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1、DRUGSUSEDFORANESTHESIA,MUSCLERELAXATION1DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛A.LocalanesthesiaAsthenameimplies,localanestheticsareappliedlocallyandfunctiontoblocknerveconduction.2DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛1.GeneralinformationThemechanismbywhichlocalanestheticsworki
2、swellknown3DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Recallthattheconcentrationofsodiumionsisnormallyhigherontheoutsideofneuronsthanontheinside.4DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Arapidfloodofsodiumionsintocellsisnecessaryforneuronstofireandconductanactionpotential.5DRUGSUSEDFO
3、RANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛6DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Localanestheticsactbyblockingsodiumchannels.7DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisblockingisnonselective,whichmeansthatbothsensoryandmotorimpulsesareaffected.8DRUGSUSEDFORANESTHESIAMUSCLERELAXATIO
4、N用于麻醉的药物肌肉松弛Thisblockingisbroughtaboutbytheanestheticreversiblybindingtoandinactivatingsodiumchannels.9DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Sodiuminfluxthroughthesechannelsisnecessaryforthedepolarizationofnervecellmembranesandsubsequentpropagationofimpulsesalongthecourseofthenerve.10DRUG
5、SUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Whenanervelosesdepolarizationandcapacitytopropagateanimpulse,theindividuallosessensationintheareasuppliedbythenerve.11DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Example:AninjectablelocalanestheticwhichcombinescapsaicinwithQX-314,avariationoflidocain
6、e12DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Alllocalanestheticshaveanaminefunctionalgroup,anaromaticring,andeitheranesteroramidegrouplinkingthem.13DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛amine14DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛aromaticring15DRUGSUSEDFORANESTHESIAMUSC
7、LERELAXATION用于麻醉的药物肌肉松弛ester16DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛amide17DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Therefore,alllocalanestheticsareclassifiedasestersoramides.18DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisisimportantbecausetheamidesarechemicallystablein vi
8、vo,whereastheestersaresubjecttohydrolysis.19DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,thehydrolysisofanesterlocalanestheticleadstotheformationofPABA,whichcausesanallergicresponseinsomeindividuals.20DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Localanestheticsmaybeadministeredto
9、pically(i.e.nasalmucosa);21DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛throughinfiltration(injectionintothedermisandsofttissueslocatednearperipheralnerveendings);22DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛andin/nearthespinalcord(includescaudalblock,epiduralblock,andspinalnerveblock).23D
10、RUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Whichlocalanestheticshouldbeusedgenerallydependsonthedurationofactionoftheprocedure.24DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Forshortprocedures,procainewouldberecommended.25DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Anintermediatedurati
11、onofactionisfoundwithcocaine,lidocaine,andmepivacaine.26DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Long-actinglocalanestheticsincludebupivacaine(andlevobupivacaine),ropivacaine,andtetracaine.27DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛2.EsterlocalanestheticsCommonlyusedlocalanestheticsc
12、ontainingtheesterfunctionalgrouparebenzocaine,cocaine,procaine,andtetracaine.28DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.procaine(Novocain)Procaineistheprototypedrugofthelocalanesthetics.Ithasthelowestpotency(exceptforBenzocaine).29DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisusedfo
13、rnerveblock,epiduralandspinalanesthesia.Novocaineisgenerallynotusedindentistryanymore.30DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛31DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.benzocaineTopicaluseonlybenzocaine(Solarcaine,Orajel,Lanacaineetc)32DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉
14、的药物肌肉松弛Itisusedforminormouthconditions(i.eteething,cankersores)sorethroat,sunburn,andotherminorskinconditions33DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛34DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.cocaineCocaineis2timesaspotentasprocaine.Itisusedforear,noseandthroatprocedures.35DRUGS
