局部麻醉（英文）.ppt

ZhangLanDepartmentofAnesthesiologyofWestChinaHospitalRegionalAnesthesia

ClinicalAnesthesiaGeneralAnesthesiaRegionalAnesthesiaTopicalanesthesiaPeripheralnerveblockLocalinfiltrationanesthesiaSpinalEpiduralAnesthesia

一、NerveBlocksDrug-Localanesthetics?Servercomplication-thetoxicityofLAAnatomyandTechnique

LOCALANESTHETICS

(LA)

1905年发现普鲁卡因、丁卡因、利多卡因、布比卡因等，可卡因因其成瘾性高和安全性低而被淘汰。

LidocaineBupivacaineRopivavaineProcaineTetracaine酯类局麻药

extremelystablerelativelyunstablehydrolyzedinplasmabythecholinesteraseenzymesundergoenzymaticdegradationintheliverChemicalstabilityBiotransformationLidocaine利多卡因Bupivacaine布比卡因Ropivavaine罗派卡因Procaine普鲁卡因Tetracaine的卡因

LocalanestheticsofPeripheralnerveblockDrugdoseconcentrationdurationRopivacaine150~200mg0.2~0.5%6~12hBupivacaine150mg0.2~0.5%6~12hLidocaine400mg0.5~1%1~3h

◆ThetoxicityofLocalanesthetics

ReasonOverdoseIntravascularinjectionRapidsystemicabsorptionoflocalanestheticfromrichbloodsupplyareaPatientstatus

CNSExcitationCNSDepressionDizzinessTinnitusFeelingsofdrowsinessMuscleTwitchingConsciousnessConvulsionsRespiratoryDepressionRespiratoryArrestCentralNervousSystemToxicity

CNSConductionPathwaysInhibitoryPathwaysExcitatoryPathwaysLACNSExcitationCNSDepression??

BP?Heartrate?CardiacArrestCardiovascularSystemToxicityBP↑Heartrate↑CardiovascularSystemexcitationCardiovascularSystemdepression

DirectCardiacEffectsDirectPeripheralVascularEffectsNegativeinotropicactionFastconductingtissuesHighconcentrationsvasodilation.?LowconcentrationsvasoconstrictionCardiovascularSystemdepressionLACNSexcitationCardiovascularSystemexcitation

ExcessivedosesofLASystemicabsorptionofLAintravascularinjectionofLATestdosesofLAPremedicationPrevention

Incipienttoxicreactions:StopadministeringLA,ventilationsupportCNSexcitation:Sedativetreatment