intravenousanaesthesia：静脉麻醉

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1、MinimalandModerateSedationT.J.Gan,M.B.,F.R.C.A.,M.H.S.,Li.Ac.ProfessorofAnesthesiologyViceChairforClinicalResearchDukeUniversityMedicalCenterContentWhysedation?CurrentsedationpracticeGuidelinesfromprofessionalsocietygoverningsedationpracticePharmacologicpropertiesofsedativesMonitorin

2、gofpatientsundergoingsedationClinicaldataonfospropofolforsedationProceduralSedationOver40millionproceduresperformedeachyearwithmoderatesedationAbout23millionsendoscopicproceduresperformedannuallyDependingoftheintendedlevelofsedation,sedationisperformedbytrainednursesaswellasanesthesi

3、apersonnelApproximatelytwo-thirdsoftheendoscopicproceduralsedationperformedbynonanesthesiapersonnelImportanceofSedationReliefofanxietyandfearReliefofdiscomfortIncreasepatientcompliancewithscreening/surveillanceguidelinesEnhancequalityoftheexaminationMinimizerisksandphysicalinjurytoth

4、epatientsImproveoverexperienceandsatisfactionCommonSedationSitesColonoscopyBronchoscopyGastroscopycardiaccatheterizationOfficebasedoutpatientsurgeryEmergencydepartmentColonoscopySafeComplicationscanoccurMajorityarecardiopulmonarycomplications,e.g.oversedation,hypoventilation,aspirati

5、on,vasovagalCVcomplicationrate:2-4/1000Patientsatrisk:elderly,morbidlyobeseOverviewofagentsusedforminimaltomoderatesedation8CharacteristicsofanIdealSedativeRapidonsetofactionallowsrapidrecoveryafterdiscontinuation1Effectiveatprovidingadequatesedationwithpredictabledoseresponse1,2Easy

6、toadminister1,3Lackofdrugaccumulation1Fewadverseeffects1-3Minimaladverseinteractionswithotherdrugs1-3Predictabledoseresponse2Cost-effective31OstermannME,etal.JAMA.2000;283:1451-1459.2Jacobietal.CritCareMed.2002;30:119-141.3DastaJF,etal.Pharmacother.2006;26:798-805.4NelsonLE,etal.Anes

7、thesiol.2003;98:428-436.PharmacologicalAgentsinMACHypnoticsMidazolamPropofolMethohexitalKetamineNitrousoxideDexmedetomidineAnalgesicsOpioidsFentanylMeperidineHydromorphoneMorphineLocalanestheticsNSAIDSCurrentSedationPractice99%ofcolonoscopiesareperformedwithsedation75%withbenzodiazep

8、ineandopioid