The Anesthesia Preparation

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The Anesthesia Machine

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 Objectives
• Anesthesia Machine
• Ventilators
• Scavenging Systems
• System Checkout

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Anesthesia machine

• Check the preparation

of the machine before
the anesthesia
procedure
• Make sure the machine
function well.

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Anesthesia machine

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Anesthesia machine

• Connect the anesthesia machine to O2 source, O2 hose color is mainly in

green and the connector can be connected to O2 plug only.

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The machine

• Check O2 pressure, green is marking O2 is enough.

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The Machine

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Checking the leakage

• Bag valve inflates well

meaning there is no
leakage

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Mesin anestesi

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Ventilators

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 Scavenging Systems
• Protects the breathing
circuit or ventilator
from excessive positive
or negative pressure.

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Scavenging Systems

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 Checking Anesthesia Machines
8 Categories of check:
• Emergency ventilation equipment
• High-Pressure system
• Low-Pressure system
• Scavenging system
• Breathing system
• Manual and automatic ventilation system
• Monitors
• Final Position

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Video 1

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Airway intubation

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Anatomy

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ANATOMY OF AIRWAY

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 Methods

E ndotracheal intubation
◦ Orotracheal
◦ Nasotracheal

Cricothyrotomy

Tracheotomy

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 Endotracheal Intubation
• Placement of a flexible plastic tube into the
trachea to:
– maintain an open airway,
– serve as a conduit through which to administer certain
drugs.
• Is performed in critically injured, ill or
anesthetized patients:
– to facilitate ventilation of the
lungs, including mechanical ventilation,
– to prevent the possibility of
asphyxiation or airway obstruction.

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 Indications:
For supporting ventilation in patient with pathologic disease:
◦ Upper airway obstruction,

◦ Respiratory failure,

◦ Loss of consciousness

For supporting ventilation during general anaesthesia:

◦ Type of surgery:
 Operative site near the airway,

 Thoracic or abdominal surgery,

 Prone or lateral surgery,

 Long period of surgery

Patient has risk of pulmonary aspiration

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Difficult mask ventilation
 Continuation...
• Maxillofacial ,cervical or laryngeal trauma
• Temperomandibular joint dysfunction
• Burn scar at face and neck
• Morbidly obese or pregnancy

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Before we do the intubation, we should evaluate the difficult airway

THE D I FFIC U L T AIRWAY

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 The Difficult Airway

SAKLES’ TRIANGLE
Difficult Bag and
Mask Ventilation

Difficult Laryngoscopy
and Intubation

Difficult
Cricothyrotomy

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 OBESE score for
Difficult Mask Ventilation

• Five predictors of difficult mask ventilation

Taken from NCPS

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The Obese patient

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The Elderly Patient

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How to predict:

T H E D IFFIC U L T
I N T U B AT I O N

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 Difficult Intubation
L E MON score

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GUIDELINES FOR
DIFFICULT INTUBATION
Difficult Airway Society Flowchart for
difficult intubation (2004)

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 Airway Assessment
1) Condition that associated with difficult intubation:
• Congenital anomalies  Pierre
Robin syndrome, Down’s
syndrome
• Infection in airway 
Retropharyngeal abscess,
Epiglottitis
• Tumor in oral cavity or larynx
 Enlarge thyroid gland trachea shift
to lateral or compressed tracheal
lumen

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 Airway Assessment
 2) Interincisor gap : normal  more than 3 cms

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 3) Mallampati classification: Class 3,4  may be
difficult intubation

Soft palate

Uvula

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 Laryngoscopic view

• Grade 3,4  risk for difficult intubation!

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 4) Thyromental distance : more than 6 cms

 5) Flexion and extension of neck

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 6) Movement of temperomandibular joint (TMJ)

Grinding
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P R E P ROC E D U R A L
E V A L U ATION

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Pre Procedural Evaluation

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 Preparing the procedure
Essentials: S A L T

Suction. This is extremely important. Often patients will have material in the
pharynx, making visualization of the vocal cords difficult.

Airway. the oral airway is a device that lifts the tongue off the posterior
pharynx, often making it easier to mask ventilate a patient. The inability to
ventilate a patient is bad. Also a source of O2 with a delivery mechanism
(ambu-bag and mask) must be available.

Laryngoscope. This lighted tool is vital to placing an endotracheal tube.

