ANESTESI lokal dan regional referat.docx

7/25/2019 ANESTESI lokal dan regional referat.docx

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BAGIAN ANESTESIOLOGI

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

REFERAT

JANUARI 2016

ANESTESI REGIONAL DAN ANESTESI LOKAL

Disusun oleh:

Ria Lelemuku Tuke!

NIM" 200#$%&$01'

Konsulen :

()" O*! +" A*,ke-a!a. S/" A*

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

PADA BAGIAN ANESTESIOLOGI

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

AMBON

20!

0


2/32

BAB I

PENDAULUAN

Pene"#n#n s#$#% &e$i%e$ '#l#( )#"*u +#n, n-#n, (ele.ihi )#"*u +#n,

se(es*in+# #"#n (en+e.#."#n #n#l,esi# +#n, le.ih '#l#( '# .#,i#n 'is*#l '#$i

*e(* &ene"#n#n s#$#%/ #l *e$se.i* (e$u"#n '#s#$ '#$i (e*o'e #nes*esi (#s#

l#(u +sn, 'i&e$"en#l"#n '# #.#' "e1! oleh seo$#n, #hli .e'#h (ili*e$ Pe$#nis3

A(.$oise P#$e 45015607/ Do(ini8ue 9e#n L#$$e+ 4!!1;


3/32

BAB II

TINJAUAN PUSTAKA

A" DEFINISI

Te"ni" #nes*esi $e,ion#l (en,,un#"#n o.#* +#n, .e$e%e" lo"#l 'en,#n

(e(.lo" i(&lus s#$#% se.elu( (en#i s#$#% &us#*/

Anes*esi lo"#l #'#l#h hil#n,n+# sens#si se(en*#$# '# su#*u #$e# *u.uh +#n,

$el#*i% "eil #*#u *e$.#*#s +#n, *e$#i 'en,#n #&li"#si *o&i"#l #*#u in-e"si o.#*1

o.#* +#n, (ene"#n e"si*#si u-un, s#$#% #*#u (en,h#(.#* "on'u"si i(&uls

sen-#n, s#$#% &e$i%e$

Anes*esi $e,ion#l #'#l#h &$oses +#n, s#(# 'en,#n #nes*esi lo"#l3 +#n,

(eli.#*"#n #$e# -#$in,#n su."u*#n +#n, le.ih lu#s #*#u s#$#%1s#$#% &e$i%e$ +#n,

le.ih lu#s/

Se#$# u(u( #nes*e*i" lo"#l (e(&un+#i $u(us '#s#$ +#n, *e$'i$i #*#s *i,#

.#,i#n: ,u,us #(in hi'$o%il +#n, .e$hu.un,#n 'en,#n ,u,us $esi'u #$o(#*i li&o%il

(el#lui su#*u ,u,us #n*#$#/ Gu,us #(in sel#lu .e$u #(in *e$sie$ #*#u #(in se"un'e$/

Gu,us #n*#$# '#n ,u,us #$o(#*i" 'ihu.un,"#n 'en,#n i"#*#n #(in #*#u es*e$/ M#"#

se#$# "i(i#3 #nes*e*i" lo"#l 'i,olon,"#n #*#s sen+#)# es*e$ '#n sen+#)# #(i'/ A'#n+#

i"#*#n es*e$ s#n,#* (enen*u"#n si%#* #nes*e*i" lo"#l se.#. '# 'e,$#'#si '#n in#"*i=#si

'i'#l#( .#'#n3 ,u,us *e$se.u* #"#n 'ihi'$olisis/ K#$en# i*u ,olon,#n es*e$ u(u(n+#

"u$#n, s*#.il '#n (u'#h (en,#l#(i (e*#.olis(e 'i.#n'in,"#n 'en,#n ,olon,#n

#(i'/Anes*e*i" lo"#l +#n, *e$,olon, '#l#( sen+#)# es*e$ i#l#h *e*$#"#in3 .en>o"#in3

"o"#in3 '#n &$o"#in 'en,#n &$o"#in se.#,#i &$o*o*i&/ Se'#n,"#n +#n, *e$,olon,

sen+#)# #(i' i#l#h 'i.u"#in3 li'o"#in3.u&i=#"#in3 (e&i=#"#in '#n &$ilo"#in/

G#(.#$ / Gu,us #nes*e*i" lo"#l

2


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T#.el / Pe$.e'##n ,olon,#n A(i'# '#n Es*e$

A(i'# Es*e$

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Di(e*#.olis(e '#l#( h#*i

M#s# "e$-# le.ih n-#n, P"# $en'#h

Ti'#" .e$si%#* #lle$,en

Rel#*i% *i'#" s*#.il '#l#( .en*u" l#$u*#n

Di(e*#.olis(e '#l#( &l#s(# oleh en>i(

&seu'oholines*e$#se M#s# "e$-# &en'e"

P"# *in,,i

D#* .e$si%#* #lle$,en

B" MEKANISME KERJA

Anes*e*i" lo"#l (ene,#h &e(.en*u"#n '#n "on'u"si i(&uls s#$#%/Te(*

e$-#n+# 'i (e(.$#ne sel e%e"n+# '# #"so&l#s(# h#n+# se'i"i* s#-#/Se.#,#i(#n#

'i"e*#hui3 &o*ensi#l #"si s#$#% *e$-#'i "#$en# #'# &enin,"#*#n ses##* 4se"il#s7

&e$(e#.ili*#s (e(.$#n *e$h#'#& ion N#?#"i.#* 'e&ol#$is#si $in,#n '# (e(.$#n/

P$oses %un'#(en*#l inil#h +#n, 'ih#(.#* oleh #nes*e*i" lo"#l3 h#l ini *e$-#'i #"i.#*

