《右美托咪定课件》.ppt

* * Sedation/Analgesia: Opioids The opioids are analgesic agents with a secondary effect of anxiolysis. These agents are useful for patients who require pain medication and are agitated as a result of their pain. These agents do not promote hypnosis or amnesia. Opioids act synergistically with benzodiazepines. Opioids cause respiratory depression and may delay weaning from ventilation. Opioids disturb natural sleep. They may increase fragmentation of sleep and decrease REM and slow-wave sleep. Sleep deprivation and its consequences may result. Harvey MA. Managing agitation in critically ill patients. Am J Crit Care. 1996;5:7-16. * * Sedation/Analgesia: ?2 Agonists The ?2 agonists cover the spectrum of patient needs, including analgesia, anxiolysis, hypnosis, and, to some extent, amnesia.1 The dexmedetomidine-treated patient, when aroused, is less confused and disoriented than the benzodiazepine-treated patient. Indeed, the quality of dexmedetomidine sedation offers several advantages in ICU sedation.2 When patients are sedated with dexmedetomidine, they appear to be asleep. When aroused, they are alert, but when left alone, they return to a sleeping state.2 Dexmedetomidine also reduces ketamine-induced post-anesthesia delirium.3 1.?Aantaa R, Kallio A, Virtanen R. Dexmedetomidine, a novel ?2-adrenergic agonist: a review of its pharmacodynamic characteristics. Drugs of the Future. 1993;18:49-56. 2. Mantz J, Singer M. Importance of patient orientation and rousability as components of intensive care unit sedation. In: Maze M, Morrison P, eds. Redefining Sedation. London, UK: The Royal Society of Medicine Press Ltd; 1998:23-29. 3. Lev?nen J, M?kel? ML, Scheinin H. Dexmedetomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anesthesiol. 1995;82:1117-1125. 右美托咪定:副作用 BP HR中度下降 65岁 低血容量 高迷走张力 糖尿病 高血压 严重心脏传导阻滞 有的患者应慎用（利尿） 给予负荷量时短暂高血压 还没有确定用于 18岁或产妇安全性 慎用于 1）? 高龄病人 2）? 低血容量 3）? 传导障碍 4） 肝肾功能不全 5） 糖尿病或慢性高血压