Tube. Endotracheal tubes come in many sizes. In the average adult a size
7.0 or 8.0 oral endotracheal tube will work just fine.

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 Or STATICS
• S  Scope : laryngoscope and stethoscope
• T  Tube : endotracheal tube
• A  Airway : oropharyngeal (OP) and
nasopharyngeal (NP)
• T  Tape : for strapping OP/NP tube
• I  Introducer : stylet
• C  Connector : for masking
• S  Suction
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EQ U I P MENT
I N T U B ATION

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Intubation

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 1) Laryngoscope : handle and blade

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 • Laryngoscope : handle
and blade

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 LARYNGOSCOPIC BLADE
 Macintosh (curved) and Miller (straight) blade
 Adult : Macintosh blade, small children : Miller blade

Miller blade Macintosh blade

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 2) Endotracheal tube
1) Size of endotracheal tube : internal diameter (ID)

The size of the tube may also be determined by the

size of the patients little finger.

Patients below the age of 8 require uncuffed ETT due

to damage caused by the cuff in younger patients.
Always monitor the ECG activity during intubation.

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 Tube sizes
• Newborn – to 4 kg - 2.5 mm (uncuffed).
• 1-6 months 4-6 kg – 3.5 mm (uncuffed).
• 7-12 months 6-9 kg – 4.0 mm (uncuffed).
• 1 year 9 kg – 4.5 mm (uncuffed).
• 2 years 11 kg – 5.0 mm (uncuffed).
• 3-4 years 14–16 kg - 5.5 mm (uncuffed).
• 5-6 years 18–21 kg – 6.0 mm (uncuffed).
• 7-8 years 22-27 kg – 6.5 mm ( uncuffed).
 Tube sizes
• 9-11 years 28-36 kg – 7.0 mm(cuffed).
• 14 to adults 46+ kg – 7.0 – 80 mm (cuffed).
• Adult female 7.0 – 8.0mm (cuffed).
• Adult male 7.5 – 8.5 mm (cuffed).
2) Material : Red rubber or PVC

3) Endotracheal tube types (cuffed-uncuffed, kinking-

nonkinking

High volume Low volume

Low pressure cuff Highpressure cuff

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 4) Bevel
 5) Murphy’s eye

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Cuffed and Uncuffed

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Cuffed

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Uncuffed

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Kinking

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Non kinking

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 6) Depth of endotracheal tube : Midtrachea or
below vocal cord ~ 2 cms
 Adult -> Male = 23 cms ,Female = 21 cms
 Children

 Oral endotracheal tube = (Age/2) + 12 (cm)

 Nasal endotracheal tube = (Age/2) + 15
(cm)

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 7) Tube markings

 Z-79
 Disposible (Do not reuse)
 Oral/Nasal
 Radiopaque marker
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 3) Other equipments

3.1 Stylet

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 3.2 Oropharyngeal or nasopharyngeal airway

Oral airway Nasal airway

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 3.3) Suction catheter
 3.4) Slip joint connector

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 4 Rules of Suctioning

Never suction further than you can see.

Always suction on the way out.

Never suction for longer than15 seconds.

Always oxygenate the patient before and after suctioning.

 3.5) Face mask and self inflating bag

 3.6) Magill forcep

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 3.7) Syringe

 3.8) Lubricating jelly

 3.9) Plaster for strap endotracheal tube

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 4. Monitoring success of
endotracheal intubation
• 4.1) Stethoscope
4.2) Endtidal - CO2
4.3) Pulse oximeter

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 Instruments used...
1. Self-refilling bag-valve combination
(eg, Ambu bag) or bag-valve unit
(Ayres bag), connector, tubing, and
oxygen source. Assemble all items
before attempting intubation.
2. Tincture of benzoin and precut tape.

3. Introducer (stylets or Magill forceps).

4. Suction apparatus (tonsil tip and

catheter
suction).

5. Syringe, 10-mL, to inflate the cuff.

6. Mucosal anesthetics (eg, 2% lidocaine)

7. Water-soluble sterile lubricant.

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8. Gloves.
Technique:

Sniffing position

Flexion at lower cervical spine

Extension at atlanto-occipital joint

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 Topical Anesthesia: Anesthetize
the mucosa of the oropharynx,
and upper airway with
lidocaine 2%, if time permits
and the patient is awake.

