General Anesthesia

Jenis anestesi ada 2, yaitu general anesthesia dan regional anesthesia.

General anesthesia (GA) :

  • Reversible loss of consciousness
  • Analgesia of entire body (opioid)
  • Antegrade amnesia (benzodiazepine)
  • Muscle relaxation

3 fase GA :

1. Induction

  • Membawa pasien dari stadium sadar ke surgical ready condition
  • Tidak selalu dalam kondisi tidak sadar, pada anestesi regional operasi dapat dilakukan pada saat pasien masih sadar.

2. Maintenance

  • Pada GA biasanya digunakan gas/volatile anesthetic
  • Pada RA, digunakan anestesi local dengan kateter (epidural, peripheral)

3. Emergence

  • Kebalikan dari proses induksi
  • Persiapan : Menjaga jalan nafas, suctioning secretion, memberi analgetik dan antivomitting drugs

Stage GA :

1. Stage 1 (amnesia/analgesia)

  • Dimulai dengan induksi dan diakhiri dengan hilangnya kesadaran (loss of eyelid reflex)
  • Ambang batas nyeri belum menurun (pain perception threshold is not lowered)

2. Stage 2 (delirium/excitement) à harus cepat dilewati

  • Uninhibited excitation, agitasi, delirium, irregular respiration, dan breath holding
  • Pupil dilatasi dan mata divergen
  • Noxious stimuli (stimulus nyeri) yang dapat ditemui : vomiting, laryngospasm, hipertensi, takikardi, dan uncontrolled movement.

3. Stage 3 (surgical anesthesia)

  • Central gaze, pupil konstriksi, regular respirasi
  • Target kedalaman anestesi : saat painful stimulation tidak mendatangkan reflex somatic (deleterious autonomic response)
  • Stage 3 ada bbrp plane :
  • # Plane 1 : regular respiration – cessation of eyeball movement (mata berhenti bergerak)
    # Plane 2 : cessation od eyeball movement – permulaan paralisis intercostals
    # Plane 3 : permulaan paralisis intercostals – komplit paralisis intercostals
    # Plane 4 : komplit paralisis intercostals – paralisis diafragma

4. Stage 4 (impending death/OD)

  • Apnea, dilatasi and nonreactive pupil, hipotensi
  • Dapat terjadi circulatory failure

 

Pemberian GA :

  • Premedication (oral) : diberikan pada malam sebelumnya
  • IV line
  • Premedication (IV) : midazolam, diphenhydramine, ranitidine
  • Induction : penthotal/propofol, fentanyl, atracurium/ rocuronium
  • Intubation
  • Maintenance : isoflurane/seroflurane
  • Emergence

Monitoring GA :

  • Heart rate
  • Blood pressure (non-invasive BP)
  • SpO2 (O2 saturation) : dengan pulse oxymetri
  • Temperature
  • EtCO2 : dengan capnography
  • Gas analyzer
  • Invasive : BP, CVP, PA

Posted on November 17, 2010, in Anestesi and tagged , , . Bookmark the permalink. 1 Comment.

  1. I have been looking around and I must say that the information provided here at, https://medicomedisch.wordpress.com/2010/11/17/general-anesthesia/, have been stellar.

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