Inhaled Anesthetics

By. Dr. Ihsan Affandi

 The discovery of the anesthetic properties of nitrous oxide, diethyl ether, and chloroform in the 1840s 1951, fluroxene, was used clinically for several years before its voluntary withdrawal from the market due to its potential flammability and increasing evidence that this drug could cause organ toxicity Halothane was synthesized in 1951 and introduced for clinical use in 1956

Enflurrane, the next methyl ethyl ether derivative, was introduced for clinical use in 1973 In search of a drug with fewer side effects, isoflurane, the isomer of enflurane, was introduced in 1981 Methoxyflurane, a methyl ethyl ether, being introduced for clinical use in 1960

Inhaled Anesthetics for the Present & Future

Desflurane, a totally fluorinated methyl ethyl ether, was introduced in 1992 Followed in 1994 by the totally fluorinated methyl isopropyl ether, sevoflurane The low solubility in blood of these newest anesthetics was desirable Facilitate the rapid induction of anesthesia, permit precise control of anesthetic concentrations during maintenance of anesthesia Favor prompt recovery at the end of anesthesia independent of the duration of administration Desflurane and sevoflurane reflects in large part the impact of market forces more than an improved pharmacologic profile on various organ systems as compared will isoflurane

CLINICALLY USEFUL INHALED ANESTHETICS

Commonly administered include the inorganic gas nitrous oxide and the volatile liquids isoflurane, desflurane, and sevoflurane Halothane and enflurane are administered Infrequently but are included in the discussion of the comparative pharmacology of volatile anesthetics since halothane in particular has been studied extensively Available but rarely administered inhaled anesthetics include the volatile liquids methoxyflurane and diethyl ether and the cyclic hydrocarbon gas

cyclopropane
Xenon is an inert gas with anesthetic properties, but its clinical use is hindered by its high cost

PHYSICAL AND CHEMICAL PROPERTIES OF INHALED ANASTHETICS

Nitrous Oxide Molecular weight Boiling point (OC) Vapor pressure (mmHg;20OC) Odor Preservative necesarry Stability in soda lime (40OC) Blood: gas partition coefficient MAC (37OC, 30 to 55years old, PB 760 mmHg) (%)

Halothane

Enflurane

Isoflurane

Desflurane

Sevoflurane

44 Gas Sweet No Yes 0.46 104

197 55.5 172 Ethernal No Yes 1.90 1.63

184 56.5 172 Ethernal No Yes 1.90 1.63

184 48.5 240 Ethernal No Yes 1.46 1.17

168 22.8 669 Ethernal No Yes 0.42 6.6

200 58.5 170 Ethernal No Yes 0.69 1.80

Riwayat Keluarga Tidak ada keluarga pasien yang sakit seperti ini Riwayat perkawinan : 1 x tahun 1998 Riwayat kehamilan / abortus / persalinan : 4/0/3

PEMERIKSAAN FISIK
KU
Kes TD

: sedang
: sadar : 120/80 mmHg

Sianosis
Ikterik pucat

:::-

Nadi : 96 x/menit

Nafas : 22 x/menit
T : 37 C Mata : tidak anemis, tidak ikterik, pupil isokor ki=ka Telinga, hidung dan tenggorokan : tak ada kelainan Leher Dada Ekstremitas : KGB tidak membesar : paru dan jantung dalam batas normal : akral hangat, edema -/-

STATUS OBSTETRI

Abdomen

Inspeksi: tampak membuncit sesuai usia kehamilan aterm Palpasi : L I L II : FUT 3 jari bpx, teraba massa besar, lunak, noduler : teraba tahanan terbesar di kiri

L III
L IV

: teraba massa bulat, keras, floating

: tidak dilakukan : 2945 gr, TFU : 32 cm, Hiss (-)

Taksiran berat anak Perkusi Auskultasi

: timpani : BU (+) normal ; BJA : -

Genitalia : Inspeksi U/V tenang Inspekulo : darah (+) warna merah segar, stosel (+) menutupi portio, laserasi (-)

Laboratorium : Hb : 10,7 g/dl CT : 3 Leu : 12400 mm

Hematokrit : 35 % BT : 4 Trombosit : 178000/mm

Diagnosis Kerja : G4P3A0H3 gravid aterm 38-39 mgg + HAP ec susp placenta previa + susp IUFD

