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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#$%&$01'
Konsulen :
()" O*! +" A*,ke-a!a. S/" A*
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
PADA BAGIAN ANESTESIOLOGI
FAKULTAS KEDOKTERAN
UNIVERSITAS PATTIMURA
AMBON
20!
0
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BAB I
PENDAULUAN
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se(es*in+# #"#n (en+e.#."#n #n#l,esi# +#n, le.ih '#l#( '# .#,i#n 'is*#l '#$i
*e(* &ene"#n#n s#$#%/ #l *e$se.i* (e$u"#n '#s#$ '#$i (e*o'e #nes*esi (#s#
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BAB II
TINJAUAN PUSTAKA
A" DEFINISI
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&en,#)e* +#n, *e$'#* 'i '#l#( l#$u*#n '#* -u,# (eni(.ul"#n $e#"si #le$,i/
T#.el 2/ Pe$.e'##n #n*#$# in*o"si"#si '#n #le$,i
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"ee*#n #.so$.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 .#$u/
9
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Anes*e*i" lo"#l +#n, 'i$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
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(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/
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(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
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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
$idokain
20(g(l in.
A%a+ eli a%a+s*ra, 10
Anes%esi
in/l%rasi: *eri;er
dan blok sara;*+sa%: anes%esi
regional i
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S*$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
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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#(.#$
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'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#(.#$
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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*
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*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
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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
"#$en# '#* (en+e.#."#n i'e$# -#$in,#n/
18
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G#(.#$ ;/Blo" -#$i *#n,#n (#u&un "#"i/
9" Dae)a4 Ek)emia 7a:a4
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