#'#n+# in*e$#"si l#n,sun, #n*#$# >#* #nes*e*i" lo"#l 'en,#n "#n#l N#? +#n, &e"#

*e$h#'#& #'#n+# &e$u.#h#n =ol*#se (u#*#n lis*$i" 4voltage sensitive Na+ channel7/

Den,#n se(#"in .e$*#(.#hn+# e%e" #nes*esi lo"#l 'i '#l#( s#$#%3 (#"# #(.#n,

$#n,s#n, (e(.$#n #"#n (enin,"#* se#$# .e$*#h#&3 "ee*#n &enin,"#*#n &o*ensi#l

#"si (enu$un3 "on'u"si i(&uls (el#(.#* '#n %#"*o$ &en,#(#n#n 4safety factor7"on'u"si s#$#% -u,# .e$"u$#n,/ F#"*o$1%#"*o$ ini #"#n (en,#"i.#*"#n &en,u$#n,#n

(en-#l#$n+# &o*ensi#l #"si '#n 'en,#n 'e(i"i#n (en,#"i.#*"#n "e,#,#l#n "on'u"si

s#$#%/

G#(.#$ 2/ Me"#nis(e "e$-# #nes*esi lo"#l

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'#l#( "e#'##n is*i$#h#*3 sehin,,# h#(.#*#n h#n*#$#n *i'#" 'ise$*#i .#n+#"&e$u.#h#n '# &o*ensi#@l is*i$#h#*/ #sil &eneli*i#n (e(.u"*i"#n .#h)# #nes*e*i"

lo"#l (en,h#(.#* h#n*#$#n s#$#% *#n (eni(.ul"#n 'e&ol#$is#si s#$#%3 .#h"#n

'i*e(u"#n hi&e$&ol#$is#si $in,#n/Pen,u$#n,#n &e$(e#.ili*#s (e(.$#n oleh #nes*esi#

lo"#l -u,# *i(.ul '# o*o* $#n,"# .#i" )#"*u is*i$#h#* #*#u )#"*u *e$-#'in+#

&o*ensi#l #"si/

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(enin,,i"#n *,#n,#n sel#&u* li&i' (ono(ole"ul#$/ Mun,"in se"#li #nes*e*i" lo"#l

(enin,,i"#n *e,#n,#n &e$(u"##n l#&is#n li&i' +#n, (e$u"#n (e(.$#ne sel s#$#%3

'en,#n 'e(i"i#n (enu*u&i &o$i '#l#( (e(.$#ne sehin,,# (en,h#(.#* ,e$#" ion

(el#lui (e(.$#n/ #l ini #"#n (en+e.#."#n &enu$un#n &e$(e#.ili*#s (e(.$#n

'#l#( "e#'##n is*i$#h#* sehin,,# #"#n (e(.#*#si &enin,"#*#n &e$(e#nili*#s N#?/

'#* 'i"#*#"#n .#h)# #$# "e$-# u*#(# o.#* #nes*e*i" lo"#l i#l#h .e$,#.un, 'en,#n

$ese&*o$ s&esi%i" +#n, *e$'#* '# "#n#l N#?sehin,,# (en,#"i.#*"#n *e$-#'in+#

.lo"#s'e '# "#n#l *e$se.u* '#n h#l ini #"#n (en,#"i.#*"#n h#(.#*#n ,e$#"#n ion

(el#lui (e(.$#n/

1" Pe)e(iaa* Se*iiia Se)a Sa)a3

P#'# u(u(n+# se$#.u* s#$#% "eil le.ih &e"# *e$h#'#& #nes*e*i" lo"#l/Se$#.u*

s#$#% "eil +#n, *i'#" .e$(ielin '# u(u(n+# le.ih e* 'ih#(.#* '#$i'#

se$#.u* .e$(ielin/ F#"*o$ l#in +#n, (enen*u"#n "e&e"##n s#$#% *e$h#'#& #nes*e*i"

lo"#l i#l#h *i&e se$#.u* se#$# #n#*o(is/ Ke&e"##n se$#.u* s#$#% *e$h#'#& #nes*e*i"

lo"#l *i'#" *e$,#n*un, '#$i %un,si se$#.u* i*u3 'en,#n 'e(i"i#n se$#.u* senso$i"(#u&un (o*o$i" +#n, s#(# .es#$ *i'#" .e$.e'# "e&e"##nn+#/ Ke&e"##n se$#.u*

h#lus .e$(ielin (ele.ihi "e&e"##n se$#.u* .es#$ .e$(ielin/ Se"i$#n+# *e(*

"e$-# #nes*e*i" lo"#l .e$lo"#si '#l#( #"so&l#s(# (#"# se$#.u* h#lus +#n,

(e(ili"i &e$(u"##n +#n, le.ih lu#s &e$ uni* =olu(e #"#n (en+e$#& #nes*e*i"

lo"#l le.ih e* '#$i'# se$#.u* .es#$ '#n '#* 'i(en,e$*i .#h)# se$#.u* "eil

#"#n le.ih e* (en,#l#(i e%e" #nes*e*i" lo"#l/

Bil# #nes*e*i" lo"#l 'i"en#"#n '# s#$#% senso$i"3 (#"# +#n, hil#n, .e$*u*u$1

*u$u* #'#l#h (o'#li*#s n+e$i3 'in,in3 n#s3 $#.#3 '#n *e"#n#n '#l#(/Se.#li"n+#

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#nes*esi# #"i.#* &ene"#n#n se$#.u* s#$#% &e$*#(#1*#(# 'i*#n'#i oleh

