ANESTESI UMUM

ANESTESI UMUM Pendahuluan Anestesia umum adalah tindakan meniadakan nyeri secara sentral disertai hilangnya kesadaran dan bersifat pulih kembali (reversibel). Komponen anesthesia yang ideal terdiri: 1. hipnotik 2. analgesia 3. relaksasi otot Keadaaan anestesi biasanya disebut anestesi umum, ditandai oleh tahap tidak sadar diinduksi, yang selama itu rangsang operasi hanya menimbulkan respon reflek autonom. Jadipasien tidak boleh memberikan gerak volunteer, tetap perubahan kecepatan pernapasan dan kardiovaskuler dapat dilihat. Keadaan anestesi berbeda dengan keadaan analgesia, yang didefinisikan sebagai tidak adanya nyeri. Keadaan ini dapat ditimbulkan oleh agen narkotika yang dapat menghilangkan nyeri sampai pasien sama sekali tidak sadar. Sebaliknya, barbiturate dan penenang tidak menghilangkan nyeri sampai pasien sama sekali tidak sadar. Banyak teori telah dikemukan, tetapi sampai sekarang belum ada keterangan yang memuaskan bagaimana kerja obat anestetika. Ditinjau dari vaskularisasi, jaringan terbagi atas: 1. kaya pembuluh darah, contoh otak dan organ lainya, misalnya jantung, ginjal, hati dsb. 2. miskin pembuluh darah, contohjaringan lemak, tulang, dsb. Obat anestetika yang masuk kepembuluh darah atau sirkulasi kemudian menyebar ke jaringan. Yang pertama terpengaruh oleh obat anestetika ialah jaringan yang kaya akan pembuluh darah seperti otak, sehingga kesadaran menurun atau hilang, hilangnya rasa sakit, dsb. Teknik Anestesi Umum Teknik anestesi umum di dunia kedokteran dapat dilakukan dengan 3 cara, yaitu:

I. Parenteral Obat anestesi masuk ke dalam darah dengan cara suntikan IV atau IM. Untuk selanjutnya dibawa darah ke otak dan menimbulkan keadaan narkose. Obat anestesi yang sering digunakan adalah:

1. Pentothal

Dipergunakan dalam larutan 2,5% atau 5% dengan dosis permulaan 4-6 mg/kg BB dan selanjutnya dapat ditambah sampai 1 gram.

Penggunaan: 1. untuk induksi, selanjutnya diteruskan dengan inhalasi. 2. operasi-operasi yang singkat seperti: curettage, reposisi, insisi abses.

Cara Pemberian: Larutan 2,5% dimasukkan IV pelan-pelan 4-8 CC sampai penderita tidur, pernapasan lambat dan dalam. Apabila penderita dicubit tidak bereaksi, operasi dapat dimulai. Selanjutnya suntikan dapat ditambah secukupnya apabila perlu sampai 1 gram.

Komplikasi: 1. Lokal: Di tempat suntikan, apabila ke luar dari pembuluh darah sakit sekali merah dan bengkak.

Tindakan: -

infiltrasi dengan anestesi lokal

-

kompres 1. Menekan pusat pernafasan:

Kecepatan menyuntik harus hati-hati jangan sampai pernafasan berhenti. 1. Menekan jantung: Tekanan darah turun sampai nadi tak teraba. 1. Larynx Spasme: -

diberi O2 murni

kalau diberi succinyl choline IV 25-50 mg untuk melemaskan spasme sambil dibuat pernafasan buatan.

Kontra Indikasi: 1. 2. 3. 4. 5. 6.

Anak-anak di bawah 4 tahun Shoch, anemia, uremia dan penderita-penderita yang lemah Gangguan pernafasan: asthma, sesak nafas, infeksi mulut dan saluran nafas Penyakit jantung Penyakit hati Penderita yang terlalu gemuk sehingga sukar untuk menemukan vena yang baik.