Direct Laryngoscopy:

MADgicWand™ Mucosal Atomization Device 1. Place the patient in the sniffing

for atomizing topical solutions. With 5mL position.
syringe

2. Check the laryngoscope and

blade for proper fit, and make
sure that the light works.

3. Make sure that all materials

are assembled and close at
hand.
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a)
Curved blade technique
Open the patient's mouth with the
right hand, and remove any
dentures.

b) Grasp the laryngoscope in the left

hand

c) Spread the patient's lips, and insert

the blade between the teeth, being
careful not to break a tooth.

d) Pass the blade to the right of the

tongue, and advance the blade into
the hypopharynx, pushing the tongue
to the left.

e) Lift the laryngoscope upward and

forward, without changing the angle
of the blade, to expose the vocal
cords.

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 Curved blade technique
f) The anesthesiologist then takes the endotracheal tube, made of
flexible plastic, in the right hand and starts inserting it through the
mouth opening.

g) The tube is inserted through the cords to the point that the cuff
rests just below the cords

h) Finally, the cuff is inflated to provide a minimal leak when the bag is
squeezed

Using a stethoscope , the anesthesiologist listens for breathing sounds to

ensure correct placement of the tube

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 Straight blade technique
Follow the steps outlined for curved blade technique, but
advance the blade down the hypopharynx, and lift the
epiglottis with the tip of the blade to expose the vocal
cords.

The tip of the laryngoscope blade fits below the epiglottis,

which is no longer visible with the blade in position.

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 Laryngoscopic View Grades
Grade 1: Full aperture visible
Grade 2: Lower part of cords visible
Grade 3: Only epiglottis visible
Grade 4: Epiglottis not visible

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Mallampati and Direct View

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 Complications:
1. Tube malpositioning (esophageal intubation )
2. Tube malfunction or physiologic responses to airway
instrumentation
3. Trauma such as tooth damage, lip/tongue/mucosal laceration,
sore throat, dislocated mandible
4. Mucosal inflammation and ulceration and excoriation of nose
can occur while the tube is in place
5. Laryngeal malfunction and aspiration, glottic, subglottic or
tracheal edema and stenosis, vocal cord granuloma or paralysis
during extubation

Physiologic responses to intubation include hypertension,

tachycardia, intracranial hypertension, and laryngospasm

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Video 2

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 Laryngeal Masks (LMA)

The Laryngeal Mask Airway is an alternative airway device used for

anesthesia and airway support.
• They cause less pain and coughing than an endotracheal tube, and
are much easier to insert .

It consists of an inflatable silicone mask and rubber connecting tube. It

is inserted blindly into the pharynx, forming a low-pressure seal around
the laryngeal inlet and permitting gentle positive pressure ventilation.

All parts are latex-free

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 Laryngeal Masks
Short Procedure:
1. The cuff of the mask is deflated
Indications: before insertion and lubricated.
When endotracheal intubation 2. The patient is sedated or fully
is not necessary or it’s difficult anaesthetized if conscious, and their
neck is extended and their mouth
Contraindications:
opened widely.
• Non-fasted patients 3. The apex of the mask, with its open
• Morbidly obese patients end pointing downwards toward the
• Obstructive or abnormal tongue, is pushed backwards towards
lesions of the the uvula.
oropharynx 4. The cuff follows the natural bend of
the oropharynx, and its long walls
Air entry is confirmed by come to rest over the piriform fossa.
listening for air entry into the 5. Once placed, the cuff around the
lungs with a stethoscope mask is inflated with air to create a
tight seal.
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 Advantages vs. Disadvantages

Advantages:
•Allows rapid access
•Does not require laryngoscope
•Relaxants not needed
•Provides airway for spontaneous or controlled
ventilation
•Tolerated at lighter anesthetic planes

Disadvantages:
• Does not fully protect against
aspiration in the non-fasted
patient

• Requires re-sterilization
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 Nasoendotracheal intubation
 Advantages:
 1) Comfortable for prolong intubation in postoperative period
 2) Suitable for oral surgery : tonsillectomy , mandible surgery
 3) For blind nasal intubation
 4) Can take oral feeding
 5) Resist for kinking and difficult to accidental extubation

 Disadvantages:

 1) Trauma to nasal mucosa

 2) Risk for sinusitis in prolong intubation
 3) Risk for bacteremia
 4) Smaller diameter than oral route  difficult for suction

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 Contraindication
for nasoendotracheal intubation

