Dexmedetomidine对於止血带所引起术中高血压的疗效及药理机转之探讨.pptxVIP

Dexmedetomidine对於止血带所引起术中高血压的疗效及药理机转之探讨第1页/共22页 Medetomidine動物鎮靜麻醉Ketamine (K他命）和 Midazolam 混合Medetomidine Medetomidine混合dextro-medetomidine levo-medetomidine第2页/共22页 DexmedetomidineAlpha-2 Agonist1999 美國FDA 核准使用Drugα2/α1 selectivityDexmedetomidine1600Medetomidine1200Clonidine200Dyck, Shafer. Aneasth Pharm Review. 1993第3页/共22页 Dexmedetomidine (Precedex?)適應症：適用於在加護病房中，插管且接受呼吸器治療的病患鎮靜用。Precedex應該以連續輸注的方式給予，連續輸注以24小時為限。第4页/共22页 自主神經系統副交感交感新腎上腺素乙醯膽鹼腎上腺素接受器第5页/共22页 腎上腺素接受器Adrenergic receptorsa1b1平滑肌節前Pre-synaptic氣管平滑肌心臟a2b2擴張心跳心搏量收縮抑制新腎上腺素NE 分泌第6页/共22页 a2腎上腺素接受器負回饋Regulate release of neurotransmittersControl epinephrine, norepinephrine releaseModulate sympathetic response “negative feedback loop”第7页/共22页 Dexmedetomidine作用機轉第8页/共22页 Dexmedetomidine作用部位作用部位Brain (locus ceruleus)第4腦室底上角之色素隆凸Spinal cord 脊髓交感神經 中樞神經之作用Sedation 鎮靜Anxiolysis 抗焦慮Analgesia 止痛交感神經之作用 ? Sympathetic activity? BP, ? HRDexmedetomidineSpinal CordLOCUSCERULEUSFOURTHVENTRICLEPONSCEREBRUMCEREBELLUM第9页/共22页 ?2-Receptor Subtypesα2Cα2Aα2Aa2A利尿止痛鎮靜心跳抑制顫抖血管第10页/共22页 Mechanism for α2-induced sedation/ hypnosis in the rat locus coeruleus第11页/共22页 第12页/共22页 Dexmedetomidine: Side EffectsBradycardiaHypotensionTransient hypertensionDry mouthLimited amnestic effectExcessive sedationReduction in CBF/CMRO2 in animal model第13页/共22页 Dexmedetomidine 的使用 (Adult)Heart block 心房心室傳導阻滯的病患，要小心使用Administer loading dose slowly 第1個劑量要慢慢給 Transient vasoconstriction mediated by α2B-adrenoceptors will ↑ BPloading : 1 mcg/kg over 10 min maintenance : 0.2 to 0.7 mcg/kg/hrOnset: 5 -10 minReduced effect: 30 minDuration: 2 hour第14页/共22页 Tournique induced hypertensionIncidence: 30%Tourniquet time 60 minAssociated with severe pain and augmented sympathetic outflowDifficult treatmentUnknown mechanism 第15页/共22页 Previous study dataKetamine ( Satsumae et al. AA, 2001)Clonidine ( Zalunardo et al. AA, 2002)Dextromethrophan ( Yamashita et al. AA, 2004)Stellate ganglion blockade ( Arai et al. Acta Anesthesiol Scand, 2004) Dexmedetomidine?第1