局部麻醉（英文）ppt培训课件

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1、ZhangLanDepartmentofAnesthesiologyofWestChinaHospitalRegionalAnesthesiaClinicalAnesthesiaGeneralAnesthesiaRegionalAnesthesiaTopicalanesthesiaPeripheralnerveblockLocalinfiltrationanesthesiaSpinal&EpiduralAnesthesia一、NerveBlocksDrug-Localanesthetics∆Servercomplication-thetoxicityofLAAnatomyandTechniqu

2、eLOCALANESTHETICS(LA)十八世纪中，人们咀嚼古柯叶感受舒适感和增加耐力1860年，从古柯叶中发现了可卡因1884年，可卡因先后用于眼部局麻手术、颌神经阻滞、脊髓麻醉、硬膜外麻醉和蛛网膜下腔阻滞麻醉1905年发现普鲁卡因、丁卡因、利多卡因、布比卡因等，可卡因因其成瘾性高和安全性低而被淘汰。LidocaineBupivacaineRopivavaineProcaineTetracaine酰胺类局麻药酯类局麻药extremelystablerelativelyunstablehydrolyzedinplasmabythecholinesteraseenzymesundergoen

3、zymaticdegradationintheliverChemicalstabilityBiotransformationLidocaine利多卡因Bupivacaine布比卡因Ropivavaine罗派卡因Procaine普鲁卡因Tetracaine的卡因LocalanestheticsofPeripheralnerveblockDrugdoseconcentrationdurationRopivacaine150~200mg0.2~0.5%6~12hBupivacaine150mg0.2~0.5%6~12hLidocaine400mg0.5~1%1~3h◆ThetoxicityofLoc

4、alanestheticsReasonOverdoseIntravascularinjectionRapidsystemicabsorptionoflocalanestheticfromrichbloodsupplyareaPatientstatusCNSExcitationCNSDepressionDizzinessTinnitusFeelingsofdrowsinessMuscleTwitchingConsciousnessConvulsionsRespiratoryDepressionRespiratoryArrestCentralNervousSystemToxicityCNSCond

5、uctionPathwaysInhibitoryPathwaysExcitatoryPathwaysLACNSExcitationCNSDepressionBPHeartrateCardiacArrestCardiovascularSystemToxicityBP↑Heartrate↑CardiovascularSystemexcitationCardiovascularSystemdepressionDirectCardiacEffectsDirectPeripheralVascularEffectsNegativeinotropicactionFastconductingtissu

6、esHighconcentrationsvasodilation.LowconcentrationsvasoconstrictionCardiovascularSystemdepressionLACNSexcitationCardiovascularSystemexcitationExcessivedosesofLASystemicabsorptionofLAintravascularinjectionofLATestdosesofLAPremedicationPreventionIncipienttoxicreactions:StopadministeringLA,ventilationsu

7、pportCNSexcitation:Sedativetreatment,BenzodiazepineConvulsionThiopental:therapyConvulsionSuccinylcholine:IntubationmaintainingadequateventilationCardiovascularSystemdepression:supportedbyusingIVfluids