15、USEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛36DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛d.tetracaine(Pontocaine)37DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Usedfor:spinalanesthesiarequiring2to3hoursofanesthesiasurfaceanesthesiaoftheeye,noseandthroat.38DRUGSUSEDFORANESTHESIAMUSCLERELAXA
16、TION用于麻醉的药物肌肉松弛Itis16timesaspotentasprocaine.39DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛3.AmidelocalanestheticsCommonlyusedlocalanestheticscontainingtheamidefunctionalgrouparebupivacaine,lidocaine,mepivacaine,andropivacaine.40DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.bupivacaine(Mar
17、caine)andlevobupivacaine(Chirocaine)41DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theseareusedininfiltrationandepiduralanesthesia.Theyare16timesmorepotentthanprocaine.42DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Generally,theyaremorecardiotoxicthantheotherlongactinglocalanesthetics.43DRUG
18、SUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.lidocaine44DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Usedtopicallyforminordermatologicalprocedures(i.eskintagremoval)45DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itis4timesmorepotentthanprocaineandhasreplacedprocaineintheareaofdentalanesthe
19、sia.46DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.mepivacaine(Carbocaine)Thislocalanestheticisusedfordentalprocedures,surgicalproceduresandduringlaboranddelivery.47DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛d.ropivacaine(Naropin)Thisisusedforsurgicalprocedures,includingcaesariansections
20、.Althoughitissimilarpharmacologicallytobupivacaine,itislesscardiotoxic.48DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛4.Adverseeffectsa.Lowconcentrationdosages:dizzinesssleepinessrestlessness49DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.Higherconcentrationdosages:musculartwitchingseizures
21、50DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛andhypotension(exceptforcocaine,whichcanresultinvasoconstrictionandhypertension,aswellascardiacarrhythmias).51DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛B.Generalanesthesia52DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛1.generalinformation
22、Generalanesthesiaprovidesrapidandcompletelossofsensation.53DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itischaracterizedby:totalanalgesia(nopain)unconsciousnessdeeperthansleeplossofmemorycompletemusclerelaxation.54DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛55DRUGSUSEDFORANESTHESIAMUSCLERE
23、LAXATION用于麻醉的药物肌肉松弛Althoughsimilartosleepthereareprofounddifferences:56DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereisthelossofthe“fightorflightresponse”,whichisnotlostduringsleep.57DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Generalanestheticsstopmostnervousactivityinthebrain,sleeponl
24、ystopsactivityinveryspecificareas,andincreasesactivityinotherareas.58DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itistheultimate“alteredstate”,likeflippingaswitchtotemporarilyturnoffthenervoussystem.59DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛InthepastdecadeithasbecomeapparentthattheGABA
25、receptor-chloridechannelisthetargetofmanygeneralanesthetics(inhaledanesthetics,BZs,barbiturates,propofol).60DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛TheGABAreceptorcomplexconsistsofalpha,beta,andgammasubunitssurroundingandcontrollingacentralchlorideionchannel.61DRUGSUSEDFORANESTHESIAMUSCLERE
26、LAXATION用于麻醉的药物肌肉松弛Allanestheticsbindatsitesintheandsubunits,whichareremovedfromtheGABAbindingsite.62DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛63DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛ThebindingofGABA(gammaaminobutyricacid)toitsreceptorcausesanopeningofthechlorideionchannel.64DRUGSU
27、SEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theincreaseofchlorideionleadstoahyperpolarizationofthecell.65DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛ForIVbenzodiazepineanestheticsandtheinhalationanesthetics,bindingtotheGABAreceptorcomplex,concurrentwithGABAbinding,resultsinagreaterdurationofchlo
28、ridechannelopening.66DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛67DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisincreasestheentryofchlorideionintothecell.Theincreasedhyperpolarizationreducesneuralexcitabilitybymakingitmoredifficultforthecelltodepolarize.68DRUGSUSEDFORANESTHESIAMUSCLEREL