(en,hil#nn+# $#s# $#.#3 '#n (o'#li*#s n+e$i hil#n, lin, #"hi$/Di'u,# .#h)#

i(&uls $#s# $#.# 'ih#n*#$"#n oleh se$#.u* +#n, le.ih .es#$ se'#n,"#n n+e$i oleh

se$#.u* "eil/

2" Pe*,a)u4 /

D#l#( .en*u" .#s# .e.#s #nes*esi lo"#l h#n+# se'i"i* l#$u* '#n *i'#" s*#.il '#l#(

.en*u" l#$u*#n/Oleh "#$en# i*u3 #nes*e*i" lo"#l 'i&e$'#,#n,"#n '#l#( .en*u"

,#$#( +#n, (u'#h l#$u* 'i '#l#( #i$3 .i#s#n+# ,#$#( hi'$o"lo$i'/Anes*e*i" lo"#l

(e$u"#n .#s#h le(#h *e*#&i l#$u*#n #s#(n+# .e$si%#* #,#" #s#( h#l ini

(en,un*un,"#n "#$en# (en#(.#h s*#.ili*#s #nes*e*i" lo"#l *e$se.u*/B#n+#" .u"*i

+#n, (enun-u"#n .#h)# '#l#( -#$in,#n3 ,#$#( #s#( ini h#$us 'ine*$#l"#n le.ih

'#hulu '#n 'iles"#n su#*u .#s# .e.#s se.elu( o.#* *e$se.u* (ene(.us -#$in,#n

'#n (en,h#sil"#n e%e" #nes*e*i"/ Anes*e*i lo"#l +#n, 'i,un#"#n u(u(n+#

(en,#n'un, #*o( N *e$sie$ #*#u se"un'e$ oleh "#$en# i*u *e$,#n*un, '#$i &K# '#n

& l#$u*#n #"#n *e$.en*u" #(in *e$sie$ #*#u se"un'e$ +#n, *i'#" .e$(u#*#n lis*$i"

#*#u *e$.en*u" "#*ion #((oniu(/

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'# & -#$in,#n *u.uh h#n+# 'i'#*i 5120 '#l#( .en*u" .#s# .e.#s/B#,i#n ini

)#l#u&un "eil s#n,#* &en*in,3 "#$en# un*u" (en#i *e(* "e$-#n+# o.#* h#$us

.e$'i%usi (el#lui -#$in,#n &en+#(.un, -#$in,#n '#n (e(.$#n sel l#in3 '#n h#l ini

h#n+# (un,"in *e$-#'i 'en,#n .en*u" #(in +#n, *i'#" .e$(u#*#n lis*$i"/

&" Pe)/a*-a*,a* e3ek 5le4 a5k5*)ik5)

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'#l#( 200/000 .#,i#n73 no$e&ine%$in 4:00/000 .#,i#n7 #*#u %enile%$in/ P#'#

u(u(n+# >#* "ons*$i"*o$ ini h#$us 'i.e$i"#n '#l#( "#'#$ e%e"*i% (ini(#l/

E&ine%$in (en,u$#n,i "ee*#n #.so$.si #nes*e*i" lo"#l sehin,,# #"#n

(en,u$#n,i -u,# *o"sisi*#s sis*e(i"n+#/

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Se.#,i#n =#so"ons*$i"*o$ (un,"in #"#n 'ise$#& '#n .il# -u(l#hn+# u"u& .#n+#"

#"#n (eni(.ul"#n e%e" s#(&in, (is#ln+# ,elis#h3 *#"i"#$'i3 l&i*#si '#n n+e$i

'i '#'#/ Un*u" (en,u$#n,i &e$#n,s#n,#n #'$ene$,i" +#n, .e$le.ih#n '#n +#n,

*i'#" 'iin,in"#n *e$se.u*3 &e$lu 'i&e$*i(.#n,"#n &en,,un##n o.#* &en,h#(.#*

#l%# #*#u .e*# #'$ene$,i/Mun,"in &ul# *e$-#'i &e$l#(.#*#n &en+e(.uh#n lu"#3

e'e(# #*#u ne"$osis/E%e" +#n, *e$#"hi$ ini '#* *e$-#'i "#$en# #(in

si(*o(i(e*i" (en+e.#."#n &enin,,i#n &e(#"#i#n o"si,en -#$in,#n '#n

'en,#n #'#n+# =#so"ons*$i"si *e$-#'i hi&o"si# #*#u "e$us#"#n -#$in,#n se*e(*/

Ke#'##n ini #"#n (e(.#h#+#"#n .il# >#* #nes*e*i" lo"#l 'i,un#"#n '# *in'##n

&e(.e'#h#n -#$i *#n,#n #*#u "#"i #*#u si$"u(sisi/ V#so"ons*$i"si &e(.uluh n#'i

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sen'i$i (un,"in '#* (en,,#n,,u &$oses &en+e(.uh#n lu"#/

