静脉麻醉的革命ppt课件.ppt

;;IV vs VOLATILE;POPULARITY OF INHALATIONAL ANAESTHETICS ;TOXICITY OF INHALATIONAL ANAESTHETICS ;CONTROL OF SUBSTANCESHAZARDOUS TO HEALTH;CONTROL OF SUBSTANCESHAZARDOUS TO HEALTH;TOXICITY OF INHALATIONAL ANAESTHETICS ;TOXICITY OF INHALATIONAL ANAESTHETICS;TOXICITY OF VOLATILE AGENTS ;TOXICITY OF VOLATILE AGENTS;Sevoflurane anaesthetic causes a transient decrease in aquaporin-2 and impairment of urine concentration Morita K. et al. BJA 1999; 83: 734-9;TOXICITY OF INHALATIONAL ANAESTHETICS ;TIVA FOR THORACIC SURGERY;Sevoflurane, but not propofol, significantly prolongsthe Q-T intervalKleinsasser,A et al. Anesth Analg 2000; 90: 25-27;Reversing sevoflurane-associated Q-Tc prolongation by changing to propofolKleinsasser, A. et al. Anaesthesia 2001; 56: 248-50;;Cerebral microdialysis II:;Glycerol Concentrations after 15, 120 and 240 minutes;Glutamate Concentrations after 15, 120 and 240 minutes;CEREBRAL MICRODIALYSISXENON vs N2O;MALIGNANT HYPERTHERMIA;INDUCTION;RECOVERY;ALERTNESS;Left atrium;VAPORISERS;VAPORISERS;POSTOPERATIVE NAUSEA AND VOMITING;SINGLE AGENT AMBULATORY ANAESTHESIA;SINGLE AGENT AMBULATORY ANAESTHESIA;SEVO IN SICK BOWL;PROPOFOL OR SEVOFLURANE FOR OFFICE-BASED ANAESTHESIA;Emergence Agitation After Sevoflurane;WOULD REFUSE A REPEAT INDUCTION WITH SEVOFLURANE;WOULD REFUSE A REPEAT INDUCTION WITH SEVOFLURANE;WOULD REFUSE A REPEAT INDUCTION WITH SEVOFLURANE;V I M A;V I M A;MINOR GYN SURGERYblood loss;PHARMACOKINETICS !!;PHARMACOKINETICS !!;MANUAL INFUSION REGIMENS FOR PROPOFOL;;;;;;;Initial Dose = C1 x target = 16 litres x 6 = 96mg (100mg);MAINTENANCE;C3;REQUIREMENTS OF TIVA;SOLUTION TO TIVA;;;;;PHARMACOKINETIC VARIATIONS;Practical Aspects of Intravenous Anaesthesia: propofol;Population Kinetics !!;Individual Kinetics ?;CAUSE OF PHARMACOKINETIC VARIATIONS;MEASURED / PREDICTED BLOOD CONCENTRATIONS OF PROPOFOL;White, M. and Kenny, G.N. (1990) Intravenous propofol anaesthesia using a computerised infusion system. Anaesthesia 45, 204-209;W