29、AXATION用于麻醉的药物肌肉松弛69DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thismeansthatamuchlargerthannormalstimulusisrequiredtoreachthethreshholdpotentialandgenerateanactionpotential.70DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛IVbarbituratebindingtotheGABAreceptorcomplexalsoincreasesthedurationof
30、GABA-activatedchloridechannelopening.71DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛72DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,higherconcentrationsofbarbituratesmaydirectlyactivatechloridechannelopeningevenintheabsenceofGABA,leadingtobarbiturateanesthesia”.73DRUGSUSEDFORANESTH
31、ESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inadditiontotheiractionsonthesechloridechannels,generalanestheticsalsodecreasethedurationofopeningofvariouscationchannels(K1+,Ca2+).74DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisenhancesthehyperpolarizationofthemembrane.75DRUGSUSEDFORANESTHESIAMUSCLERELAXATION
32、用于麻醉的药物肌肉松弛Generalanesthesiausuallyrequiresmorethanonedrug.Multiplemedicationsareusedtorapidlycauseunconsciousnessandmusclerelaxationandtomaintaindeepanesthesia.76DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛IVagentsareusuallyadministeredfirstbecausetheyactwithinafewseconds.77DRUGSUSEDFORANESTHE
33、SIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Afterthepatientlosesconsciousness,inhaledagentsareusedtomaintaintheanesthesia.78DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisapproachallowsthedoseofinhalationanesthetictobelowersothattheprocedureissaferforthepatient79DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物
34、肌肉松弛Generalanesthesiaoccursindistinctstepsorstages:80DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Stage1Lossofpain,lossofgeneralsensation,butthepatientmaybeawake81DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Stage2ExcitementandhyperactivityThepatientmaytrytoresist,theirheartbeatandbreathingm
35、aybecomeirregularandbloodpressurecanincrease.82DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theanesthesiologistwilltrytoquicklymovethroughstage2.OftenanIVagentwillbegiventocalmthepatientduringthisstage.83DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Stage3CalledsurgicalanesthesiaSkeletalmuscl
36、esbecomerelaxed,cardiovascularandbreathingactivitiesstabilize84DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Eyemovementsslowdownandthepatientbecomesverystill.Thisisthestagewhensurgerybeginsandremainsuntiltheprocedureends.85DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Stage4,oroverdoseThisism
37、arkedbyhypotensionorcirculatoryfailure.Deathmayresultifthepatientcannotberevivedquickly.86DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛2.InhaledgeneralanestheticsTheseagentsarenonflammable,nonexplosivegasesorvolatileliquids.87DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Oneoftheirmajoradvant
38、agesisthatthedepthofanesthesiamaybeveryquicklychangedbyalteringtheconcentrationoftheagent.88DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Themedianalveolarconcentration(MAC)isatermusedtodeterminethepotencyofvariousinhalationanesthetics.89DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisthemed
39、ianeffectivedose(ED50)oftheanesthetic,andisexpressedasthe%ofthegasinthemixturenecessarytoachieveananestheticeffect.90DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛ThesmallertheMAC,themorelipidsolubleistheanesthetic,andthelowertheconcentrationoftheanestheticneededtoproduceanesthesia.Therefore,them
40、orepotentistheanesthetic.91DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Anesthetic MAC value, in %Isoflurane1.2Sevoflurane2.0Desflurane6.0Nitrousoxide10092DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Alloftheinhalationanesthetics(exceptnitrousoxide)arerespiratorydepressants.93DRUGSUSEDFORANE
41、STHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Isofluraneismoredepressantthandesfluraneandsevoflurane94DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛All3increasetherestingpartialpressureofCO2inarterialblood(PaCO2),increasetheapneicthreshold,anddecreasetheventilatorresponsetohypoxia.95DRUGSUSEDFORANESTHESIAMUS
42、CLERELAXATION用于麻醉的药物肌肉松弛Theseeffectscanbemitigatedbymechanicallyassistingventilation.96DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.Nitrousoxide(laughinggas)Thisistheonlygasusedroutinelyforanesthesia.97DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisnotverysolubleinbloodandtissues,whichen
