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ID:19553235
大小:653.00 KB
页数:42页
时间:2018-10-03
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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+Theunchargedformdiffusemorereadilyacrossnervembdet
5、erminetheonsetofLAOnsetofblockagepKaCarbonacidiclidocaineQuickEffect2.LipidsolubilityItseffectononsetispoorlyunderstoodhighlipidsolubilityincrateofdiffandshortenonsettimeBUTitalsoincsolubilityinthesurroundingtissuePharmacology3.DurationofblockageProteinbindin
6、gregulatethedurationofanaestheticactivityDuetoproteinbindingofLAtoproteinreceptorintheNachannelofnervembHighlyproteinboundwillremainforalongtimeProcain6%proteinboundRopi,bupi,etidocaine94-96%prot.boundPharmacologyPlasmaconcentration:dependsonabsorptionkineti
7、csHOWWHEREsystemicdispositionkineticsDistributionEliminationmetabolismPlasmaEZLiverEZexcretionPharmacologyPHARMACOKINETICSAbsorptionofLASiteofinjection(intercostal>caudal>brachialplexusetc)Dosage(bloodlevelofLArelatedtototaldoseofdrugratherthanspesificvolume
8、orconcentrationofsolutionAdditionofvasoconstrictorMetabolismofLAA.ESTERSRapidhydrolysisbyplasmacholinesteraseWatersolublemetabolitesexcretedintheurine(p-aminobenzoic,diethyl
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