" FARMAKOKINETIK

1" Li/i( 5lu7ili!

u.un,#n #n*#$# "el#$u*#n le(#" 'en,#n &o*ensi o.#* .e$.#n'in,

lu$us/Li&i'W#*e$ solu.ili*+ $#*io3 (enen*u"#n COnset of Action/ Se(#"in

*in,,i "el#$u*#n '#l#( le(#" #"#n se(#"in *in,,i &o*ensi #nes*esi lo#l/

2" P)5ei* 7i*(i*,

L#(# "e$-# o.#* lo"#l #nes*esi .e$,#n*un, '# "e(#(&u#nn+# .e$ii"#*#n

'en,#n &$o*ein/ B#,i#n +#n, .e$*#n,,un, -#)#. un*u" #"si #nes*esi lo"#l #'#l#h

"#n#l so'iu( +#n, (e$u"#n (ole"ul &$o*ein oleh "#$en# i*u i"#*#n +#n,

se(#"in *in,,i #"#n (e(&en,#$uhi l#(# "e$-# o.#* #nes*esi lo"#l/ Se(#"in

*in,,i i"#*#n 'en,#n &$o*ein #"#n se(#"in l#(# 'u$#si n+#/

Anes*e*i" lo"#l ,olon,#n #(i'# 55165 'ii"#* &$o*ein &l#s(# *e$u*#(# 1

,li"o&$o*ein/K#'#$ &$o*ein ini '#* (enin,"#* '# "#$sino(#3 *$#u(#3 in%#$"

(io"#$'3 (e$o"o" '#n u$e(i# #*#u '#* (enu$un '# &en,,un##n

&il"on*$#se&si/ Pe$u.#h#n "#'#$ &$o*ein ini '#* (en+e.#."#n &e$u.#h#n "#'#$

#nes*e*i" lo"#l +#n, 'i.#)# "e h#*i un*u" 'i(e*#.olis(e sehin,,# #"#n

(e(&en,#$uhi *o"sisi*#s sis*e(i"n+#/

&" /Ka

6


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&K# su#*u >#* "i(i# 'i#$*i"#n se.#,#i &/ Onse* #nel,esi# *e$,#n*un, .en*u" .#s#

4+#n, *i'#" .e$(u#*#n7 '#l#( su#*u l#$u*#n/9u(l#h .en*u" .#s# +, *e$.en*u"

.e$.#n'in, *e$.#li" &K# su#*u o.#* #nes*esi lo"#l/Se(#"in *in,,i &K# se(#"in

l#(.#* onse* #nel,esin+#/ O.#* #nes*esi lo"#l +#n, (e(&un+#i &K# +#n,

(en'e"#*i & *u.uh 43513


9/32

"u$#$e .e$si%#* #'i"*i%/Be$.e'# 'en,#n "u$#$e3 &$o"#in (e(ili"i e%e" n+#*# '#

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&" Siem Ka)(i5akula)

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*in,,i '#n sesu'#h (eni(.ul"#n e%e" '# SSP/ W#l#u&un -#$#n,3 '#

&e(#"#i#n #nes*e*i" lo"#l 'osis "eil un*u" #nes*esi# in%il*$#si '#* *e$-#'i "ol#&s

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8" Ale),i

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T#.el 2/ Pe$.e'##n #n*#$# in*o"si"#si '#n #le$,i

In*o"si"#si Ale$,i

Be$l#"u u(u(

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Ge-#l# s#(#

Pen,o.#*#n s#(#

T#.el / Ge-#l# in*o"si"#si #"i.#* o.#* #nes*e*i" lo"#l

Ge-#l# NS Ge-#l# VS

Tini*us

Visu#l 'is*u$.#ne

T#"i&neu

T)ihin,

Kon=ulsi

Ko(#

A&neu

T#"i"#$'i

B$#'i"#$'i

i&o*ensi

i&e$*ensi

#$'i# #$$es*

9" Bi5)a*35)mai

8


10/32

To"sisi*#s su#*u #nes*esi lo"#l se.#,i#n .es#$ *e$,#n*un, "esei(.#n,#n #n*#$#

"ee*#n #.so$.si '#n "ee*#n 'es*$u"sin+#/Kee*#n #.so$.si '#*

'i&e$l#(.#* oleh =#so"ons*$i"*o$ (#"# ee*#n 'es*$u"sin+# +#n, .e$.e'#1.e'#

(e$u"#n %#"*o$ u*#(# +#n, (enen*u"#n #(#n #*#u *i'#"n+# su#*u #nes*esi

lo"#l/Se.#,i#n .es#$ #nes*esi lo"#l #'#l#h ,olon,#n es*e$ '#n .i#s#n+#

*o"sisi*#sn+# hil#n, se*el#h (en,#l#(i hi'$olisis 'i h#*i '#n &l#s(#/ Anes*e*i"