43、ablesittomoveinandoutofthebodyveryrapidly98DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Usedfordentalproceduresandbriefobstetricalandsurgicalprocedures99DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛SeeYoutubevideofromthePinkPantherStrikesagain(GooglevideoPeterSellers;Clouseau,Dentist)100DRUG
44、SUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itmayalsobeusedtogetherwithothergeneralanesthetics.101DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Nitrousoxideinhigherdoseshasbeenfoundtodepresstheheart.102DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛3.VolatileanestheticsTheseareliquidatroomtemp
45、erature,convertedintoavaporandinhaled103DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛ThemostcommonlyadministeredliquidvolatileagentsintheU.S.are:desflurane(Suprane)Sevoflurane(Ultane)Isoflurane(Forane)104DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.desfluraneAdvantages:rapidonsetandrecover
46、yofanesthesia(usefulforoutpatientprocedures)oneofleastmetabolizedtotoxicbyproducts105DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Disadvantages:lowvolatility,sorequiresaspecialvaporizerpungentandirritatingtotheairway(leadingtomorecoughing,laryngospasm,soitisnotasusefulforextendedsurgicalprocedur
47、es)106DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,whenhighinspiredgasconcentrationsareadministered,thereisasignificantincreaseinthepatientsbloodpressureandheartrate.107DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛sevoflurane:Advantages:rapidonsetandveryrapidrecoveryofanesthesia(u
48、sefulwithchildren)Notaspungentasdesflurane(alsousefulwithchildren)108DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Hasgoodbronchodilatingpropertiesandistheagentofchoiceinpatientswithasthma,bronchitis,andCOPD.Ithaslittleeffectontheheartrate.109DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Disad
49、vantages:ItsmetabolismresultsinF1-whichmayreachtoxiclevelsinkidneys110DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,carbondioxideabsorbentsinanesthesiamachinesdegradesevofluranetoafluorinatedhydrocarbon,whichisdegradedbyrenallyaseenzymestoathioacylhalide.111DRUGSUSEDFORANESTHESIAMUSCLE
50、RELAXATION用于麻醉的药物肌肉松弛Thiscompoundhasbeenobservedtocausenecrosisoftheproximaltubuleinrats.112DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛isoflurane:Advantages:Itcausesperipheralvasodilationandincreasedcoronarybloodflow(usefulinpatientswithischemicheartdisease)oneofleastmetabolizedtoF1-113DRUGSUS
51、EDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Disadvantages:moderatesolubility,sorecoveryfromanesthesiamaybedelayed114DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Isofluranecanmaketheheart“moresensitive”tocirculatingcatecholamines(likeepinephrine).115DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛
52、Thiscouldleadtoaventriculararrhythmiainpatientswithheartdiseasewhoaregivenepinephrineincombinationwithananesthetic,orinchronicallyanxious,“TypeA”patients(theyhavehighercirculatinglevelsofendogenousepinephrine).116DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛C.IntravenousanesthesiaIntravenousanes
53、thesiaisusedfortherapidinductionof,butnotthemaintenanceofanesthesia.117DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Themaintenanceofanesthesiaiswithaninhalationanesthetic.118DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereare5categoriesofdrugsusedasintravenousanesthetics:119DRUGSUSEDFORANE
54、STHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛1.Benzodiazepines(BZ)The3maindrugsusedinthiscategoryarediazepam,lorazepamandmidazolam.120DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theysedate,relieveanxiety,andcontrolacuteagitation,thereforetheirprimaryindicationisforpremedication.121DRUGSUSEDFORANESTHESIAMU
55、SCLERELAXATION用于麻醉的药物肌肉松弛Theyareinadequateforuseinsurgicalanesthesia“ontheirown”,andmustthereforebeusedwithanotheranestheticagent(i.e.aninhalationanesthetic).122DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.diazepam(Valium)ThisistheprototypedrugoftheBZs123DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用
56、于麻醉的药物肌肉松弛Itiswater-insoluble,soIVuserequiresanonaqueousvehiclewhichcancauselocalirritation/pain124DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.midazolam(Versed)Midazolamiswatersoluble,sodrugofchoiceforIVadministration125DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ithasamorerapidonsetandm