 1) Fracture base of skull

 2) Coagulopathy
 3) Nasal cavity obstruction

 4) Retropharyngeal abscess

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Complication of endotracheal intubation

 1) During intubation
 2) During remained intubation

 3) During extubation

 4) After extubation

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During intubation

Trauma to lip, tongue or teeth


Hypertension and tachycardia or arrhythmia


Pulmonary aspiration


Laryngospasm


Bronchospasm


Laryngeal edema

Arytenoid dislocation  hoarseness




Increased intracranial pressure


Spinal cord trauma in cervical spine injury


Esophageal intubation
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During remained intubation
 Obstruction from klinking , secretion or overinflation of cuff

 Accidental extubation or endobronchial intubation

 Disconnection from breathing circuit

 Pulmonary aspiration

 Lib or nasal ulcer in case with prolong period of intubation

 Sinusitis or otitis in case with prolong nasoendotracheal intubation

During Extubation
• Laryngospasm

• Pulmonary aspiration

• Edema of upper airway

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After Extubation
• Sore throat
• Hoarseness
• Tracheal stenosis (Prolong
intubation)
• Laryngeal granuloma

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 IF
Endotracheal Intubation fails,
you must have a back-up plan

• BVM • LMA

• Combi-tube • Cricothyrotomy

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 Cricothyrotomy
• Incision made through the skin and cricothyroid membrane to
establish a patent airway during certain life-threatening situations,
such as airway obstruction by a foreign body, angioedema, or
massive facial trauma.
• Is easier and quicker to perform than tracheotomy, does not
require manipulation of the cervical spine and is associated with
fewer complications.
• Used almost exclusively in emergency circumstances

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 Tracheostomy
Making an incision on the front of the neck and opening a
direct airway through an incision in the trachea.

Allows a person to breathe without the use of their nose

or mouth

Used primarily in situations where a prolonged need for

airway support is anticipated.

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 Conclusion

Always oxygenate patient before and after intubation.

Do not attempt intubation unless you are totally skilled, rather perform bag-valve-
mask ventilation.

Always monitor the spO2 readings.

Always reconfirm tube placement from time to time.

 Anesthetic Agents Commonly Used
• Benzodiazepine
– Midazolam
– Diazepam
• Opioid
– Meperidine
– Fentanyl
• Barbiturate
– Sodium methohexital
• Propofol
• Ketamine
• Inhalational agent
– Isoflurane, Sevoflurane, Halothane
 Point to Remember
• Any anesthetic/sedative/opioid regardless of
route of administration can be a general
anesthetic (can cause unconsciousness)
 Routes for Delivery of General Anesthetics

• Intravenous (IV)
• Inhalational
 Types of General Anesthetics
• Induction agents
– Induction agents usually administered IV
– can be inhalational for those who do not tolerate
IV access
• Maintenance agents
– Maintenance agents usually administered
inhalationally or IV with bolus or continuous
infusion technique
 General Anesthetics-Intravenous Agents

• Primary role as induction agents

• Maintenance with total intravenous
anesthesia
– Rapid redistribution
– Shorter half lives
– Environmental risk of inhalational agents
• Rapid distribution to vessel rich tissues
 General Anesthetics-Intravenous
Agents

• High lipid solubility allows for rapid induction

• When redistributed out of the brain, effect
decreases
• Advantages
– Rapid and complete induction
– Less CV depression
General Anesthetics-Intravenous Agents

• Benzodiazepines
– Rarely used alone for general anesthesia
• Cannot easily induce and maintain general anesthesia
• Lack analgesic properties
– Used for sedative and amnestic effects
• Opioids
– Decrease MAC of inhalation agents
– Primarily used as adjuncts
– Respiratory depression
General Anesthetics-Intravenous Agents