,olon,#n #(i'# (is#n+# li'o"#in #"#n (en,#l#(i 'es*$u"si 'i '#l#( $e*i"ulu(

en'o&l#s(# h#*i3 (ul#1(ul# *e$-#'i &$oses N1'e#l"il#si +#n, 'isusul 'en,#n

hi'$olisis se.#li"n+# &$ilo"#in (ul#1(ul# (en,#l#(i hi'$olisis +#n,

(en,h#sil"#n (e*#.oli* o1*olui'in +#n, '#* (en+e.#."#n (e*he(o,lo.ine(i#/

Anes*e*i" lo"#l ,olon,#n es*e$ (en,#l#(i 'e,$#'#si oleh es*e$#se h#*i '#n -u,#

oleh su#*u es*e$#se &l#s(# +#n, (un,"in se"#li "olines*e$#se/P#'# (#nusi#

'e,$#'#si 'en,#n es*e$#se &l#s(# ini s#n,#* &en*in, "#$en# 'e,$#'#si &$o"#in

*e$u*#(# *e$-#' 'i'#l#( &l#s(# h#n+# se.#,i#n "eil s#-# 'ih#*i/P#'# &en+un*i"#n

in*$#*e"#l #nes*esi# '#* .e$l#n,sun, l#(# '#n .#$u .e$#"hi$ se*el#h #nes*hesi#

lo"#l *e$se.u* 'ise$#& "e'#l#( '#$#h3 "#$en# #i$#n se$e.$os&in#l (un,"in *i'#"

(en,#n'un, es*e$#se/

P#'# (#nusi# se.#,i#n .es#$ "o"#in (en,#l#(i 'e,$#'#si 'i '#l#( h#*i

se'#n,"#n '# "elini 'e,$#'#si se.#,i#n .es#$ "o"#in *e$-#'i 'i'#l#( &l#s(#/

Oleh "#$en# i*u *i#& #nes*e*i" lo"#l 'i(e*#.olis(e 'i *e(* +#n, .e$.e'#1.e'#

(#"# u$u*#n $el#*i% (en,en#i "e"u#*#n '#n *o"sisi*#s su#*u #nes*e*i" lo"#l

.i#s#n+# *e$,#n*un, '#$i #$# &e(.e$i#n '#n s&esies he)#n +#n, 'i,un#"#n/ Ini

.e$#*e .#h)# "i*# h#$us .e$h#*i1h#*i '#l#( (enil#i "e"u#*#n '#n "e#(#n#n su#*u

#nes*e*i" lo"#l .#$u/

9


11/32

Anes*e*i" lo"#l +#n, 'i$us#" 'i '#l#( h#*i se#$# l#(.#* se.#,i#n #"#n 'i"elu#$"#n

.e$s#(# u$in/

T#.el 5/Dosis #nes*esi lo"#l

E" MAAM$MAAM OBAT ANESTESI LOKAL

/ Ko"#in

Di'#* '#$i '#unErthroxylon coca3 .e"e$-# (en,h#(.#* h#n*#$#n s#$#%/E%e"

sis*e(i"n+# lin, (enolo" +#i*u $#n,s#n,#n SSP 'i "o$*eH/D#* (en+e.#."#n

.#n+#" .i#$#3 ,elis#h '#n eu%o$i#/D#* -u,# (e$#n,s#n, '# .#*#n, o*#"3 &us#*

=#so(o*o$ '#n &us#* (un*#h/P#'# sis*e( "#$'io=#s"ul#$3 'osis .es#$ '#*

10

T#.el


12/32

(en+e.#."#n "e(#*i#n #"i.#* +#h -#n*un,/Suhu .#'#n/P#'# "e$#un#n "o"#in *-'

&i$e"si#Sis*e(s#$#% si(*is *e$s*i(ul#si (en+e.#."#n sensi*is#si *e$h#'#&

"#*e"ol#(in +#n, (en+e.#."#n =#so"ons*$i"si '#n (i'$i#sis/Ko"#in 'i#.so$.si

'ise,#l# *e(* *e$(#su" sel#&u* len'i$/N#(un (u'#h *e$hi'$olisis 'i usus

.es#$/Dosis %#*#l #'#l#h 32 ,$/

2/ Li'o"#in

Li'o"#in 4Hilo"#in7 #'#l#h #nes*e*i" lo"#l "u#* +#n, 'i,un#"#n se#$# lu#s

'en,#n &e(.e$i#n *o&i#l '#n sun*i"#n/Anes*esi# *e$-#'i le.ih e*3 le.ih "u#*3 le.ih

l#(# '#n le.ih e"s*ensi% '#$i'# +#n, 'i*i(.ul"#n oleh &$o"#in '# "onsen*$#si

+#n, se.#n'in,/Li'o"#in (e$u"#n #(inoeil#(i' '#n (e$u"#n &$o*o*i& '#$i

#nes*esi lo"#l ,olon,#n #(i'e/ L#$u*#n li'o"#in 035 'i,un#"#n un*u" #nes*esi#

in%il*$#si se'#n,"#n 3012 un*u" #nes*esi# .lo" '#n *o&i#l/ Anes*esi# ini e%e"*i%

.il# 'i,un#"#n *#n =#so"ons*$i"*o$ *e*#&i "ee*#n #.so$.si '#n *o"sisi*#sn+#

.e$*#(.#h '#n (#s# "e$-#n+# le.ih &en'e"/Li'o"#in (e$u"# o.#* &ilih#n .#,i

(e$e"# +#n, hi&e$sensi*i% *e$h#'#& #nes*e*i" lo"#l ,olon,#n es*e$/ Se'i##n .e$u

03515 'en,#n #*#u *#n e&ine%$in 4:50/000 #*#u : 200/0007/

Se'i##n li'o"#in 4(u$ni7 'en,#n 'osis *o*#l "u$#n, '#$i 00 (, '#l#( )#"*u

2< -#(3 .il# 'en,#n e&ine%$in 'osis .e$u 500 (, '#l#( )#"*u 2< -#(/Un*u"