57、orerapideliminationthantheotherBZs.126DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,midazolamisthemostpotentamnestic127DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.lorazepam(Ativan)Itiswater-insoluble,soIVuserequiresanonaqueousvehiclewhichcancauselocalirritation/pain128DRUGSUSEDF
58、ORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisalesspotentamnesticthanmidazolam,butamorepotentamnesticthandiazepam.129DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛2.BarbituratesThe3maindrugsusedinthiscategoryarethiopental,thiamylal,andmethohexital.130DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛
59、Theirhypnoticactivityisduetosidechainsatposition5(especiallyifoneofthemisbranched).131DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereisamorerapidonsetandshorterdurationofactionifthereisasulfurinsteadofoxygenatomatposition2(so,thiamylalandthiopentalhavemorerapidonsetandshorterdurationofactiont
60、hanmethohexital).132DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Noneofthesedrugsprovidesanalgesiaorsignificantmusclerelaxation.133DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Likemostofthe“older”drugs,barbiturateshaveaworsetoxicologicalprothebenzodiazepines134DRUGSUSEDFORANESTHESIAMUSCLEREL
61、AXATION用于麻醉的药物肌肉松弛Theyallmaycausecoughing,laryngospasm,bronchospasm,orapnea.135DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛136DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.ThiopentalThiopental,theflagshipofthebarbiturateanestheticgroup,hasbeenastandardanestheticinductionagentformorethan60y
62、earsandisthedruginthiscategory,towhichallothersarecompared.137DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.Thiamylal138DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.Methohexitol139DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thiamylalisnotsignificantlydifferentfromthiopentalinpotency,
63、incidenceoflaryngospasm,respiratorydepression,cardiotoxicityorrecoverytime.140DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛3.OpioidsThetermsopioidandopiateareoftenusedinterchangeably,buthavedifferentmeanings.141DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Anopiateisderivedfromthejuiceoftheop
64、iumpoppy,Papaver Somniferum,whichiscommonlycalledWhitePoppyandHerbofJoy.142DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛143DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Anopioidisacompound,eithersynthetic,oranaturalproductwhichhasmorphine-likeeffects.144DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用
65、于麻醉的药物肌肉松弛Opioidsproducemoderatesedationandprofoundanalgesia.Theyexerttheireffectsbybindingwithopioidreceptorsinthecentralnervoussystem.145DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛146DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereare3majoropioidreceptorsclassified,functionally,as(mu),
66、(kappa),and(delta).147DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereispharmacologicalevidenceforsubtypesofeachreceptorinadditiontoother,lesswell-knownopioidreceptors,epsilon(),zeta(),iota()andlambda().148DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereisacommongeneralstructurefoundinal
67、lopioidreceptorsembeddedinplasmamembranes.Theyare,usually,linkedtoaGprotein.149DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Oncethereceptorsarebound,aportionoftheGproteinisactivated,allowingittodiffusewithintheplasmamembrane.150DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛TheGproteinmoveslat
68、erallywithinthemembraneuntilitreachesitstarget,anionchannel.151DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛TheionchannelsareinvolvedwitheitherareductionofCa2+influxoranincreaseinK1+efflux.152DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Eitheroftheseresultsinhyperpolarization(becomingmoreneg
69、ative)whichimpairsthefiringofneuronsandneurotransmitterrelease.153DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Opioidsmaybeusedtosupplementanesthesiawhenotheranestheticdrugsdontadequatelycontrolpainreactions.154DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theymaybeusedasinductionagentsorasth
70、eprimarydrugforthemaintenanceofanesthesiawhenhemodynamicstabilityisessential155DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thehighdosesrequiredtoproduceunconsciousnessdonotdepressthemyocardium,nordotheycauseasignificantreductioninbloodpressure.156DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松
