1.KULIAH PENDAHULUAN.ppt

8/11/2019 1.KULIAH PENDAHULUAN.ppt

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BIODATA

Imam Ghozali, dr.,SpAn.,Mkes.

Lahir Bandar Lampung 3-Agustus

Pendidikan terakhir :

Sp. Anestesiologi (Unpad)

Magister Kesehatan (Unpad)

Pengalaman Kerja

PNS DPK Tulang Bawang


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Anesthesia

Dr. Imam Gz. SpAn., Mkes.

Maret, 2010


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History of Anesthesia

Ether synthesized in 1540 by Cordus

Ether used as anesthetic in 1842 by Dr.

Crawford W. Long

Ether publicized as anesthetic in 1846

by Dr. William Morton

Chloroform used as anesthetic in 1853

by Dr. John Snow


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Endotracheal tube discovered in 1878

Local anesthesia with cocaine in 1885

Thiopental first used in 1934

Curare first used in 1942 - opened the

Age of Anesthesia


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Basic Principles of Anesthesia

Anesthesia defined as the abolition of sensation

Analgesia defined as the abolition of pain

Triad of General Anesthesia

need for unconsciousness

need for analgesia

need for muscle relaxation


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General & Regional

Anesthesia Intra vena

Intra muscular

Rectal

Inhalasi

BALANCE ANASTHESIA


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PHYSIOLOGY

PHARMACOLOGY


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BASIC

PHYSIOLOGY RESPIRATORY

CENTRAL NERVUS SYSTEM

CARDIOVASCULAR SYSTEM


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Fundamentals of

Anatomy &PhysiologyDr. Imam Ghozali.,SpAn.,MKes

Unit

1Fisiologi Respirasi

Disampai15 Maret 2010,


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The Respiratory System


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What are theprimary functions of

the respiratory system?


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Functions of the Respiratory

System Breathing process

Exchange of Oxygen and Carbon

Dioxide

Enable speech production


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Respiration

external respiration- exchange of

gases in lungs

internal respiration- exchange of gaseswithin cells of the body organs and

tissues

ventilation- movement of air


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Internal Respiration

All cells require oxygen for metabolism

All cells require means to remove

carbon dioxide

Gas exchange at cellular level


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External Respiration

Ventilation

exchange of air between lungs and

atmosphere

Gas Exchange in pulmonary capillaries

Breathing largely involuntary activity


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Structures of Respiratory System

upper respiratory tract

nose, mouth, pharynx, epiglottis, larynx

and trachea

lower respiratory tract

bronchial tree and lungs


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Nose

nasal cavity

nasal septum

mucous membrane mucus

cilia

olfactory receptors


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Pharynx

Nasopharynx

adenoids or pharyngeal tonsils

oropharynx

palatine tonsils

laryngopharynx

larynx


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Epiglottis

oropharynx and laryngopharynx serve

as a common passageway for both food

and air epiglottis acts as a lid or flap that

covers the larynx and trachea (airway)

so food does not enter the lungs.


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Larynx

voice box

larynx/o

glottis (vocal apparatus)

vocal bands or vocal cords


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Trachea

Windpipe or airway

mucous membrane lining with cilia

smooth muscle with c-shaped cartilage

rings

divides into two branches: bronchi

no gaseous exchange


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Alveoli

air sacs

alveolar wall membranes one

cell thick and surrounded bycapillaries

gaseous exchange takes place

here


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Right-3 lobes Left-2 lobes

Lungs

trachea


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Pleura

each lung enclosed in pleura

parietal pleura (inner)

visceral pleura (outer)

pleural space or pleural cavity

lubricating fluid


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Diaphragm

muscle separating chest and abdomen

inspiration, diaphragm contracts and

increases thoracic space

air flows in

expiration, diaphragm relaxes and

decreases thoracic space

air flows out

phrenic nerve


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Components of the Respiratory System

Figure 231


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Figure 232

Alveolar sac

Alveoli


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. Hidung

Rongga hidung memiliki

3 fungsi utama yaitu :

1.memanaskan udara

2.melembabkan udara

3.menyaring udara

Adenoid

Tonsil


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2. Pangkal Tenggorokan (Laring)

1. Tersusun dari lempengan-lempengan tulang rawan.

2. Terdapat GLOTIS yaitu celah penghubung trakea - faring,

3. Terdapat EPIGLOTIS yaitu katup pengarur jalannya udara dan makanan.


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Divisions of the Pharynx

Nasopharynx

Oropharynx

Laryngopharynx

A f h L


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Anatomy of the Larynx

Figure 234


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3. Batang Tenggorokan (Trakea)

1. Tersusun dari cincin tulang rawan berbentuk pipa

2. Terletak di depan kerongkongan

3. Bagian dalam licin dan berlendir terdapat jaringan epitelyangtersusun dari sel-sel bersilia yang berfungsi menahan debu

dan kotoran.

Trakea


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4. Bronkus & 5. Bronkiolus

1. Bronkus = penghubung trakea dengan paru-paru.

2. Ada 2 bagian yaitu bronkus kiridan bronkus kanan.

3. Bronkus bercabang menjadi BRONKIOLUS.

4. Pada ujung BRONKIOLUSterdapat kantung udara yang disebut

ALVEOLUS.

* Dinding alveolus terdapat banyak pembuluh kapiler darahtempat terjadinya pertukaran gas O2 dan CO2.

Alveolus Pembuluhkapiler darah

Bronkus


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. Paru-Paru (Pulmo)

1. Terletak di dalam rongga dada diatas diafragma.

2. Terdapat BRONKUS, BRONKIOLUS, ALVEOLUS.

DIAFRAGMA = sekat yang membatasi rongga dadadengan

rongga perut.

PLEURA = selaput elastis pembungkus paru-paru.