• Ketamine
– Duration of anesthesia 5-20 minutes
– Metabolized in the liver
– Increase in HR, BP, and CO due to
sympathomimetic effects
– Do not use in patients that will not tolerate above
– Stimulates salivary secretions
– Emergence phenomenon 5-30%
 General Anesthetics-Intravenous Agents
• Ketamine
– “Dissociative anesthesia”
• Amnesia
• Analgesia
• Catalepsy
– Thalamoneocortical and limbic systems
– Protective reflexes maintained
– NMDA antagonist
 General Anesthetics-Intravenous Agents
• Ketamine (cont.)
– Affects mu opioid receptors
– Onset and peak plasma concentrations
• 1 minute after IV
• 5-15 minutes after IM
• 30 minutes after oral
– Distributional half life 11-16 minutes
– Elimination half life 2-3 hours
 General Anesthetics-Intravenous Agents
• Methohexital
– 2.5 times more potent than thiopental
– Shorter duration of action
– Sleep time 5-7 minutes
– Mean elimination half life 3.9 hours
– Biotransformed in the liver
– Excitatory phenomena
– Most often used GA in OMS
 General Anesthetics-Intravenous Agents
• Propofol
– Unrelated to other general anesthetics
– Oil in water emulsion
– Rapid onset
– Distributional half life 1-8 minutes
– Terminal elimination half life 4-24 hours
– Extensive plasma and tissue protein binding
 General Anesthetics-Intravenous Agents
• Propofol (cont.)
– Disappears from bloodstream more rapidly than
thiopental
– Decreases MAP 20-30 %
– Apnea 22-45% after induction dose
– Pain on injection
– Less N & V
– Discard unused portion after 6 hours
Inhalational General Anesthetics
 Inhalational Anesthetics Uptake and
Distribution

• Blood solubility- low, intermediate and high

• Muscle has an affinity for anesthetic agents
similar to that of blood
• Lipids have a high affinity for anesthetic agents
 MAC-Minimum Alveolar Concentration

• The amount of anesthetic gas that will provide

surgical anesthesia so that 50% of the subjects
will not respond to the surgical incision
 Elimination and Metabolism of Anesthetic
Gases

• Same factors apply as uptake regarding gas

principles
• Most agents are biotransformed in the liver to
some degree
 Pharmacologic Effects of Inhalation Agents
• CV
– Depression of myocardial contractility
• Sensitivity to catecholamines
• Concerns regarding bradycardia
– Decrease of peripheral vascular resistance
• Effect is hypotension
• Respiration
– Depression of medullary responses and respiration
 General Anesthetics-Inhalational Agents

• Nitrous Oxide
– MAC is 105%
– Blood/gas partition coefficient 0.47
– With other Gas, concentration is 50-70%
– Little effect on respiration
– Eliminated unchanged
– Dysphoria and nausea with increased concentrations
– Diffusion hypoxia
– Can induce changed in folate and amino acid metabolism
General Anesthetics-Inhalational Agents

• Sevoflurane
– MAC 2.05%
– Mild airway irritant
– Suitable for mask induction
– Rare hepatotoxicity
 Inhalational Agents
• Desflurane
– Blood gas partition coefficient 0.42
– Irritating to airway
– MAC 6%
– Required heated vaporizer
– Expensive compared to other anesthetic gases
– Reduces SVR and MAP, but increase in heart rate causing stable
CO
– Low risk of hepatotoxicity
– Rapid depth and recovery
 Inhalational Agents

• Isoflurane (Forane)
– Anesthesia of choice – Dose dependent
depression of
– Blood/gas partition
myocardial contractility
coefficient 1.4 MAC
– Coronary vasodilation
1.15%
– CO maintained
– “Pungent” odor
– Can use
– Can provide muscle catecholamines
relaxation (high – Respiratory depression
concentrations) – Neither nephrotoxic or
hepatotoxic
 Inhalational Agents
• Halothane
– Halogenated hydrocarbon
– MAC is 0.75%
– Blood/gas partition coefficient 2.3
– Poor analgesic properties
– Incomplete muscle relaxation
– Decreased MAP
– Depressant effect on myocardial contractility
 Inhalational Agents
• Halothane (cont.)
– Vasodilator
– Depressant effect on respiration
– Elimination-alveolar excretion and hepatic
metabolism
– Sensitizes heart to catecholamines
– Associated with hepatoxicity
– Malignant hyperthermia
 Anesthesia drugs in
RSUD Ulin Banjarmasin
Pembimbing:
dr. Mahendratama Purnama Adhi,
SpAn

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 Anesthesia drugs
• Induction
• Muscle Relaxant
• Emergency drugs

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 Induction drugs
• IV
– Ketamin
– Propofol
• Inhalation
– Halotan/Fluothan
– Nitrous Oxide (H2O)
– Ether
– Enfluran
– Isofluran
– Sevofluran
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 Ketamin
• Dosage: 1-2 mg/kgBB
• Onset: 30 sec
• Duration: 15-20 minutes
• Provided in vial packaging with dose 10mg/ml
(Usually it is diluted in 10 cc syringe)

