Dexmedetomidine 用於降低小儿Sevoflurane麻醉后躁动.ppt

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1、Dexmedetomidine用於降低小兒Sevoflurane麻醉後躁動徐永偉醫師馬偕紀念醫院麻醉科2006.12.1LearningObjectives學習目標什麼是DexmedetomidineDexmedetomidine的藥理作用Dexmedetomidine用於麻醉的臨床報告Dexmedetomidine用於降低小兒Sevoflurane麻醉後躁動的研究：實證醫學的應用2Medetomidine動物鎮靜麻醉Ketamine(K他命）和Midazolam混合MedetomidineMedetomidine混合dextro-m

2、edetomidinelevo-medetomidine3Dexmedetomidine(Precedex®)CH3CH3NNCH3HDexmedetomidine:Alpha-2Agonist1999美國FDA核准使用4Dexmedetomidine(Precedex®)適應症：適用於在加護病房中，插管且接受呼吸器治療的病患鎮靜用。Precedex應該以連續輸注的方式給予，連續輸注以24小時為限。5有關Dexmedetomidine的研究2005:242006:256自主神經系統副交感交感新腎上腺素乙醯膽鹼腎上腺素接受器7腎上腺素接受器

3、Adrenergicreceptorsa1b1平滑肌節前Pre-synaptic氣管平滑肌心臟a2b2擴張心跳心搏量收縮抑制新腎上腺素NE分泌8a2腎上腺素接受器負回饋RegulatereleaseofneurotransmittersControlepinephrine,norepinephrinereleaseModulatesympatheticresponse“negativefeedbackloop”9Dexmedetomidine作用機轉10Dexmedetomidine作用部位作用部位Brain(locusceruleus)

4、第4腦室底上角之色素隆凸Spinalcord脊髓交感神經中樞神經之作用Sedation鎮靜Anxiolysis抗焦慮Analgesia止痛交感神經之作用SympatheticactivityBP,HRDexmedetomidineSpinalCordLOCUSCERULEUSFOURTHVENTRICLEPONSCEREBRUMCEREBELLUM112-ReceptorSubtypesα2Cα2Aα2Aa2A利尿止痛鎮靜心跳抑制顫抖血管12Precedex在呼吸以及止痛方面的研究Anesthesiology,November

5、200413Dexmedetomidine的使用(Adult)Heartblock心房心室傳導阻滯的病患，要小心使用Administerloadingdoseslowly第1個劑量要慢慢給Transientvasoconstrictionmediatedbyα2B-adrenoceptorswill↑BPloading:1mcg/kgover10minmaintenance:0.2to0.7mcg/kg/hrOnset:5-10minReducedeffect:30minDuration:2hour14Dexmedetomidine使用於

6、麻醉SevererespiratorycompromiseObesity“cooperativesedation”CraniotomyInterventionalproceduresunderLAe.g.vascularPainfulproceduresFiberopticintubationDecreasecoughduringemergenceStablehemodynamicwithpronepositionEffectonemergenceagitation15實證醫學實證醫學在Dexmedetomidinem預防emergenc

7、eagitation的應用16DexmedetomidineforemergenceagitationDouble-blindedRandomizedCase-controlStudiesLevelofEvidenceIb17LevelofEvidence18WhatDidTheySaidAboutDexmedetomidineforemergenceagitation0.3,0.5,1ug/kgDexmedetomidineaftersevofluraneinductionDecreaseemergenceagitationtoabou

8、t5~10%TimeatPACU(POR):Nodelay19Dexmedetomidineforemergenceagitation(AnesthAnalg2004;98:60–3)Grou