(精选)Toxicity of Local Anesthetics教学课件.pptVIP

A. BorgeatBalgrist University Hospital, ZurichSwitzerland;Faculty Disclosure;Nerve;;CNS Toxicity;First Stage numbness, metalic flavour, dysgeusea;Regional anesthesia and seizures(retrospective study);Seizures after PNB(prospective study);Interaction Propofol - Remifentanil;Total;;CNS toxicity after IVRA: lidocaine 0.5% versus ropivacaine 0.2% in volunteers;CNS toxicity of ropivacaine and levopubivacaine: a volunteer study; ;Drug;Factors influencing toxicity; ; ; ; ; ;Continuous infusion of ropivacaine for pain relief after iliac crest bone grafting for shoulder surgery;Booker et alBr J Anaesth 1996;76:365,;Effect of age on the serum concentration of AAG in 35 male and 33 female subjects;NormalCNS activity;CNS toxicity: treatment ;CNS depression ? respiratory depression;CNS toxicity: treatment ; ;3.5 min; ;Systemic toxicity of LA: why the brain first ? ;Cardiac Toxicity; ;First Stage numbness, metalic flavour, dysgeusea;Cardiotoxicity of local anesthetics;Local anesthetics :physiochemical properties;Cardiotoxicity of LA : effect on sodium channel;;;;;;Bupivacaine n=11 ;;; ; ;Influence of stereoselectivity on cardiac toxicity;CV resuscitation Epinephrine Intralipid (bupivacaine); Lipids for Local Anesthetics Has the Silver Bullet been Identified?;Anaesthesia 2006;61:800,;Dillane D et al. Can J Anesth 2010; 57:368-80;;no significant differences regarding starting points prophylactic substitution of lipids: significant duration till cardiac arrest for bupivacaine  no significant differences for ropivacaine and mepivacaine ;Protocol: Isolated rat hearts were perfused with or without intralipid before administration of bupivacaine or mepivacaine;Protocol: Newborn piglets received levobupivacaine until CV collapse - Saline - Intralipid alone - Epinephrine alone - Intralipid + epinephrine;Mauch J et al.  Paed Anaesth 2011; 21:1103,;Notably, ILE h