Infeksi pada pembuluh darah ( infus ) Sakit Tenggorokan Gigi Patah / tanggal Luka Kornea Sakit kepala
Resiko sedang sampai berat Kerusakan saraf perifer Gangguan irama jantung Serangan Jantung Pneumonia/atelectase Gangguan fungsi organ vital Stroke Reaksi Alergi Malignant hyperthermia Reaksi Transfusi Mortality

Table 9-7. Physical Status Classification of the American Society of Anesthesiologists (ASA)
Status
ASA Class 1

Disease State
No organic, physiologic, biochemical or psychiatric disturbance. Mild to moderate systemic disturbance that may not be related to the reason for surgery. Examples: Heart disease that only slightly limits physical activity, essential hypertension, diabetes mellitus, anemia, extremes of age, morbid obesity, chronic bronchitis. Severe systemic disturbance that may or may not be related to the reason for surgery. Examples: Heart disease that limits activity, poorly controlled essential hypertension, diabetes mellitus with vascular complications, chronic pulmonary disease that limits activity, angina pectoris, history of prior myocardial infarction.

ASA Class 2

ASA Class 3

Status
ASA Class 4

Disease State
Severe systemic disturbance that is life-threatening with or without surgery. Examples: Congestive heart failure, persistent angina pectoris, advanced pulmonary renal or hepatic dysfunction. Moribund patient who has little chance of survival but is submitted to surgery as a last resort (resuscitative effort). Examples: Uncontrolled hemorrhage as from a ruptured abdominal aneurysm, cerebral trauma, pulmonary embolus.

ASA Class 5

Emergency Any patient in whom an emergency operation is required. Operation (E) Examples: An otherwise healthy 30-year-old female who requires a dilatation and curettage for moderate but persistent hemorrhage (ASA Class 1 E).

(From information in American Society of Anesthesiologists. New classification of physical status Anesthesiology 1963; 24: 111.)

Table 9-1 Perioperative Events that Should be Discussed with the Patient Preoperatively
Preoperative insomnia and medication available for its treatment Time, route of administration and expected effects from the preoperative medication Time of anticipated transport to operating room for surgery Anticipated duration of surgery Awakening after surgery in the recovery room Likely presence of catheters on awakening (tracheal, gastric, bladder, venous, arterial) Time of expected return to hospital room after surgery Magnitude of post operative discomfort and methods available for its treatment Insidence o postoperative nausea and vomiting

Table 9-8 Considerations that Determine the Technique of Anesthesia

Co-existing disease that may or may not be related to the reason for surgery Site of surgery Body position of patient during surgery Elective or emergency surgery Likelihood of the presence of increased amounts of gastric contents Age of patient Preference of patient

Sepuluh prinsip amanat (ten commandments)

1. Janganlah bagaimanapun juga mengakibatkan penderita mengalami hipoksia/anoksia. 2. Jalan pernafasan penderita harus dijaga selalu aman dan bebas. 3. Jangan memberikan anestesia kepada penderita tanpa izinnya dan janganlah antara resiko dan hasil tindakan anestesi tidak ada keseimbangan yang menguntungkan. 4. Janganlah menyalahgunakan waktu dari orang lain dengan memperlambat program/rencana pembedahan. 5. Janganlah memberikan anestesi tanpa membuat laporan tertulis (medical record).

6.

Semua peralatan harus dipersiapkan dengan rapi dan bersih serta lengkap sesuai standard.

7.

Tubuh penderita harus dilindungi terhadap pengaruh-pengaruh yang merugikan selama pembedahan (perioperatif) karena penderita tidak sadar, maka andalah yang bertanggung jawab terhadap keselamatannya.

8.

Janganlah penderita anda diserahkan kepada pihak lain jika belum stabil dan masih membahayakan.

9.

Janganlah memberikan anestesia dengan tehnik-tehnik dan obat-obat yang tidak dikuasai oleh anda.

10. Dalam keadaan bagaimanapun anda adalah seorang spesialis klinik yang mengutamakan kepentingan penderita diatas kepentingan lainnya.