局部麻醉（英文）

《局部麻醉（英文）》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、ZhangLanDepartmentofAnesthesiologyofWestChinaHospitalRegionalAnesthesiaClinicalAnesthesiaGeneralAnesthesiaRegionalAnesthesiaTopicalanesthesiaPeripheralnerveblockLocalinfiltrationanesthesiaSpinal&EpiduralAnesthesia一、NerveBlocksDrug-Localanesthetics∆Servercomplicat

2、ion-thetoxicityofLAAnatomyandTechniqueLOCALANESTHETICS(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extremelysta

3、blerelativelyunstablehydrolyzedinplasmabythecholinesteraseenzymesundergoenzymaticdegradationintheliverChemicalstabilityBiotransformationLidocaine利多卡因Bupivacaine布比卡因Ropivavaine罗派卡因Procaine普鲁卡因Tetracaine的卡因LocalanestheticsofPeripheralnerveblockDrugdoseconcentration

4、durationRopivacaine150~200mg0.2~0.5%6~12hBupivacaine150mg0.2~0.5%6~12hLidocaine400mg0.5~1%1~3h◆ThetoxicityofLocalanestheticsReasonOverdoseIntravascularinjectionRapidsystemicabsorptionoflocalanestheticfromrichbloodsupplyareaPatientstatusCNSExcitationCNSDepressionD

5、izzinessTinnitusFeelingsofdrowsinessMuscleTwitchingConsciousnessConvulsionsRespiratoryDepressionRespiratoryArrestCentralNervousSystemToxicityCNSConductionPathwaysInhibitoryPathwaysExcitatoryPathwaysLACNSExcitationCNSDepressionBPHeartrateCardiacArrestCardiovas

6、cularSystemToxicityBP↑Heartrate↑CardiovascularSystemexcitationCardiovascularSystemdepressionDirectCardiacEffectsDirectPeripheralVascularEffectsNegativeinotropicactionFastconductingtissuesHighconcentrationsvasodilation.LowconcentrationsvasoconstrictionCardiovascul

7、arSystemdepressionLACNSexcitationCardiovascularSystemexcitationExcessivedosesofLASystemicabsorptionofLAintravascularinjectionofLATestdosesofLAPremedicationPreventionIncipienttoxicreactions:StopadministeringLA,ventilationsupportCNSexcitation:Sedativetreatment,Benz

8、odiazepineConvulsionThiopental:therapyConvulsionSuccinylcholine:IntubationmaintainingadequateventilationCardiovascularSystemdepression:supportedbyusingIVfluids