1. Ketalar (Ketamine) Diberikan IV atau IM berbentuk larutan 10 mg/cc dan 50 mg/cc. Dosis: IV 1-3 mg/kgBB, IM 8-13 mg/kgBB 1-3 menit setelah penyuntikan operasi dapat dimulai.

Komplikasi: 1. menekan pusat pernafasan , tetapi lebih kurang daripada pentothal. 2. merangsang jantung: tekanan darah naik 3. sekresi kelenjar ludah dan saluran pernafasan bertambah

Penggunaan: 1. operasi-operasi yang singkat 2. untuk indikasi penderita tekanan darah rendah

Kontra Indikasi: Penyakit jantung, kelainan pembuluh darah otak dan hypertensi.

Catatan Oleh karena komplikasi utama dari anestesi secara parenteral adalah menekan pusat pernafasan, maka kita harus siap dengan peralatan dan tindakan pernafasan buatan terutama bila ada sianosis.

II. Perrectal Obat anestesi diserap lewat mukosa rectum kedalam darah dan selanjutnya sampai ke otak. Dipergunakan untuk tindakan diagnostic (katerisasi jantung, roentgen foto, pemeriksaan mata, telinga, oesophagoscopi, penyinaran dsb) terutama pada bayi-bayi dan anak kecil. Juga dipakai sebagai induksi narkose dengan inhalasi pada bayi dan anak-anak. Syaratnya adalah: 1. rectum betul-betul kosong 2. tak ada infeksi di dalam rectum Lama narkose 20-30 menit. Obat-obat yang digunakan: -

Pentothal 10% dosis 40 mg/kgBB

-

Tribromentothal (avertin) 80 mg/kgBB

III. Inhalasi Obat anesthesia dihirup bersama udara pernafasan ke dalam paru-paru, masuk ke darah dan sampai di jaringan otak mengakibatkan narkose. Obat-obat yang dipakai: 1. Induksi halotan. Induksi halotan memerlukan gas pendorong O2 atau campuran N2O dan O2. Induksi dimulai dengan aliran O2 > 4 ltr/mnt atau campuran N2O:O2 = 3:1. Aliran > 4 ltr/mnt. Kalau pasien batuk konsentrasi halotan diturunkan, untuk kemudian kalau sudah tenang dinaikan lagi sampai konsentrasi yang diperlukan. 2. Induksi sevofluran Induksi dengan sevofluran lebih disenangi karena pasien jarang batuk walaupun langsung diberikan dengan konsentrasi tinggi sampai 8 vol %. Seperti dengan halotan konsentrasi dipertahankan sesuai kebutuhan. 3. Induksi dengan enfluran (ethran), isofluran ( foran, aeran ) atau desfiuran jarang dilakukan karena pasien sering batuk dan waktu induksi menjadi lama.

Pengobatan Gigi Anestesi Posted on November 11, 2011 by admin

Hampir semua orang akrab dengan sensasi mulut “tidur” ketika kita pergi ke dokter gigi. Bahwa perasaan adalah hasil dari anestesi lokal, dokter gigi menyuntikkan larutan ke dalam mulut untuk memblokir rasa sakit selama prosedur gigi. Meskipun kegunaan mereka untuk mencegah nyeri, aplikasi untuk jarum dikenal dan ditakuti menghasilkan banyak kecemasan pada pasien gigi. Hari ini, kita dapat merasa lega bahwa ada teknik

modern anestesi

lokal

yang memungkinkan

kita untuk

mengunjungi lebih menyenangkan. Selain itu, pasien cemas dapat menggunakan obat penenang dan teknik psikologis lain untuk bersantai pasien. Namun, anestesi lokal tidak cukup pada beberapa pasien. Pasien muda dan beberapa orang dengan cacat tertentu tidak mentoleransi pengobatan walaupun anestesi lokal biasa gigi. Pada pasien ini, anestesi umum dianjurkan.