Gross Anatomy of the Lungs


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Figure 237

Gross Anatomy of the Lungs


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The Right Lung

Has 3 lobes: superior,

middle, and

inferior

separated by

horizontal and

oblique fissures


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The Left Lung

Has 2 lobes:

superior and

inferior

are separated

by an obliquefissure


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Relationship between Lungs and Heart

Figure 238


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Bronchitis

Inflammation of bronchial walls:

causes constriction and breathing

difficulty

The Bronchioles


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Figure 2310

The Bronchioles

Bronchodilation


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Bronchodilation Dilation of bronchial airways

Caused by sympathetic ANS activation Reduces resistance

Bronchoconstriction Constricts bronchi

Caused by:

parasympathetic ANS activation

histamine release (allergic reactions)

Asthma Excessive stimulation and bronchoconstriction

Stimulation severely restricts airflow


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Surfactant Is an oily

secretion Contains

phospholipids and

proteins

Coats alveolarsurfaces and

reduces surface

tension


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Figure 238

Pleural Cavities and Pleural Membranes


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Pleural Cavities and

Pleural Membranes 2 pleural cavities:

are separated by the mediastinum

Each pleural cavity: holds a lung

is lined with a serous membrane (the

pleura)


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The Pleura

Consists of 2 layers:

parietal pleura

visceral pleura

Pleural fluid:

lubricates space between 2 layers


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3 Processes of

External Respiration1. Pulmonary ventilation(breathing)

2. Gas diffusion:

across membranes and capillaries

3. Transport of O2and CO 2:

between alveolar capillaries

between capillary beds in other tissues


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Mekanisme Pernapasan

Dalam pernapasan ada 2 siklus1.Menghirup (INSPIRASI)

2.Mengeluarkan (EKSPIRASI)

M k i P


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Pernapasan Dada / Tulang Rusuk

Mekanisme Menghirup Udara (INSPIRASI)

Otot antar tulang rusuk berkontraksi sehingga:

1. Rongga dada membesar,

2. Tekanan udara dalam paru mengecil,

3. Udara masuk dari luar ke dalam paru-paru.

Mekanisme Mengeluarkan Udara (EKSPIRASI)

Otot antar tulang rusuk berelaksasi sehingga:

1. Rongga dada mengecil,

2. Tekanan udara dalam paru membesar

3. Udara keluar dari paru-paru

M k i P


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Pernapasan Perut

Mekanisme Menghirup Udara (INSPIRASI)

Otot diafragma kontraksi sehingga:

1. otot diafragma mendatar,

2. rongga dada membesar

3. tekanan udara dalam paru mengecil,

4. udara dari luar masuk kedalam paru-paru

Mekanisme Mengeluarkan Udara (EKSPIRASI)

Otot diafragma relaksasi sehingga:

1. otot diafragma kembali melengkung ke atas,

2. rongga dada mengecil

3. tekanan udara dalam paru meningkat,

4. udara keluar paru-paru


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Volume Kapasitas Paru-Paru


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Volume & Kapasitas Paru-Paru

Volume paru-paru= 5-6 liter

Terdiri dari :

Volume Tidal sebanyak 0,5 liter hasil pernafasan normal

Volume Cadangan Inspirasi = volume udara ekstrayang dapat di inspirasi setelah volume tidal, bisa mencapai

3 liter

Volume Cadangan Ekspirasi = volume udara ekstra

yang dapat di ekspirasi setelah ekpirasi normal, bisa

mencapai 1,1 liter. Volume Residu adalah = volume udara yang masih

tetap berada di paru-paru sekalipun sudah dilakukan

ekspirasi kuat, bisa mencapai 1,2 liter.

0,5 + 3 + 1,1 + 1,2 = 5,8 liter


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Kapasitas Paru-Paru

Kapasitas Paru-paruadalah aplikasi/kombinasi dari

dua jenis volume paru-paru :

Kapasitas Inspirasi = VT+ VCI Kapasitas Residu Fungsional = VCE+ VR

Kapasitas Vital =VCI+ VT+ VCE

Kapasitas Paru-Paru Total = Kapasitas Vital + VR

Adi memiliki VT = 0,6; VCI = 3,2; VCE = 1,1; VR = 1

Hitung:

1. Kapasitas Inspirasi 3. Kapasitas Vital

2. Ka asitas Residu Fun sional 4. Ka asitas Total


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Frekuensi Pernapasan

Cepat lambatnya pernapasan dipengaruhi oleh:

1. Umur

Makin tua makin lambat, karena butuh sedikit

energi

2. Jenis Kelamin

Laki-laki lebih butuh banyak energi dibandingperempuan

3. Suhu Tubuh Suhu tubuh turun, O2makin butuh banyak untuk

meningkatkan metabolisme

4. Posisi Tubuh / Aktivitas

Makin aktif tubuh makin banyak butuh O2


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Mekanisme Pertukaran

O

2

dan CO

2


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Mekanisme Pertukaran O2 dan


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Mekanisme Pertukaran O2danCO2

Mechanisms of Pulmonary Ventilation


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Figure 2314

Mechanisms of Pulmonary Ventilation


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Respiration

Causes volume changes that create

changes in pressure

Volume of thoracic cavity changes: with expansion or contraction of

diaphragm or rib cage

The Respiratory Muscles


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Figure 2316a, b

e esp ato y Muscles



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Figure 2316c, d

3 Muscle Groups of Inhalation


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p1. Diaphragm:

contraction draws air into lungs

75% of normal air movement

2. External intracostal muscles:

assist inhalation

25% of normal air movement

3. Accessory musclesassist in elevating

ribs:

sternocleidomastoid serratus anterior

pectoralis minor

scalene muscles

Respiratory Performance and Age


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Respiratory Performance and Age

Figure 2328


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