Diagnosis Banding HAP ec solusio placenta

Terapi
O2 3 liter/ IVFD RL tetesan cepat KONSUL SpOG Kontrol KU, VS, perdarahan pervaginam Pasang kateter urine

Ceftriaxone inj 1 x1 gr iv
Persiapkan contoh darah untuk crossmatch Rencana sectio sesarea sito

Laporan Operasi

Dilakukan SCTPP ai HAP ec placenta previa, lahir seorang bayi perempuan dengan BB : 2700 gr, PB : 47 cm, A/S : - (IUFD), sisa ketuban hijau kental, placenta lahir lengkap 1 buah, berat 500 gr, perdarahan selama tindakan 300 cc, BAK lancar via cateter 100cc/sewaktu

FOLLOW UP POST OP
Pukul 18.00 WIB S / Demam (-), BAK (+) terpasang kateter 0 / Ku : sedang Kes : sadar Nfs : 20 x/ TD : 120/80 mmHg T: afebris Nadi : 82 x/ Abdomen, I : tampak sedikit membuncit, luka operasi tertutup verban Pa : FUT 2 jari bawah pusat kontraksi uterus baik NT (-), NL (-), defans muscular (-)

Genitalia : V/U tenang, PPV (+) A/ P4A0H3 Post SCTPP ai placenta previa, ibu dalam perawatan + anak meninggal P/ Awasi KU, VS, PPV post SCTPP Diet TKTP Mobilisasi bertahap IVFD RL 20 tetes/ Ceftriaxon inj 1 x 1 gr iv Metronidazole infus/8 jam Invitex/ 4 jam suppositoria 2 x pemberian

Pukul 23.00 WIB Hb post op : 8,1 gr/dl Rencana : transfusi darah, namun keluarga belum mendapatkan pendonor

Tanggal 5-10-2010 S / Demam (-), BAK (+) terpasang kateter BAB (+), PPV (-) 0 / Ku : sedang TD 120/100 mmHg Kes : sadar Nfs : 20 x/ T: afebris Nadi : 80 x/

Abdomen, I : tidak tampak membuncit luka operasi tertutup verban Pa : FUT 2 jari bawah pusat kontraksi uterus baik NT (-), NL (-), defans muscular (-) Genitalia : V/U tenang, PPV (-) Kesan : perbaikan

A/ P4A0H3 Post SCTPP ai placenta previa, ibu dalam perawatan + anak meninggal + Nifas hari ke-1

P/ Breast care Mobilisasi bertahap IVFD RL 20 tetes/ Transfusi darah 2 kolf pukul 13.00 dan 22.00 Ceftriaxon inj 1 x 1 gr iv Ciprofloxacin 2 x1 po Metronidazole aff ganti oral 3 x 1 tab Viliron 1 x1 po Asam mefenamat 3 x 1 po Linoral 3 x 1 po

Tanggal 6-10-2010
S / Demam (-), BAK (+), BAB (+), PPV (-) 0 / Ku : sedang TD 120/100 mmHg Kes : sadar Nfs : 20 x/ T: afebris Nadi : 80 x/ Abdomen, I : tidak tampak membuncit luka operasi tertutup verban

Pa : FUT 2 jari bpst kontraksi uterus baik NT (-), NL (-), defans muscular (-) Genitalia : V /U tenang, PPV (-)

P/ Breast care Diet TKTP Mobilisasi bertahap IVFD RL 20 tetes/ Terapi lain lanjut

Tanggal 7-10-2010

S / Demam (-), BAK (+), BAB (+), PPV (-) 0 / Ku : sedang TD 120/100 mmHg Kes : sadar Nfs : 20 x/ T: afebris Ndi : 80 x/ Abdomen I : tidak tampak membuncit luka operasi tertutup verban Pa : FUT 2 jari bpst kontraksi uterus baik NT (-), NL (-), defans muscular (-)

Genitalia : V/U tenang, PPV (-) A/ P4A0H3 Post SCTPP ai placenta previa, ibu dalam perawatan + anak meninggal + Nifas hari ke-3 P / Terapi lanjut

TERIMA KASIH