"e'o"*e$#n ,i,i 4l#$u*#n 12 'en,#n e&ine%$in7/ Anes*esi $on,,# (ulu*3

"e$on,"on,#n '#n s#lu$#n e$n# .#,i#n #*#s +#i*u l#$u*#n 1< 'en,#n 'osis

(#"si(#l ,$#( seh#$i 'i.#,i '#l#( .e.e$# 'osis

Li'o"#in '#* 'ise$#& '#$i *e(* sun*i"#n3 s#lu$#n e$n# '#n s#lu$#n

&e$n#s#n se$*# '#* (ele)#*i s#)#$ '#$#h o*#"/ K#'#$n+# '#l#( &l#s(# '#$#h

%e*us '#* (en#i !0 "#'#$ '#l#( '#$#h i.u/ D#l#( h#*i li'o"#in (en,#l#(i

'e#l"il#si oleh en>i( o"si'#se %un,si ,#n'# 4mixed-function oksidases7 (e(.en*u"

(onoe*il,lisin Hili'i' '#n ,lisin Hili'i'/Ke'u# (e*#.oli* ini (#sih (e(ili"i e%e"

#nes*e*i" lo"#l/

E3ek am/i*,

E%e" s#(&in, .e$hu.un,#n 'en,#n e%e" *e$h#'#& sis*e( s#$#% &us#* (is#ln+#

(en,#n*u"3 &usin,3 $es*esi#3 "e'u*#n o*o*3 ,#n,,u#n (en*#l3 "o(# '#n

"e-#n,/Mun,"in se"#li (e*#.oli* li'o"#in +#i*u (onoe*il,lisin Hili'i' '#n ,lisisn

Hili'i' i"u* .e$&e$#n '#l#( *i(.uln+# e%e" s#(&in, ini/Li'o"#in 'osis .e$le.ih#n

'#* (en+e.#."#n "e(#*i#n oleh %i.$il#si =en*$i"el #*#u oleh hen*i -#n*un,/

I*(ikai

11


13/32

Li'o"#in se$in, 'i,un#"#n '# #ns*esi in%il*$#si3 .lo" s#$#%3 #nes*esi# s&in#l3

#ns*esi# e&i'u$#l (#u#&un "#u'#l '#n se#$# se*e(* un*u" #nes*esi# sel#&u* len'i$3

Tabel 6. Berbagai sediaan lidokainNAMA PT II IN!I"AI #!IAAN#M$A As%ra&en

'a

$idokain 25

(g )

*rilokain 25

(g

Anes%esi %o*i'al

*ada k+li% ,ang

ber-+b+ngan

dengan ar+(

s+n%ik dan

*rosed+r

*e(beda-an

s+*er/sial

"ri( 5 gr *.

44.000

#%ra'ai

n

#%-i'a $idokain l

2 )

adrenalin

1100000

Anes%%ik+( lokal !+s 100 a(*.

2 (l 135.000

Pe-a'ai

n

P-ar*os $idokain l

2 dala(

180.000

%ia* 2 (l in.

Anes%e%ik+(

lokal

,lo'ai

n

As%ra&en

'a

$idokain

20(g(l in.

