Epidural Anesthesia - Cheatsheet - daily Ojik

Contekan Insersi dan target blok epidural

CAUDAL BLOCK

Agent:

• Bupivacaine 0.25%, atau 
• Lidocaine 1%

Dosis:  

• LumboSacral 0.5-0.75 mg/kgBB
• Lower Abdomen 0.75-1 mg/kgBB
• Upper Abdomen 1-1.5 mg/kgBB

Epidural Anesthesia - Cheatsheet

CERVICAL EPIDURAL

Pro:

• Thyroidektomi Mastektomi dll

Insersi:

• C6/C7, atau 
• C7/T1 posisi prone (duduk), atau
• Th 4-5 (cat. 4 di ruang epidural)

Target blok:

• C2/4-T10

Bromage Score:

• 0.6-0.8 ml / segment

Agent:

• Lidocaine 2% 7 ml +/- Epinephrine = 140 mg
• Maintenance Dose 4-5 ml / 60 menit = 80 ml, atau
• Ropivacaine 0.75% 10 ml + 10 mcg Sufentanyl
• Bupivacaine 0.25% 10 ml + 25 mcg Fentanyl

EPIDURAL

UROLOGI

Extended Nefrektomi (CEGA - Combined Epidural GA)
Insersi: 

• Th9 - 10

Target Blok: 

• Th6 - L2 = 9 segment

Bromage score: 

• 0.9 - 1 - 1.2 ml /segment

Agent:

• Lidocaine 2% + Epinephine = 162 - 180 - 216 mg, atau
• Bupivacaine 0.25% = 22.5 - 25 - 27 mg

Dosis toksis:

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB

Open Prostatektomi (Epidural)
Insersi:

• L2-L3

Target Blok:

• Th8- S2 = 12 segmen

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidocaine 2% + Epi = 160-180 mg, atau
• Bupivacaine 0.5% = 60 mg

Dosis toksis :

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB

OBGYN

HT-SOB atau SC (Epidural)
Insersi:

• Th11 - 12
• Th10 - 11

Target Blok:

• Th6- S2 = 14 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidocaine 2% = 252 - 280 - 336 mg
• Bupivacaine 0.5% = 63 - 70 - 84 mg

Dosis toksis:

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB

ORTOPEDI

ORIF DHS atau THR atau TKR (Epidural Murni)
Insersi:

• L2-3
• L3-4

Target Blok:

• Th12 - S3 = 9 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidokain 2% = 160 - 180 mg
• Bupivacain 0.5% = 50 mg

Dosis toksis:

• Bupivacain 3 mg / kgBB
• Lidokain 5 mg / kgBB
• Lidokain + epinefrin 7 mg / kgBB
  

DIGESTIF

Hemorrhoidektomi (Epidural Murni)
Insersi:

• L2-3

Target Blok:

• Th12 - S3 = 9 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidokain 2% = 180 mg - 200 mg
• Bupivacain 0.25% = 35 mg

Dosis toksis :

• Bupivacain 3 mg / kgBB
• Lidokain 5 mg / kgBB
• Lidokain + epinefrin 7 mg / kgBB
  

Laparotomi Eksplorasi (CEGA - Combined Epidural GA)
Insersi:

• Th9 - 10

Target Blok:

• Th6 - S2 = 14 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidocaine 2% = 252 - 280 - 336 mg
• Bupivacaine 0.25% = 32 - 35 - 42 mg

Dosis toksis :

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB

Prosedur Miles (Epidural + Sedasi)
Insersi:

• Th11 - 12

Target Blok:

• Th6 - S5 = 17 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidocaine 2% = 282 - 340 - 360 mg
• Bupivacaine 0.5% = 76 - 85 - 94 mg

Dosis toksik:

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB

• (60=420; 55=385; 50=350)

Laparotomi Eksplorasi CBD (CEGA - Combined Epidural GA)
Insersi:

• Th9 - 10

Target Blok:

• Th4 - L2 = 10 segment

Bromage score:

• 0.9 - 1 - 1.2 ml / segment

Agent:

• Lidocaine 2% = 252 - 280 - 336 mg
• Bupivacaine 0.25% = 25 mg

Dosis toksik:

• Bupivacaine 3 mg / kgBB
• Lidocaine 5 mg / kgBB
• Lidocaine + Epinephrine 7 mg / kgBB