局部麻醉英文版 ppt课件

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1、AnesthesiaLocalanesthesiawangjieUnionHospitalHistoryCocaplantleavesinPeru.Cocainewasisolatedin1860Firstusedasalocalanestheticin1884.Procainein1904.lidocainein1943,Bupivacainein1957andprilocainein1959.Spinalanesthesiawasfirstusedin1885butnotintroducedintoclinica

2、lpracticeuntil1899Brachialplexusanesthesiabypercutaneousinjectionthroughaxillaryandsupraclavicularapproacheswasdevelopedintheearly20thcentury.HistoryDefinitionLocalanesthesiaisanytechniquetorenderpartofthebodyinsensitivetopainwithoutaffectingconsciousness.Aloca

3、lanestheticisadrugthatreversiblyinhibitsthepropagationofsignalsalongnerves.Analgesia(lossofpainsensation)Paralysis(lossofmusclepower)LocalAnestheticsPharmacologyClassificationStructureAminoesters:procainetetracaineAminoamides:bupivacainelidocaineropivacaineEffe

4、ctiveTimeShortterm:procaineMiddle:lidocaineLong：bupivacainetetracaineropivacaine(pKa)=pH-log[B]/[BH+]OnsetTimeBasesIonicpositiveionPharmacologySPEEDOFONSETWeakbasestendtoberelativelyionizedathighconcentrationH+Theunchargedformdiffusemorereadilyacrossnervembdet

5、erminetheonsetofLAOnsetofblockagepKaCarbonacidiclidocaineQuickEffect2.LipidsolubilityItseffectononsetispoorlyunderstoodhighlipidsolubilityincrateofdiffandshortenonsettimeBUTitalsoincsolubilityinthesurroundingtissuePharmacology3.DurationofblockageProteinbindin

6、gregulatethedurationofanaestheticactivityDuetoproteinbindingofLAtoproteinreceptorintheNachannelofnervembHighlyproteinboundwillremainforalongtimeProcain6%proteinboundRopi,bupi,etidocaine94-96%prot.boundPharmacologyPlasmaconcentration:dependsonabsorptionkineti

7、csHOWWHEREsystemicdispositionkineticsDistributionEliminationmetabolismPlasmaEZLiverEZexcretionPharmacologyPHARMACOKINETICSAbsorptionofLASiteofinjection(intercostal>caudal>brachialplexusetc)Dosage(bloodlevelofLArelatedtototaldoseofdrugratherthanspesificvolume

8、orconcentrationofsolutionAdditionofvasoconstrictorMetabolismofLAA.ESTERSRapidhydrolysisbyplasmacholinesteraseWatersolublemetabolitesexcretedintheurine(p-aminobenzoic,diethyl