A%a+ eli a%a+s*ra, 10

Anes%esi

in/l%rasi: *eri;er

dan blok sara;*+sa%: anes%esi

regional i


14/32

S*$u"*u$ (i$i& li'o"#in .e'#n+# ,u,us +#n, (en,#n'un, #(in #'#l#h .u*il

&i&e$i'in/M#s# "e$-# n-#n,3 e%e" .lo"#'e senso$i" le.ih .es#$ '#$i'#

(o*o$i"/Dosis .es#$ '#* (en+e.#."#n #$i*(i# =en*$i"ul#$ '#n 'e&$esi (io"#$'/

L#$u*#n .u&i=#"#in hi'$o"lo$i'# 0325 u*" in%il*$#si '#n 035 u*" $#=e$*e.$#l/

5/ Di.u"#in

Di.u"#in (e$u"#n 'e$i=#* "uinolon/P#lin, "u#*3 lin, *o"si '#n (#s#

"e$-# n-#n,/Su'#h *i'#" 'i,un#"#n se.#,#i &$e$#* sun*i"3 "eu#li #nes*esi s&in#l/

!/ Me&i=#"#in L

To"si" un*u" neon#*us sehin,,# *i'#" un*u" #nes*esi# o.s*e*$i"/Ti'#" e%e"*i%

un*u" *o&i#l #nes*esi/Se'i##n un*u" sun*i"#n .e$u 3 35 '#n 2

/ Te*$#"#in

9#$#n, 'i,un#"#n se*el#h #'#n+# .u&i=#"#in/Di&e$lu"#n 'osis .es#$ '#n (ul#

"e$-# l#(.#* n#(un (#s# "e$-# le.ih l#(# '# #nes*esi s&in#l/Pe(.e$i#n IV 30H

le.ih #"*i% '#n *o"si" '#$i &$o"#in/ Bi#s#n+# 'i,un#"#n '# (#*# .e$u l#$u*#n

*e*$#"#"in 0353 un*u" hi'un, '#n *en,,o$o" .e$u 2/ Un*u" #nes*esi s&in#l 'osis

*o*#l 0120 (,/

;/ P$ilo"#in

Mul# "e$-# '#n (#s# "e$-# le.ih l#(#/E%e" =#so'il#*#si le.ih "eil sehin,,#

*i'#" &e$lu =#so"ons*$i"*o$/To"sisi*#s *e$h#'#& susun#n s#$#% &us#* le.ih $en'#h

sehin,,# #(#n un*u" .lo"#'e in*$#=en#/Se'i##n sun*i"#n: 30 3 230 '#n 30/

F" TEKNIK PEMBERIAN ANESTESI LOKAL

1" A*eeia /e)mukaa*

K)i5a*eei

Anes*esi se(&$o* +#n, &e$*#(# "#li 'i,un#"#n +#i*u e*il "lo$i'#3 'en,#n e%e"

s#(&in, (u'#h (ele'#" -i"# .e$#(&u$ 'en,#n u'#$#3 '#* (en+e.#."#n

he*o*o"sisi*#s3 '#n -i"# u#&n+# *e$hi$u& '#l#( -u(l#h .es#$ '#* (en+e.#."#n

#nes*esi sis*e(i"/

13


15/32

A*eei T5/ikal

EMLA (eutectic mixture of local anesthetics) li'o"#in 235 ? &$ilo"#in 235

'#l#( =ehi"ulu( "husus/ P#'# .#+i3 EMLA '#* (en-#'i &ilih#n un*u"

si$"u(sisi/

G#(.#$ / A&li"#si #nes*esi &e$(u"##n

2" A*eei i*3il)ai

Tu-u#n un*u" (eni(.ul"#n #nes*esi u-un, s#$#% (el#lui "on*#" l#n,sun,

'en,#n o.#*/ P#'# u(u(n+#3 in-e"si in%il*$#si *i'#" 'il#"u"#n se#$# l#n,sun, '#

lesi *e*#&i -us*$u '# se"i*#$ lesi3 'en,#n .e.e$# *usu"#n (e(.en*u" su#*u inin

un*u" (en#"u& selu$uh #$e# o&e$#si

G#(.#$


16/32

'en,#n in-e"si 21 (l li'o"#in "e '#l#( %o$#(en su&$#o$.i*#lis/Se'#n,"#n s#$#%

su&$#*$o"le#$is "elu#$ 'i sen-#n, .#*#s #*#s o$.i*#3 "i$#1"i$# ( (e'i#l %o$#(en

su&$#o$.i*#lis/ Blo" s#$#% su&$#*$o"le#$is 'il#"u"#n 'en,#n in-e"si 21 (l li'o"#in

'# .#*#s #*#s o$.i*#3 ( (e'i#l %o$#(en su&$#o$.i*#lis/ Un*u" .lo" "e'u#

s#$#% se"#li,us3 in%il*$#si 51 (l li'o"#in 'il#"u"#n '# 'u# &e$*i,# *en,#h #lis3

*e* 'i #*#s *ul#n, o$.i*#/

G#(.#$


17/32

G#(.#$ 5/ Blo" '#e$#h .i.i$

S#$#% (en*#lis (e(.e$i ine$=#si senso$i" '# .#,i#n #n*e$io$ (#n'i.ul#/S#$#%

ini "elu#$ '#$i %o$#(en (en*#lis3 +#n, *e$le*#" 'i #n*#$# .#*#s #*#s '#n .#)#h

(#n'i.ul# se$*# .e$#'# '#l#( s#*u ,#$is i(#-ine$ 'en,#n %o$#(en su&$#o$.i*#lis3

&u&il3 '#n %o$#(en in%$#o$.i*#lis/ 9#$u( 'i*usu""#n "u$#n, le.ih 35 (

&os*e$ol#*e$#l %o$#(en "e #$#h %o$#(en3 "e(u'i#n 'iin-e"si"#n 21 (l li'o"#in /

G#(.#$ !/ Blo" '#e$#h *elin,#

8" Dae)a4 Ek)emia aa

S#$#% (e'i#nus (e(.e$i sens#si '# sisi $#'i#l *el#" *#n,#n3 sisi l(#$ i.u

-#$i3 -#$i *elun-u"3 -#$i *en,#h3 '#n se$uh -#$i (#nis3 se$*# '#s#$ "u"u -#$i1-#$i

