第7章 静脉麻醉药

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1、IntravenousAnestheticsLinHan静脉的,静脉注射的，ivintravenousanesthetics：静脉麻醉药sedation：镇静（adj.sedative）hypnosis：催眠药（adj.hypnotic）thiopental：硫喷妥钠barbiturate：巴比妥酸盐endogenous：内源性的,内在的propofol：异丙酚benzodiazepine：苯(并)二氮卓类NewWordspharmacokinetics:药物(代谢)动力学，药代学pharmacodynamics:药效动力学，药效学etomidate：依托咪酯

2、ketamine：氯安酮diazepam：地西泮,安定lorazepam：劳拉安定midazolam：咪达唑仑NewWordsanalgesia:镇痛opioid:阿片morphine：吗啡pethidine：哌替啶fentanyl：芬太尼sufentanil：舒芬太尼alfentanil：阿芬太尼remifentanil：雷米芬太尼NewWordsTwoCategoriesIntravenousSedativeHypnoticsOpioidIntravenousAnestheticsThestandardsofanidealintravenousanesth

3、eticDrugcompatibilityandstabilityinsolutionLackofpainoninjectionortissuedamagefromextravasationLowpotentialtoreleasehistamineorhypersensitivityreactionsRapidandsmoothonsetofactionwithoutexcitatoryactivityRapidmetabolismtopharmacologicallyinactivemetabolites配伍性,相容性渗出超敏反应Thestandardso

4、fanidealintravenousanestheticTitratabilityandminimizesaccumulationLackofacutecardiovascularandrespiratorydepressionDecreasesincerebralmetabolismandintracranialpressureRapidandsmoothreturnofconsciousnessandcognitiveskillsAbsenceofpostoperativenauseaandvomiting,amnesia,psychomimeticre

5、actions,dizziness,headache,orprolongedsedation可滴定蓄积遗忘精神样反应Awidelyacceptedtheoryofanestheticactionisthatbothivandinhalationalanestheticsexerttheirprimarysedativeandhypnoticeffectsthroughaninteractionwiththeinhibitoryg-aminobutyricacid(GABA)neurotransmittersystemThedegreeofmodulationo

6、ftheGABA-receptorfunctionislimited,whichexplainsthe“ceilingeffect”producedbybenzodiazepineswithrespecttoCNSdepression.P82GABA受体功能的调节程度是有限的，因此苯二氮卓类对中枢神经系统的抑制作用会出现“封顶效应”TheCNSpropertiesofbenzodiazepines(e.g.,hypnosis,sedation,anxiolysis,anticonvulsanteffects)arepresumedtobeassociatedw

7、iththestimulationofdifferentreceptorsubtypesand/orconcentration-dependentreceptoroccupancy.P82苯二氮卓类的中枢神经系统特性(如镇静、催眠、抗焦虑、抗惊厥作用)可能与刺激不同的受体亚型和/浓度依赖性受体占有的不同有关。MechanismofAction封顶效应抗惊厥的Ketamineproducesafunctionaldissociationbetweenthethalamocorticalandlimbicsystems,astatethathasbeenterme

8、d“dissociative”anes