Download - OBAT ANES LOKAL.pptx
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Golongan Ester
1860 : Kokain diekstrak dari daun Erythroxyloncoca pertama kali, rx. alergi
1904 : Prokain (sintetik; ester PABA), rx. alergi1930 : Tetrakain (lebih potent), rx. alergi
Golongan Amida
1943 : Lidokain (derivat DAA - diethylaminoaceticacid), min imrx.alergi
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Struktur Kimia Gol. Ester
Gol. Amide
PENGGOLONGAN
ANEST. LOKAL
Cara Pemberian Blok Saraf Sentral
Blok Saraf Tepi
Potensi Obat Short Acting
Medium Acting
Long Acting
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Cincin aromatis (Lipofilik) & kelompok Amino(Hidrofilik) yg dihubungkan oleh gugus ester /amida.
a. Golongan Ester (Amino Ester)Cokain KlorprokainBenzokain ProkainTetrakain
b. Golongan Amida (Amino Amide) Lidokain Bupivakain Etidokain Prilokain Mepivakain Ropivakain
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2. CARA PEMBERIAN
a. Blok Saraf Tepi Topical Infiltrasi Regional IV Nerve Block
b. Blok Sentral Spinal / SAB Epidural
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Anestes i Blok
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SHORT ACTING MEDIUM ACTING LONG ACTING
Prototipe Prokain Lidokain Bupirokain
Gol Ester Amida Amida
Onset 2 5 15
Durasi 30-45 60-90 2-4jam
Potensi 1 3 15
Toksisitas 1 2 10
Dosis max 12 Mg/KgBB 6 mg/KgBB 2 Mg/KgBB
Metabolisme Plasma Liver Liver
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Zat tambahan obat AL
Epinephrine
With the exception of cocaine, local
anesthetics directly cause relaxation of the
vascular smooth muscle, which leads to
vasodilation. This effect increases bleeding atthe surgical site. Vasoconstrictors, such as
epinephrine, are often added to anesthetic
solutions to counteract this effect.
The vasoconstrictor effect of epinephrine ismaximal at 7-15 minutes, and this effect is
clinically evident as blanching of the skin.
This blanching also is useful in determining
the area that is anesthetized.
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A premixed solution of lidocaine withepinephrine in a concentration of 1:100,000 (1
mg/100 mL) is available.
Concentrations greater than this are associatedwith a higher rate of adverse effects, including
an increased risk of tissue necrosis as a result
of prolonged ischemia
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Epinephrine is contraindicated in patients with
pheochromocytoma, hyperthyroidism, severe
hypertension, or severe peripheral vascularocclusive disease.
Relative contraindications include pregnancy
and psychological instability; epinephrine can
induce an acute psychotic episode inpredisposed patients.
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Sodium bicarbonate
To reduce the pain of an injection of lidocaine
and epinephrine, 1 mL of sodium bicarbonate
8.4% is added to 10 mL of the anestheticsolution to neutralize the solution. Buffered
solutions should be discarded after 1 week
because the effectiveness of epinephrine
decreases by almost 25% during this time.
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ANESTETIKUMDuration Without
Epinephrine
Duration With
Epinephrine,
Maximum
Dose
Without
Epinephrine,
Maximum Dose
With Epinephrine
min min mg/kg mg/kg
Esters
Cocaine 45 - 2.8 -
Procaine 15-30 30-90 7.1 8.5
Chloroprocaine 30-60 - 11.4 14.2
Tetracaine 120-240 240-480 1.4 -
Amides
Lidocaine 30-120 60-400 4.5 7Mepivacaine 30-120 30-120 4.5 7
Bupivacaine 120-240 240-480 2.5 3.2
Etidocaine 200 240-360 4.2 5.7
Prilocaine 30-120 60-400 5.7 8.5
*Adapted from Dinehart.[2]
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1. Operasi emergensi
2. Alergi GA
3. Pasien dengan PPOK
4. Tindakan dimana dengan anestesi lokal akanlebih aman
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KONTRAINDIKASI
1. ABSOLUT :a. Pasien menolakb. Alergi anestesi lokalc. Infeksi sekitar penyuntikan
d. Tx. Antikoagulane. Diatesis hemoragikf. Tx. Trisiklik anti depresan
Untuk spinal ditambah :
a. Syokb. TIK tinggic. Septikemia
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2. Relatif:
a) Pasien tak kooperatifb) Penyakit neurologi akutc) Laminectomi luas
d) Scoliosise) IHD
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a. Urtikaria - anafilaktik syok
b. Menggigilc. Mual muntahd. Disartrie. SKV hipotensi & bradikardi
Manifestasi Klinik:SSP:a. Stimuli
Cortex : kejang, gelisahMedula : hipertensi, takikardi,
hiperventilasib. Depresi
Cortex : lemah, kesadaran turunMedula : hipotensi, bradikardi,
hipoventilasi
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Pencegahan :a. Dosis minimumb. Hindari daerah hiperemisc. Infiltrasid. Tes sensitivitas
Komplikasi:a. Lokal b. Sistemik Abses Intravasasi Hematom Hipersensitif Nekrosis Hiperabsorbsi
Over dosis
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GUNAKAN ZAT ANESTETIK SESUAI INDIKASI
TERIMA KASIH
Wassalamualaykum.