( dr.

Marwoto )

Hal hal yang perlu diingat sebelum

melakukan anestesi regional

I. Preoperatif preparation : Anestesi Umum

II. Obat obat anestesi regiona

No Procaine Lidocaine Buficaine

1. Gol Ester : - COO - Amide,-CNH- Amide

2. Onset 2 5 15
3. Durasi 30 45 45 90 2 4 jam

4. Metab Plasma Hepar Hepar

5. D. Max 12 mg / kg BB 6 mg / kg BB 2 mg / kg BB
6. Potensi 1 3 15

7. Toksisitas 1 2 10
 III.
1. Any procedure for which local anaesthesia will
provide satisfactory operating conditions

2. Pulmonary disease provide that the patient will

be able to tolerate the position reguired for the
operation.

3. Previous adverse reaction to general

anaesthetic agents

4. Anticipated problems with maintaining the

air way or intubation

5. Urgent operation without adequate starvation

IV.

A. Absolute C.I.

1. Refusal by the patient

2. Allergy to local anaesthetic drugs

3. Infections at the site of injection

4. Anticoagulant therapy

5. Bleeding diathesis

6. Use of adrenaline containing silution for

patients on tricyclic antidepressants
B. Relative C.I.

1. Lack of patiens co operation

2. Neurological desease; an exacerbation

maybe blamed on the anaesthetic
technique
V.

A. Absolute C. I.

1. Sepsis near or at the site of injection

2. Anticoagulant theraphy

3. Bleeding diathesis

4. Hypovolemia and shock

blocker therapy

6. Septicaemia

7. Fixed cardiac output

8. Raised intracrainal pressure

B. Relative C.I.

1.MAOI therapy

1.Active neurological disease

1.I. H. D

1.Scoliosis

1.Previous laminectomy
 VI.

1. Lokal

A. Abses insisi

B. Hematom
Kompres
C. Infiltrat

D. Nekrosis Nekrotomi

E. Nerve Injury Nerotonik /

Tropik
2. Sistemik.
O.K Over dosis

Hyper absorbsi
Hyper sensitivity

Intravasasi
A. SSP
Cortex
Kejang + gelisah
Stim
(O2 + anti kejang )

Dep Lemas + kesadaran

(O2 + infus)
 Medula
Resp * St. Hiperventilasi
( Resp. Dep. - Petidin / Morfin )

* Dep Hipoventilasi
( Ventilasi bantu )

St Hipertensi + takhikardi
Circ
( O2 + blocker )

Dep Hipotensi + bradikardi

( L Pos + infus + O2
+ Vasopresor )
 B. Otot Jantung Depresi
Hipotensi + Brakikardi
( = Dep. Circ )
Pemb. Drh. Tepi Dilatasi

C. Alergi / urticaria. ( Hidrocortison + atihistamin )

D. SYOK anafilaktik

L Pos + infus + O2
Adrenalin 0,3 0,5 mg i.m
( dapat diulang tiap 5 10 mnt
K/P Adrenalin drip 1 4 gr/ kg / mnt.
Metil Prednisolon Succ 100 ml gr i.v / 6 jam
Aminofilin bolus dan drip
Difen hidramin 1 ml gr / kg BB / 6 jam

E. Lain lain - Menggigil

- Mual / muntah
- Dysarthri