71、弛Dosesmustbeatleast10timesthedoseusedforcontrolofpaininambulatorypatients,thusthisisreferredtoashighdoseopioid.157DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛OpioidsdepressrespirationbyinhibitingtheresponsivenessofthemedullaryrespiratorycentertoPCO2andaltertherhythmofbreathing.158DRUGSUSEDFORAN
72、ESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Consequently,itisnecessarytoassistventilation.159DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Sincerespiratorydepressionmayextendintothepost-operativeperiodasaresultofdrugaccumulationinthetissues,theuseofopioidswhoseclearancesareslowremainmostappropriateforpati
73、entswhoareexpectedtorequirep.o.ventilatorycare.160DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theopioidsmostcommonlyusedarefentanyl(Sublimaze)sufentanilcitrate(Sufenta)alfentanil(Alfenta)remifentanil(Ultiva)161DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.fentanyl(Sublimaze)Oneofthemostfre
74、quentlyusedbecauseofhowquicklyitproducesanalgesia162DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Fentanylisapotentsyntheticopioidagonistwithbetween50-100timestheanalgesicpotencyofmorphine.163DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Fentanylisusedtoaidinductionandmaintenanceofgeneralanest
75、hesiaandtosupplementregionalandspinalanesthesia.164DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Fentanylispreferredtomorphineinanesthesiaduetoitsabilitytomaintaincardiacstability.165DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Fentanylmaybeadministeredaloneorincombinationwithinhalationanesth
76、etics,localanesthetics,orbenzodiazepines.166DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.sufentanilcitrate(Sufenta)Rapidinductionofanalgesia(similartoFentanyl)167DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.alfentanil(Alfenta)168DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Comparedto
77、fentanylandsufentanil,alfentanilhasashorterdurationofactionbecauseitshighproteinbindingandrelativelylowlipidsolubilityfavoritssequestrationinplasma169DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛d.remifentanil(Ultiva)170DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Remifentanilisultrashortact
78、ingandrapidlyclearedbecauseitsesterlinkagesaresusceptibletohydrolysisbyesterasesintissuesandRBCs.171DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisconvertstheesterfunctionalgroupintoaninactivecarboxylicacidmetabolite.172DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisparticularopioidisuse
79、fulwhendealingwithpatientswithliverorkidneyfailure.173DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Lesspotentopioidssuchasmorphineanddemerolhavefallenintodisfavorbecauseoftheiradverseeffectswhengiveninhighdoses.174DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛DemerolmaycauseV-tach175DRUGSUSED
80、FORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Morphinemayproducehypotensionandbronchoconstrictionasaconsequenceofitshistamine-releasingaction.176DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Oneofthemostseriousdrawbacksoftheopioidanestheticsoverall,isthepossibilityofinadequateanestheticdepth.177DRUGSUS
81、EDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Signsofthisincludesweating,wrinklingoftheforehead,andopeningoftheeyes.178DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Topreventthis,thehighdoseopioidtechniquesmaybesupplementedwithinhalationanestheticsorhypnoticssuchasbenzodiazepines(midazolamforshorterc
82、ases,lorazepamforcaseslongerthan4hours),ormorerecently,propofol.179DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛However,theuseofthesemayresultinsomelossofcardiovascularstability.180DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛4.DissociativeanestheticsThisrelatestoatypeofgeneralanesthesiathat
83、ischaracterizedbyamnesia,sedation,andanalgesia,althoughthepatientappearstobeawake.181DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Oneofthedissociativeanestheticscommonlyusedisketamine(Vetalar,Ketaset).182DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ketamine,isanN-methyl-D-aspartate(NMDA)rece
84、ptorantagonist.183DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ketamineblockstheionchannelinthefollowingdiagram184DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itincreasesbloodpressureandincreasescardiacoutput(usefulinpatientsexperiencingshock)185DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌
