右美托咪啶的基础与临床1课件.pptVIP

* Summary of actions: CNS – sedation/anxiolysis locus ceruleus CNS – analgesia spinal, substance P Cardiovascular – bradycardia sympathetic inhibition Cardiovascular – hypertension early, peripheral ?1 agonism Cardiovascular – hypotension later, sympathetic inhibition ? vasodilation Renal – diuresis ANP/renin/vasopressin * Bispectral index BIS is a widely used quantitative parameter for evaluating anesthesia and sedation levels. Dexmedetomidine is a novel sedative, providing sedation while patients remain cooperative and can be easily aroused; as a consequence, BIS used with dexmedetomidine may poorly characterize sedation. Thus, we tested the hypothesis that BIS values are lower with dexmedetomidine than with propofol at comparable Observers Assessment of Alertness and Sedation OAA/S scores. * In mechanically ventilated ICU patients managed with individualized targeted sedation, use of a dexmedetomidine infusion resulted in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion * Kaplan-Meier curve showing probability of survival during the first 28 days according to treatment group, among patients with sepsis. Dexmedetomidine decreased the probability of dying within 28 days by 70%; this beneficial effect was not seen in patients who were not septic P value for interaction 0.11 implying an interaction between sepsis and the treatment groups . * Atrophy:肌萎缩 * * Interpretable:可解释的，native:天生的， * * Overall goal of anesthesia is to establish + maintain adequate drug concentration at effector site to produce desired effect Dex can help optimize anesthesia via: Sedation/hypnosis, analgesia + ?? sympathetic activity Attenuation of stress response with ? HR Smooth emergence + tracheal extubation Unique mechanism of action on natural sleep pathway permits patients to be well rested yet easily aroused Pain control w/o respiratory depression Adjunct agent of choice for many surgeries *  AIRW