【外科学习课件】_4.2.2局麻Reginal Anaesthesia.pptVIP

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2020-10-14 发布于四川
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【外科学习课件】_4.2.2局麻Reginal Anaesthesia.ppt

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Combined spinal-epidural anesthesia Differential nerve blockade of regional block Sympathetic fibers block Sensory block Motor block Clinical Anaesthesiology(Reginal Anaesthesia) 内容局麻的方法局麻药种类和常用剂量局麻药毒性反应的临床表现、预防和治疗原则椎管内麻醉阻滞的生理、实施方法、管理方法椎管内麻醉并发症及处理原则 Contents Methods of local anaesthesia Local anesthetics Regional block manipulation Physiology effects of regional block Management of regional block Complications of regional block Methods of local anaesthesia Surface anaesthesia Local infiltration Field block Regional blocks (Spinal, epidural, caudal blocks) Peripheral nerve blocks Local Anesthetics Ester local anesthetics Amide local anesthetics Ester local anesthetics Esters. Procaine, cocaine, chloroprocaine, and tetracaine The ester linkage is cleaved by plasma cholinesterase The half-life of esters in the circulation is very short (about 1 minute) The degradation product of ester metabolism is p-aminobenzoic acid Amide local anesthetics Amides. Lidocaine, mepivacaine, bupivacaine, etidocaine, and ropivacaine The amide linkage is cleaved through initial N-dealkylation followed by hydrolysis, which occurs primarily in the liver Clinical uses of local anesthetics The choice of local anesthetic must take into consideration Duration of surgery Regional technique used Surgical requirements Potential for local or systemic toxicity Any metabolic constraints Complications of local anaesthesia Local anaesthetic toxicity Allergic reactions Local toxicity Systemic toxicity Hypotension Motor blockade Pneumothorax Urinary retention Neurological complications Horner syndrome Local anaesthetic toxicity Allergic reactions Local toxicity Systemic toxicity Local anaesthetic toxicity Allergic reactions Ester-type local anesthetics: cause allergic reactions from the metabolite p-aminobenzoic acid Amide-type local anesthetics: rare Local hypersensitivity reactions: local erythema, urticaria, edema, or dermatitis Systemic hypersensitivity rea