OBAT ANES LOKAL.pptx

7/30/2019 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.

OBAT ANES LOKAL.pptx

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