Documente Academic
Documente Profesional
Documente Cultură
DR.
DR. KUSUMA
KUSUMA HARIMIN
HARIMIN ,SpAn
,SpAn
Departemen Anestesiologi
dan
Reanimasi RSMH/FK Unsri
TEKNIK R.A
I.
- INFILTRASI LOKAL
- BLOK LAPANGAN (FIELD BLOCK)
- BLOK SYARAF (NERVE BLOCK)
- TOPICAL BLOCK (PERMUKAAN)
- ANALGESIA REGIONAL INTRA VENA
II.
- SPINAL ANALGESIA
V.
- BRACHIAL BLOCK
- SUPRA CLAVICULAR
- AXILAR BLOCK
- INTERSCALENUS
ANALGESIA SPINAL
= LUMBAL = SUBARACHNOID
MENYUNTIKKAN OBAT LOKAL ANESTESI KEDALAM RUANG
SUBARACHNOID DI DAERAH VERTEBRA L2 L3, L3 L4, L4 L5,
SEHINGGA DIDAPAT ANALGESIA YANG BERSIFAT REVERSIBEL.
- POSISI :
DUDUK
MIRING FLEXI MAKSIMAL
- LAND MARK :
SIAS KI - KA
INTERSPACE
- TEKNIK :
MEDIAN
PARA MEDIAN
TAYLOR
- TEKNIK :
MEDIAN
PARA MEDIAN
TAYLOR
- OBAT OBAT L . A
LIDOCAINE 5 % IN. 7,5% DEXTROSE
BUPIVACAINE 0,5% HYPERBARIC
TETRACAINE
- OBAT OBAT L . A
LIDOCAINE 5 % IN. 7,5% DEXTROSE
BUPIVACAINE 0,5% HYPERBARIC
TETRACAINE
Sampai
Th 10
Th 4
50-60
75-100 mg
60
75-100
Tetracaine
6-8
10-16
70-90
100-150
Bupivacain
8-10
12-20
90-110
100-150
L.A
Lidocain 5%
Plain
0,2 mg
Epieprin
SPUIT
CATAPRES 1 Ampul
CAMPUR DALAM
(bisa + 90 %)
Teknik Penyuntikan
Umur (Geriatri (tua))
Tinggi Pasien
Berat
Gender (Sex) ,
hamil
Tekanan Intra Abdominal
Konfigurasi kolumna Vertebralis (Anatomi)
Posisi
Karakteristik Cairan L. A
Density
Concentrasi
Volume
Temperatur
Vaso Contrictor
Pencegahan :
1.Jarum Kecil No.25 ,27
2.Hydrasi Adekuat
3.Tusukan Sejajar Duramater
Distribution of Local
Anaesthetics and Other
Adjuncts within the
Subarachnoid Space as
Demonstrated Visually by the
Glass Spine
History
1907: Glass Spine: Arthur Baker:
University College, London
1950: Lumbar Puncture & Spinal
Anaesthesia: MacIntosh, Oxford
1970s- : Popularised the
demonstration (including Asia): Len
Carrie, Oxford.
Glass spine
Expansion chamber
Thoracic concavity + lumbar convexity
Specific gravity, density and baricity
Contents of subarachnoid space
Surface landmarks
Baricity
Hyperbaric
Specific Gravity >1.009
eg. Bupivacaine 0.5% Heavy (8% dextrose)
Isobaric
Specific Gravity 1.003-1.009
Hypobaric
Specific Gravity <1.003
Density
Plain 2% chloroprocaine*
Hyperbaric
Density:1.00123g/mL
Plain 3% chloroprocaine*
Hyperbaric
1.00257
Hypobaric
1.00004
Plain 2% lignocaine
* preservative free
*antoxidant free
Position
Speed of injection
Size of the needle
MCQ
AnaesthesiaUK
Pain Resources, 2004
MALE SUPINE
FEMALE SUPINE
ISOBARIC
TETRACAINE
L3-4
Solution Spread
Supine
HYPERBARIC
TETRACAINE
L3-4
Solution Spread
Head down
HYPERBARIC
TETRACAINE
L3-4
Solution Spread
Supine
HYPERBARIC
TETRACAINE
L3-4
Solution Spread
Saddle block
Height
Sitting Position
BMI*
Fentanyl + Bupivacaine
low dose
Weight
Labour analgesia
No effect on
sensory analgesia
extent*
11.7mg (95%CI:11.1-12.4)
Ropivacaine MLAD
12.8mg (95%CI:12.2-13.4)
Demonstration 1 Lying CS
Hyperbaric
Lateral position to Supine
(extension to mid thoracic)
(slight head down: +1-2 segments)
Waxoline rhodamine
then, turned to the side + head down
(extensive additional cranial spread)
Demonstration 2 Saddle
Block
Hyperbaric
Sitting
Saddle block
Waxoline rhodamine
Demonstration 3
CS
Sitting
Hyperbaric
Sitting to supine
(intense caudal spread)
(limited cranial spread and less intense upper level)
Waxoline rhodamine
Demonstration 4 Isobaric
hip
Isobaric
Lateral to supine
(effect of temperature, coughing)
(sometimes high, L1 -> T1)
Methylene blue
Demonstration 5 Continuous
spinal
28-32G microspinal catheter
22G spinal needle
1cc syringe
Useless for surgery
Cauda equina syndrome
High local concentrations
Miscellaneous
Barbotage
minor effect through 27G spinal
needles
Small needles
little effect on spread
EVE
epidural volume extension
SECTION 2
FULL GOWN
FULL SCRUB
MASK, GLOVES, etc
ONCE YOU
DEFINE THE
MIDLINE, NEVER
LET GO OF IT
Position Patient
Drape Carefully
BACKHAND
PULLTHRO
Technique
THOSE
ACCURSED
WINGS
Ropivacaine/fentanyl Polybag
Lignocaine 2% w. Adrenalin
#11 Bard Parker knife blade
AWFUL
LOSS OF
RESISTANCE
DEVICES ARE NOT
ALL MADE EQUAL
KNEEL
IDENTIFY TUFFIERS LINE
IDENTIFY THE MIDLINE
HOLD THE MIDLINE & LEVEL