INTRODUCTION TO

ANESTHESIOLOGY

DEPARTMENT OF ANESTHESIOLOGY
Dr. HASAN SADIKIN HOSPITAL
PADJADJARAN UNIVERSITY

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

HILANGNYA
KESADARAN

ANESTESI

SENSASI
RASA PANAS-DINGIN
PERABAAN
KEDUDUKAN TUBUH

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
4

- GENERAL
ANESTESI

IMPULS
PATHWAY

S E JARAH

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

Hashish (C. Indica)

Yunani

Beladona Alkaloid

Assyria

Mencekik Tidak Sadar Sirkumsisi

Abad 17-18 : Morphin, Scopolamin

Abad 19 :

Alkohol

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 :

Akhirnya : - Long
- Wells
- Morton
- Jackson

sulit menentukan siapa pemenang

hadiah penemu anestesi tsb.
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 penderita tidak sadar oleh karena sebab apapun.

4.

Mengelola penderita yang mengidap masalah nyeri

5.

Mengelola masalah resusitasi.

6.

Mengelola terapi pernapasan.

7.

Mengelola 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

Bidang Ilmu Yang Dipelajari

1. Fisika

5. Klinik umum

2. Anatomi

6. Klinik khusus

3. Fisiologi

7. Keterampilan.

4. Farmakologi

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

Less Serious Risks
Nausea and vomiting
Bruising or superficial thrombophlebitis at the intravenous acces site
Sore throat
Dental injury
Corneal abrasion
Headache
More Serious Risks
Peripheral neuropathy (ulnar neuropathy most common)
Cardiac dysrhytmias
Myocardial iinfarction
Atelectasis/pneumonia
Renal or hepatic insufficiency
Stroke
Allergic drug reactions
Malignant hyperthermia
Blood reactions
Mortality

Table 9-7. Physical Status Classification of the American

Society of Anesthesiologists (ASA)
Status

Disease State

ASA Class 1

No organic, physiologic, biochemical or psychiatric

disturbance.

ASA Class 2

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.

ASA Class 3

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.

Status

Disease State

ASA Class 4

Severe systemic disturbance that is life-threatening with

or without surgery.
Examples: Congestive heart failure, persistent angina
pectoris, advanced pulmonary renal or hepatic
dysfunction.

ASA Class 5

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.

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

General Considerations.
1. Preanesthetic Preparation of the patient
2. Choice of Anesthesia
3. Preanesthesia Medication
4. Medicolegal Aspects of Anesthesia
5. Cleaning and Sterilization of the Anesthesia
Equipment
6. Monitoring During Anesthesia and Postanesthesia
Period

7. Electrocardiography
8. Cardiac Arrest and Cardiopulmonary Resuscitation
9. The Anesthesia Machine
10. General Anesthesia
11. Intravenous Anesthesia
12. Muscle Relaxants
13. Laryngoscopy an Endotracheal Intubation
14. Local and Regional Anesthesia
15. Spinal Anesthesia
16. Lumbar Epidural and Caudal Anesthesia

17. Regional Nerve Block Anesthesia

18. Vasopressor and Adrenergic Blocking Agents
19. Hypotensive Techniques and Induced Hypothermia
20. Intravenous Fluid Therapy
21. Blood Transfusions
22. Liver and Anesthesia
23. The Recovery Room and Intensive Care Unit
24. Blood Gases: Acid-Base Balance and Oxygen
Transfer
25. Respiratory Therapy

26. Chest Physiotherapy

27. Respiration and Respiratory Care
28. Diabetes and Anesthesia
29. Pollution, Fires, Explosions, and Electrical Hazards
30. Complications During Anesthesia and the Recovery
Periode

Special Anesthesia Problems in

Surgical Specialities
1. Anesthesia in Thoracic Surgery
2. Anesthesia in Cardiac Surgery
3. Anesthesia in Neurosurgery
4. Anesthesia in Surgery for Endocrine Disoders
5. Anesthesia and Analgesia in Obstetrics and
Gynecology
6. Pediatric Anesthesia

7. Anesthesia for Orthopedic Procedures

8. Dental Anesthesia
9. Anesthesia in Ophthalmology
10. Anesthesia in Otolaryngology
11. Anesthesia in Urologic Surgery
12. Anesthesia for Outpatient Surgery
13. Anesthesia for Emergency Surgery
14. Invasive Hemodynamic Monitoring

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.