85、肉松弛Ketaminehasbothverypoormusclerelaxationandanalgesicactivity.186DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ketaminemaybeused,alongwithdiazepamforcosmetic/reconstructivesurgeryanesthesia.187DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisnotwidelyusedforanesthesiaasittendstoinducepostope
86、rativehallucinations.188DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itissometimesusedasarecreationaldrug,butithasanumberofadverseeffects:189DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛lossofcoordination190DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛exaggeratedsenseofstrength191DRUGSUS
87、EDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛blankstare192DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛slurredspeech193DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛ABBCreportinMay2000claimedthatmedicalresearchhadshownthatcontrolledtestsonketamineusershadrevealedimpairedmemoryandmildschizophreni
88、aseveraldaysaftertakingthedrug.194DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛KetaminewasclassifiedasaClassCdrugin2005.OtherclassCdrugsincludecannabisandanabolicsteroids 195DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ketamineplaysanextensiveroleintheseason2finaleofHouse,M.D,titled“Noreason
89、”196DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛5.Propofol(Diprivan)FromDI-isoPRopyl IV ANestheticchemicalname:2,6-diisopropylphenol197DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Propofolisasedative/hypnoticthatcanbeusedforinductionormaintenanceofgeneralanesthesia.198DRUGSUSEDFORANESTHESIA
90、MUSCLERELAXATION用于麻醉的药物肌肉松弛Itisalsousedforsedatingintubated,mechanicallyventilatedpatients.199DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Analgesiceffectispoorandadditionofananalgesictotheanestheticregimenisnecessaryforsurgery.200DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Advantages:Rapid
91、inductionandrecoverytimesItcanbegivenforprolongedperiodswithoutresultinginprolongedrecovery201DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Disadvantages:apneabradycardiaandhypotension.202DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Propofolsabuseasarecreationaldrug(itproduceseuphoria)hasbeen
92、seen,insomeanesthesiologistswhohaveaccesstothedrug.203DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Inaddition,MichaelJacksonsdeathinJune2009hasbeenattributedtoa“cocktail”ofpropofolandotherdrugs204DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Jacksonscardiologist,Dr.ConradMurrayhadbeenadminist
93、eringtoJackson50mgofpropofolIV,nightlyfor6weeksforhisinsomnia.205DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛FearingthatJacksonwasforminganaddictiontotheanesthetic,heattemptedtoweanhimbyloweringthedoseto25milligramsandaddingthesedativeslorazepamandmidazolam.206DRUGSUSEDFORANESTHESIAMUSCLERELAXA
94、TION用于麻醉的药物肌肉松弛AccordingtotheMSNBCnewsservice,thesequenceofdrugsgiven,onthedayofhisdeathwere:1:30 a.m. 10 mg tablet of diazepam2 a.m. 2 mg, IV of lorazepam 3 a.m. 2 mg, IV of midazolam5 a.m. 2 mg, IV of lorazepam 7:30 a.m. 2 mg, IV of midazolam 10:40 a.m. 25 mg, IV of propofol diluted with lidocaine
95、 10:50 a.m. Dr leaves Jacksons room; returns minutes later to him not breathing. Administers 0.2 mg of flumazenil (a BZ antagonist)207DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛D.NeuromuscularblockingdrugsThesedrugsareusedduringsurgery(especiallyintra-abdominalandintra-thoracic),andtoaidintuba
96、tionforsurgicalanddiagnosticprocedures(endoscopy).208DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Previously,adequatemusclerelaxationwasonlypossiblewithdeepanesthesia(whichleadstoCNSdepressanteffects).209DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Contractionofskeletalmusclesisvoluntarilyco
97、ntrolledbyimpulsesthatoriginateintheCNS.210DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Impulsesfromthebrainareconductedthroughthespinalcordtothesomaticmotorneutrons.211DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Somaticmotorneuronseventuallyconnectwithskeletalmusclefibersforminganeuromuscu
98、larjunction(NMJ).212DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theneuronalendingsofthesomaticmotorfiberscontaintheneurotransmitteracetylcholine(ACH).213DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛WhenACHisreleasedintotheneuromuscularsynapses,itbindstoreceptorsknownasnicotinic-II(NII)recep
