麻醉心搏骤停的原因与防治_培训课件.pptVIP

Weinberg’s dose regimen for use in humans Intravenous Intralipid 20% 1. Give 1 ml / kg over 1 min. 2. Repeat twice more at 3～5 min intervals 3. Then ( or sooner if stability is restored), convert to an infusion at a rate of 0.25 ml / kg / min, continuing until haemodynamic stability is restored Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob Editorial, Anaesthesia February 2006 Recommendation: Lipid emulsion, along with Weinberg’s protocol, should be immediately available whenever patients receive large boluses of local anaesthetic and that patient in cardiac arrest attributable to overdose with local anaesthetic should be able to resuscitate following current advanced life support guidelines, with the addition of a lipid emulsion. Case report 1 Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine- related cardiac arrest Rosenblatt MA et al Anesthesiology 2006; 105:217-8 ? 58 year male ? History of CAD, CABG, RBBB, LAH ? Elective shoulder surgery ? ISB with Bupivacaine 100 mg and Mepivacaine 300 mg ? Brief seizure followed by asystole with interval of VTs ? Refractory to multiple cycles of CPR (drugs and shocks) ? Received 100 ml of 20% Intralipid ? Return of SR and normal BP ? Patients trachea was successfully extubated and recovered without neurological deficit Case report 2 Successful resuscitation of a patient with ropivacaine induced asystole after axillary brachial plexus block using lipid infusion Litz RJ et al Anaesthesia 2006; 61: 800-801 ? 84 year female for elective surgery on a Dupuytren contracture ? History of Morgagni-Adams-Stokes syndrome, LBBB, MR TR ? Axillary BPB with Ropivacaine 400 mg ? Seizure followed by severe bradycardia and asystole ? CPR for 10 minute with 3 doses of Epinephrine without success ? Received 100 ml of Intra