右美托咪定的临床应用.pptVIP

Acknowledgements Medical Research Council (UK) RCoA/BJA AAGBI Action Medical Research ESA CW Medical School and NHS Trust Colleagues * sdfgafgafga * Clinical Applications of Dexmedetomidine:From bench to bedside  Dr. Daqing Ma MD, PhD Anaesthetics, Pain Medicine Intensive Care Department of Surgery Cancer Imperial College London Magill Anaesthesia department Chelsea and Westminster Hospital Annual meeting of Chinese Society of Anesthesiology -Sept 24 , 2010 Beijing  新晨卫星会 Outline Introduction Laboratory bench work Bedside: clinical applications (sedation; pain relief; anaesthesia) Conclusions Alpha-2 adrenoceptor agonist –History Old drug for veterinary anaesthesia since 1967. Central alpha-2 receptor being established at 1981. Xylazine + Ketamine for rodents … Cattle Anxiolysis Analgesia Sedation Anaesthetic sparing Cytoprotection Clonidine ?2:?1 = 200:1 10 min 9-12 hrs 20% 1.7-2.5 L/kg Liver 50% Kidney 30% Faeces 20% Dexmedetomidine ?2:?1 = 1600:1 5 min 2 hrs 94% 200L ????? Cl Cl N NH N H N N H C CH3 H CH3 H3C Alpha-2 adrenoceptor agonist-Pharmacokinetics Selectivity t1/2 ? t1/2 ? Binding to albumin Volume distribution Metabolised Alpha-2 adrenoceptor agonist-Pharmacodynamics Ca++ Ca++ Ca++ – – + Decrease in influx of Ca++ Decrease in actionpotential due tohyperpolarization ?2A ?2AR Go Gk K+ K+ K+ Alpha-2 adrenoceptor agonist-Pharmacodynamics Hypotension Bradycardia Imidazoline receptor agonist – Dex Two subtypes of imidazoline receptor I1 and I2 I1 receptors: restricted distribution in the ventrolateral medula I2 receptors: Brain, kidney and pancreas, function not clear Dexmedetomidine: Sedation Dexmedetomidine vs sedation or sleep The sleep switch: hypothalamic control o