*e$se.u*/ S#$#% (e'i#nus .e$#'# 'i #n*#$# *en'o1*en'o %le"so$ "#$&i $#'i#lis '#n

l(#$is lon,us3 'i .#)#h %le"so$ $e*in#"ulu(/Ke'u# *en'o *e$se.u* '#* 'i"en#li

'en,#n (e(in*# sien (e(&e$*e(u"#n i.u -#$i '#n -#$i "elin,"in,/9#$u(

'isun*i""#n 'en,#n su'u*


18/32

*i(.ul $es*esi#3 -#$u( h#$us 'i*#$i" se'i"i* 4se"i*#$ 2 ((7 un*u" (en,hin'#$i

"e$us#"#n se$#.u* s#$#% #*#u in-e"si in*$#neu$#l/

#.#n, su&e$%isi#lis s#$#% $#'i#lis (ens#$#%i 'o$su( *#n,#n '#n .#,i#n

&$o"si(#l sen'i in*e$%#l#n,e#l 'is*#l *i,# -#$i &e$*#(#/ Se.elu( (en#i

&e$,el#n,#n *#n,#n s#$#% ini (e(ili"i .#n+#" #.#n,3 sehin,,# #$e# +#n, &e$lu

'i#nes*esi un*u" (en#i .lo" *o*#l u"u& lu#s/ Pe$*#(#1*#(#3 (l li'o"#in

'iin-e"si"#n *e* 'i l#*e$#l #$*e$i $#'i#lis '# li*#n &e$,el#n,#n *#n,#n

&$o"si(#l/9#$u( "e(u'i#n 'i,ese$ '#n 'i*usu""#nse#$# su."u*#n (elin*#si *e&i

&$o"si(#lsnuffox (enu-u &e$*en,#h#n sisi 'o$s#l &e$,el#n,#n *#n,#n/In-e"si 51 (l

o.#* #nes*esi 'il#"u"#n se#$# (elin,"#$ s#(.il (en#$i" -#$u(/

S#$#% uln#$is .e$#.#n, "e l(#$ '#n 'o$s#l '# li*#n %le"so$ &$o"si(#l

&e$,el#n,#n *#n,#n3 (ens#$#%i .#,i#n uln#$is &e$(u"##n l(#$ '#n 'o$s#l *el#"

*#n,#n '#n -#$i "elin,"in,3 se$*# se$uh .#,i#n uln#$is -#$i "elin,"in,/ In-e"si 51

(l o.#* #nes*esi se'#l#( 12 ( "e '#e$#h #n*#$# *en'o %le"so$ "#$&i uln#$is '#n

#$*e$i uln#$is #"#n (e(.lo" #.#n, l(#$ '#$i s#$#% uln#$is/ #.#n, uln#$is 'o$s#l

'#* 'i.lo" 'en,#n in%il*$#si 1< (l #i$#n '# '#e$#h 'is*#l &$osesus s*iloi'eus

uln#$is/Ke'u# #.#n, s#$#% *e$se.u* -u,# '#* 'i.lo" se"#li,us '# si"u/ #$#n+#3

si"u 'i%le"si"#n 603 -#$u( 'i*usu""#n 035 ( "e '#l#( "uli* #n*#$# ole"$#non '#n

e&i"on'ilus (e'i#lis3 "e(u'i#n sun*i""#n 15 (l #i$#n/ Risi"o "e$us#"#n s#$#% '#

&$ose'u$ini le.ih *in,,i "#$en# s#$#% '#* *e$-e.#" 'i #n*#$# #nes*esi lo"#l '#n

*ul#n,3 (en+e.#."#n is"e(i# s#$#%/

17


19/32

G#(.#$ / Blo" &e$,el#n,#n *#n,#n

Ke'u# s#$#% +#n, .e$-#l#n '# *i#& sisi -#$i *#n,#n '#n "#"i '#* 'i.lo"

'en,#n in-e"si '# *i#& sisi -#$i/9#$u( 'i*usu""#n "e #$#h *ul#n,3 '# &e$.#*#s#n

&e$(u"##n l(#$ '#n 'o$s#l -#$i3 12 ( 'is*#l sel# -#$i/Anes*esi 'i.e$i"#n 'en,#n

-#$u( *e,#" lu$us -#$i3 "e(u'i#n se'i"i* .e$su'u* "e #$#h l(#$ '#n 'o$s#l/Bi#s#n+#

h#n+# 'i.u*uh"#n 35 (l o.#* #nes*esi un*u" *i#& sisi -#$i/9#n,#n (ele.ihi < (l

"#$en# '#* (en+e.#."#n i'e$# -#$in,#n/

18


20/32

G#(.#$ ;/Blo" -#$i *#n,#n (#u&un "#"i/

9" Dae)a4 Ek)emia 7a:a4

Anes*esi lo"#l '# *el#" "#"i $el#*i% suli* "#$en# $#s# n+e$i +#n, n+#*# s##*

&ene*$#si@ .lo" s#$#% $e,ion#l se$in,"#li le.ih 'isu"#i/ Blo" &e$,el#n,#n "#"i

&os*e$io$ 'i,un#"#n un*u" (en,#nes*esi *el#" "#"i (el#lui.lo" s#$#% su$#lis '#n

*i.i#lis &os*e$io$/ S#$#% su$#lis .e$-#l#n 'i .el#"#n, %i.ul# '#n (#leolus l#*e$#l3 '#n

(ens#$#%i *u(i* '#n sisi l#*e$#l "#"i/ Un*u" (el#"u"#n .lo" s#$#% su$#lis3 sien

'i&osisi"#n *elun,"u& 'en,#n "#"i se'i"i* 'o$so%le"si/ 9#$u( 'i*usu""#n 'i l#*e$#l*en'o Ahilles '#n 12 ( 'i #*#s u-un, l#*e$#l (#leolus/O.#* #nes*esi 'isun*i""#n

'en,#n &ol# se&e$*i"is '#$i s#*u sisi "e sisi l#in un*u"(en#"u& selu$uh &e$s#$#%#n/

S#$#% *i.i#lis *e$le*#" 'i #n*#$# (#lleolus (e'i#lis '#n *en'o Ahilles3

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