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 Ketamin
• Have the strong effect of analgesic, mainly for
somatic pain, but not for visceral pain.
• Lack in hypnotic effect, do not have relaxation
effect, can cause respiratory depression if overdose.
• Causing dream dissociation, disorientation,
hallucination and anxiety.
• Elevate systolic pressure by 20-25%, increase heart
rate.
• Increas blood glucose by ± 15%

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 Propofol
• Dosage: 2-2,5 mg/kgBB
• Onset: 2 min
• Duration: 30-45 min

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 Propofol

• Have a strong effect of analgesic and weak in hypnotic

effect, can be used as induction drug and
maintenance drug.
• Side effect: apnea, hypotension, bradycardia.
• Can cause nausea and headache.
• Overdose can cause heart and respiratory depression.
• Should not give this drug to patients with respiratory
disorder, spleen and liver disease, and hypovolemic
shock.
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 Halothan/Fluothan
• Uncolored, volatile
• Non-flammable
• Aromatic

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 Halothan/Fluothan
• Pros:
– Fast to induce patient to sleep
– Not stimulating respiratory tract
– Minimal salivation
– Bronchodilator
– Fast recovery time ( 1 hour post anesthesia )
– Minimal effects of nauseous and vomitus

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 Halotan/Fluothan
• Cons:
– Need another anesthetic drugs to work better
– Cause hypotension because of myocard
depression and vasodilation
– Heart arythmia
– Not a good analgesic
– Expensive

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 N2O
• It smells, non-flammable, and tidak mudah
terbakar, and insoluble in blood.
• Has a strong effect of analgesic (the same level
with morphine but with a weak hypnotic effect
and do not have relaxation effect.
• Need to be given with O2 minimally 255
because it can cause depression and dilatation
of heart and damaging the Central Nervous
System (CNS).
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 Ether
• Uncolored, volatile and flammable
• Fulfilled the triad of anesthesia
• Has the strong effect of analgesic
• Can cause respiratory tract irritation and
secretion of bronchus glands

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 Enfluran
• Isofluran isomer
• Non-flammable and it smells
• With high level of dose was thought can cause
brain waves activity like seizure (in EEG).
• Respiratory distress and depression of
circulation are stronger than halotan and also
more irritative

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 Isofluran
• Clear liquid, it smells strong, non-flammable in
room temperature
• At level 2 for its high stabilisation and can
stand for 5 years in storage or from sun light
exposure.
• The use of muscle relaxant dosage is reduced
to 1/3 dose

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 Sevofluran
• Its smell is not that strong comparing to
Isofluran, it has bronchodilator effect so it’s
chosen by many to induce patients (children
and adults) by using facemask.
• There is no reports about immune-mediated
hepatitis before for using sevofluran.

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 Muscle Relaxant
• Atracurium (Tramus)
• Rocuronium (Roculax)
• Cisatracurium
• Pancuronium

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 Atracurium
• Dosage: 0,5 mg/kgBB
• Onset: 3-5 min
• Duration: 15-30 min

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 Atracurium, Side effects & clinical
consideration

• Side effects of cardiovascular system if given

more than 0,5mg/kgBB, they are hypotension
and tachycardia.
• Can not be used for patients with asthma,
because it can cause bronchospasm.
• Prolonged-effect of Atracurium can cause
hypothermia and asidosis.

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 Rocuronium
• Dosage:
– Intubation: 0,6-1,2 mg/kgBB IV
– Maintenance: 0,1-0,2 mg/kgBB bolus (adults)
0,075-0,125 mg/kgBB (children)
• Onset: 1-2 min
• Duration: 15-30 min

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Emergency drugs

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 Nama Berikan bila
Efe drin TD menurun >20 % dari T D awal
(biasanya bila T D si s t o l < 9 0
d i be r i k a n)

Dosis: 5-10 mg IV
Su l f a s a t r o p i n Br a d i k a r d i (< 6 0 )

D o s i s : 0 , 1 m g IV
Amin of ilin Bronkokonstriksi

Dosis:5mg/kgBB
Dexamethason R e a k s i a n a f il a k s i s

Dosis:1 mg/kgBB
Adren alin Ca r d i a c a r r e s t

Dosis:0,25 – 0,3 mg/kgBB

Succinilcholin Sp a s m e l a r i n g

Dosis:1mg/kgBB

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