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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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History of Anesthesia
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History of Anesthesia
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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Mekanisme Pernapasan
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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Mekanisme Pernapasan
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
The Respiratory Muscles
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The Respiratory Muscles
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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