局部麻醉(英文版)　.ppt

Anesthesia;Local anesthesia ;History;Spinal anesthesia was first used in 1885 but not introduced into clinical practice until 1899 Brachial plexus anesthesia by percutaneous injection through axillary and supraclavicular approaches was developed in the early 20th century. ;Definition;A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. Analgesia (loss of pain sensation) Paralysis (loss of muscle power) ;Local Anesthetics Pharmacology;Classification;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+] Onset Time ;SPEED OF ONSET;2. Lipid solubility Its effect on onset is poorly understood high lipid solubility ? inc rate of diff and shorten onset time BUT it also inc solubility in the surrounding tissue;3. Duration of blockage Protein binding regulate the duration of anaesthetic activity Due to protein binding of LA to protein receptor in the Na channel of nerve mb Highly protein bound will remain for a long time Procain ? 6% protein bound Ropi, bupi, etidocaine ? 94-96% prot. bound;Plasma concentration : depends on ? absorption kinetics HOW WHERE ? systemic disposition kinetics Distribution Elimination ? metabolism Plasma EZ Liver EZ ? excretion ;Absorption of LA;Metabolism of LA;Cont.;Mechanism of action;Order of sensory function block ;Local anesthetics Side effect;Toxicity may occur if The maximum safe dose is exceeded Transient high blood levels are achieved by accidental intravenous injection Rapid absorption from an inflamed or vascular area Use normal dose to weak patients;Clinic presentation Numbness or tingling of the tongue and circumoral area Lightheadedness,anxiety,restlessness, drowsiness and/or complain of tinnitus and visual disturbance ;Central nervous system;Cardiovascular system;Prevention of toxicity A benzodiazepam premedication is recommended Do not exceed the maximum safe dose for the particular local anaesthetic used All injections should be give