Anestesi umum diproduksi oleh agen farmakologi yang mengakibatkan pasien tidur nyenyak (kehilangan kesadaran dan refleks). Karena sifat dan risiko dari jenis anestesi, itu diberikan dalam ruang operasi rumah sakit di bawah perawatan anestesi. Dokter gigi anak memberikan perawatan gigi di ruang operasi dengan pasien tertidur dengan anestesi. Pengobatan Gigi Anestesi Indikasi paling umum untuk anestesi umum ketik perawatan gigi adalah: 1. Status gigi atau kondisi pasien secara signifikan kompleks. 2. Karena usia tidak mampu untuk menolak atau mentoleransi nyeri, atau bekerja sama dengan pengobatan. 3. Kondisi medis yang sangat diperlukan untuk melakukan perawatan di bawah anestesi umum di sebuah rumah sakit yang lain dapat menimbulkan risiko signifikan bagi kesehatan pasien. 4. Anestesi lokal tidak efektif atau kontraindikasi. 5. Negara ketakutan atau kecemasan dan bahwa penundaan pengobatan dapat mengakibatkan rasa sakit, infeksi atau komplikasi. 6. Parah gigi trauma mana anestesi lokal tidak efektif. 7. Dengan alasan cacat atau ketidakmampuan untuk mentoleransi ressitri atau sakit, atau bekerja sama dengan pengobatan. Adalah penting bahwa dokter gigi anak memeriksa pasien dan menentukan apakah jenis anestesi ini diindikasikan untuk pasien ini. Jika demikian, akan memerlukan konsultasi medis yang diperlukan,

termasuk ahli anestesi untuk menjadwalkan perawatan gigi di rumah sakit. Beberapa tahun yang lalu itu praktek umum untuk beberapa rencana kesehatan menolak untuk menutup layanan anestesi umum dan rawat inap untuk pasien ini. Hari ini, berkat UU 352 Desember 22, 1999 dan kesadaran untuk perusahaan asuransi, layanan ini umumnya ditutupi oleh rencana kesehatan pasien di Puerto Rico. Kami mendorong orang tua atau wali orang yang telah mencoba namun gagal untuk menyelesaikan perawatan gigi anak-anak mereka karena kecemasan dan perilaku di kantor dokter gigi, untuk berkonsultasi dengan dokter gigi anak. Profesional ini dapat memandu Anda jika anestesi umum akan sesuai dalam kasus ini.

Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient's level of apprehension. The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.

Method of Description of Anesthe Technique sia

Usual Indications

Local Anesthetic The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.

Simple oral surgery procedures such as minor soft tissue procedures and basic tooth extractions. Patients may elect to have wisdom teeth removed with local anesthetic.

Nitrous Oxide

Simple oral surgery procedures

A mixture of nitrous oxide

Sedation with (laughing gas) and oxygen is Local Anesthetic administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a sedative and analgesic (pain- controlling) effect.

to more involved procedures such as removal of wisdom teeth and placement of dental implants.

Office Based Intravenous Anesthesia with Local Anesthetic*

Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient's vital signs are closely monitored.

Intravenous anesthesia includes I.V. sedation and general anesthesia for all types of oral surgery. A patient may choose intravenous anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose intravenous anesthesia. General anesthesia and/or I.V. sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.

Hospital or Surgery Center Based General Anesthesia

A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.

Indicated for patients undergoing extensive procedures such as face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia.

*To administer general anesthesia in the office, an oral surgeon must have completed at least three months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which general anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.

Again, when it comes to anesthesia, our first priority is the patient's comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.

Intravenous Sedation ("Twilight Sedation") Oral and Maxillofacial Surgery offices offer their patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as "Twilight Sedation" for their dental treatment. Intravenous Sedation or "twilight sleep" helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or "IV sedation” (twilight sedation) is designed to better enable you to undergo your dental procedures while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep – a "twilight sleep”. If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by your Oral Surgeon therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.

