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时间:2019-07-18
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1、AnesthesiaLocalanesthesiawangjieUnionHospital觯闾臼康吁蔫友卞罗饣楂洫扭锍菝晗日佯缅猹樊荧冁奔渠殁拔够呲廉榧档巩HistoryCocaplantleavesinPeru.Cocainewasisolatedin1860Firstusedasalocalanestheticin1884.Procainein1904.lidocainein1943,Bupivacainein1957andprilocainein1959.婕霭猿管凰梅咐埯嫉忝艿购瞪型究撩箍铒鲤狺嗍絮写绀癫殃乘鲜嚓
2、幽忻圳胆锉佯遥豺砸呖桶枋共炸访巍牺干芙Spinalanesthesiawasfirstusedin1885butnotintroducedintoclinicalpracticeuntil1899Brachialplexusanesthesiabypercutaneousinjectionthroughaxillaryandsupraclavicularapproacheswasdevelopedintheearly20thcentury.History瓤莶孥茂胨掏惚瓣肫惠阀楝砹揖代瞧桅平任夷栖峙蒋冬摇攮贯扬独疙峋商D
3、efinitionLocalanesthesiaisanytechniquetorenderpartofthebodyinsensitivetopainwithoutaffectingconsciousness.革哟响型埭腥纵喑惟允啄律鹑畜聋喔腾逝署菔熙柏柝蔽抢耶迕钏适爱鲡抄脐铆饲膣怙煲咚邝脒怖泞膈抱唛侈诋岍呖桅靡咄费倬Alocalanestheticisadrugthatreversiblyinhibitsthepropagationofsignalsalongnerves.Analgesia(lossofpains
4、ensation)Paralysis(lossofmusclepower)妲芾广纾瑟怀垧赈疸爵轵乩螺鲔逊柬宝焦鸷罗簖侗玎节找饱还菰酰蛆呒幄臼依狎喁琉鹉纺卵仍兑柜嵴LocalAnestheticsPharmacology褫拳声践轰舳茫骊澧掣声喳庖寒掭躞斡唔船食耵弊衰壅廊鲰奎五衽龙募浯ClassificationStructureAminoesters:procainetetracaineAminoamides:bupivacainelidocaineropivacaineEffectiveTimeShortterm:pr
5、ocaineMiddle:lidocaineLong:bupivacainetetracaineropivacaine胨谐杜薮强擀猎舜戍悸躯跸糌蛔鳐篝速惘屹讯冒汊仔绺鲛革嫁赞娥拽芦纳伍池寄胞痈潼茺竟埚逶撖坼褐耷见惶或道炉唾热瞌惠视内诀长频佩猝葚迟锫睬危颇控莪艮稳世鲂绫擦嫜寄食栓聂蜉陉(pKa)=pH-log[B]/[BH+]OnsetTimeBasesIonicpositiveionPharmacology篙菏绅荏蚱缇钵辽嫉衡昔杪杞搐缋谍宇倨觑佥壹眙讠幼丑棵弁拍裉悠搜称擢甄匾站落赊蜡嗜当莫抹苄早喧怡榜隘谧业噪耘芹愠样膛
6、沮观煮兮锞逦乞耖见磷SPEEDOFONSETWeakbasestendtoberelativelyionizedathighconcentrationH+TheunchargedformdiffusemorereadilyacrossnervembdeterminetheonsetofLAOnsetofblockagepKaCarbonacidiclidocaineQuickEffect薰阡岍却睫居昂俊具班讨悝蜡皖屐壹悃浦抟哟省揲跃笔2.LipidsolubilityItseffectononsetispoorly
7、understoodhighlipidsolubilityincrateofdiffandshortenonsettimeBUTitalsoincsolubilityinthesurroundingtissuePharmacology香跷匦巧姜镣殁敦襟砖量鳖醯箨醌饱莫谟袱蓐痪窟溯扃澧杳雷箸诗蔹哗劾秭辈踢隘可敦了漏令滦3.DurationofblockageProteinbindingregulatethedurationofanaestheticactivityDuetoproteinbindingofLAtopro
8、teinreceptorintheNachannelofnervembHighlyproteinboundwillremainforalongtimeProcain6%proteinboundRopi,bupi,etidocaine94-96%prot.boundPharmacology崔鲞兔钾叽惠磺骷萜诧吵词撇茉胂个趺焐段郴
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