How is the IV Sedation Administered? A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient's vein may not be maintainable, in these situations the medications will be administered and the needle retrieved - both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all. The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant "drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with IV sedation there are also other different "levels” of sedation available to you in our office. There is nitrous oxide analgesia.

Sedation Dentistry for the Elderly As we age, our oral health becomes more important than ever. Periodontal disease can lead to bone and tooth loss, which affects nearly every part of our daily lives. To lead full and active lives, we need our teeth and gums. They allow us enjoy food, support speech

and good conversation, and facilitate digestion. Your Oral Surgeon is dedicated to treating elderly patients with care and commitment to comfort and health. Elderly patients as a group tend to avoid dental visits for a variety of reasons, including: more pressing medical concerns, anxiety about treatment, the hardship of transportation, or fixed incomes. Once their oral health has reached an unmanageable point, fear and embarrassment further keep these patients away from the dentist. For elderly patients embarrassed or fearful of their current oral state, sedation dentistry provides the opportunity for your Oral Surgeon to treat these conditions while the patient remains relaxed and unaware until "awaking” to an improved oral state!

Sedation Dentistry for the Disabled It may be especially difficult for people with disabilities to obtain access to proper dental care. They must find a dentist who is skilled and compassionate, and who can provide services for which some dentists may not be qualified. Your Oral Surgeon provides the expertise, state-of-the-art-equipment, and dedication to assisting special-needs patients necessary to ensuring great oral care for our patients. Disabled patients may face added challenges in maintaining their oral health. Their disability may make it difficult to brush or floss regularly; they may also suffer a severe gag reflux, or dry mouth as a result of medication. Your Oral Surgeon meets these challenges with sedation dentistry for the disabled. He/she is skilled in anesthesia for special-needs patients, and can ease the fear associated with out-of-control oral hygiene with one visit.

Sedation Dentistry for the Fearful Dental phobia is a real, often overwhelming reality for thousands of people. Negative previous dental experiences, fear of needles or drills, and severe gag refluxes are just some of the reasons people feel extreme anxiety when thinking about visiting the dentist. If you suffer from dental phobia- fear no more! Your Oral Surgeon is committed to understanding the very real nature of your fears. Not only will our staff treat you with delicacy and care, but IV sedation will allow you to experience dentistry in a whole new way. While engaging in a pleasant sleeplike experience, your Oral Surgeon will be hard at work making sure you "wake up” with the results you desire.

Nitrous Oxide (Laughing Gas) Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily

functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment. There are many advantages to using Nitrous Oxide • • • • •

The depth of sedation can be altered at any time to increase or decrease sedation. There is no after effect such as a "hangover". Inhalation sedation is safe with no side effects on your heart and lungs, etc. Inhalation sedation is very effective in minimizing gagging. It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.

Reasons to not use Nitrous Oxide

Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a "5 minute trial" to see how you feel with this type of sedation method before proceeding.

ABSTRACT Providing dental care for developmentally disabled patients who require general anesthesia is challenging for both dentists and anesthesiologists. This study aimed to compare the efficacy of two anesthetic methods for dental care. The researchers retrospectively analyzed morbidity data following anesthesia using either a reinforced laryngeal mask airway (LMA) or endotracheal intubation anesthesia for a two-year time period. The subjects were developmentally disabled patients receiving dental care. Statistical analyses were by unpaired student t-tests and chisquare tests. Patients were who anesthetized with a reinforced laryngeal mask airway had a significantly shorter recovery period and lower postanesthetic complication rates when compared to patients undergoing endotracheal intubation anesthesia. Although hypoxemia (SPO2 90%) during dental care occurred more frequently when using the reinforced laryngeal mask airway, the difference was not significant. Nausea and vomiting were the major complications in the postanesthetic care unit and after discharge. When complication rates were compared in the two patient groups, nausea and vomiting were significantly higher during postanesthetic care and after discharge in the intubated group. In conclusion, reinforced laryngeal mask airway provides general anesthesia with less risk of side effects for developmentally disabled patients undergoing dental care.