99、tors.214DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛215DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛NeuromuscularblockersinhibitskeletalmusclecontractionbyinterferingwiththeNIIreceptors.216DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thereare2typesofneuromuscularblockers:nondepolarizing
100、depolarizing217DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛1.NondepolarizingblockersThesebindtothereceptorsbutdonotstimulatethereceptors.TheyarestructurallysimilartoACHandfunctionasacompetitiveinhibitor.218DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Bybindingtothenicotinicreceptor,theyprev
101、entACHfrombindingandinhibitmuscularcontraction.219DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theydonotcausethesodiumchannelsinthemembranetoopen,thereforenodepolarizationofthereceptoroccurs.220DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Remember,therestingmembranepotential(ontheinsideofthe
102、cellmembrane)istypically70mV,withclosedsodiumchannels.Anyshiftfromtherestingpotentialtoward0mViscalledadepolarization.221DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛AfterI.V.injection,thereisgenerally,arapidonsetofeffects:1st:Finemusclesaffected(thoseofeyes&fingers)222DRUGSUSEDFORANESTHESIAMUSC
103、LERELAXATION用于麻醉的药物肌肉松弛2nd:limbs,neck&trunk223DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛3rd:intercostalmuscles4th:diaphragm224DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Recoveryisinthereverseorder225DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛a.TubocurarineThisistheprototypeoftheno
104、n-depolarizingneuromuscularblockers.Itisfoundincurare,whichderivesfromtheSouthAmericanplantgenusStrychnos.226DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛227DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Ithasaslowonset(5min)andalongdurationofaction(1-2hours),anditisnotcommonlyusedanymore.228D
105、RUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛b.Pancuroniumbromide(Pavulon)Fullmuscleparalysisformajorsurgeryisachievedinabout24minutes,recoveryisabout2-3hours229DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itisalsofoundasoneofthecomponentsinlethalinjections.AmnestyInternationalhasobjectedtoth
106、isusestatingthatitmaymaskthecondemnedprisonerssufferingduringtheexecution”.230DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛PancuroniumbromidewasoneofthecompoundsusedbyEfrenSaldivar,theAngelofDeath”.231DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Hewasaserialkillerwhomurderedpatientswhilework
107、ingasarespiratorytherapist.232DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛HewasemployedbytheGlendaleAdventistMedicalCenter,workingthenightshift,whentherewerefewerstaffonduty.233DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thepolice,insearchingforevidencestrongenoughtoobtainacourtconviction,
108、exhumedtheremainsof20patientswhohaddiedduringthetimeSaldivarwasonduty.234DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛TheywerespecificallylookingforunusuallyhighlevelsofPavuloninthecadaver,asthisdrugremainsidentifiableformanymonths.235DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛6ofthe20cada
109、vershadevidenceofalethalconcentrationofPancuroniumbromide.236DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛In2002,Saldivarpleadedguiltytosixcountsofmurderandreceivedsixconsecutivelifesentenceswithoutthepossibilityofparole.237DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛c.Atracuriumbesylate(Tr
110、acrium)anditsisomercisatricuriumbesylate(Nimbex)238DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theyarewidelyusedandhaveanintermediateduration(recoveryis95%completeonehourafterinjection).239DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛However,abreakdownproductofatracurium,laudanosinemayaccum
111、ulateduetoveryslowhepaticmetabolismanduponcrossingintothebrainmaycauseseizures240DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Cisatracuriumhaslesslaudanosineformedandlesshistaminereleasedthanatracurium.241DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛FederalregulatorshavecitedSt.MargaretMercy
112、HealthcareCentersinIndianafordispensingTracriumtoHammondFireDepartmentCapt.MichaelMagdziarzinJanuary2002.242DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Magdziarzhadunderwentasuccessfulbypasssurgeryandwasrecovering.Hissurgeonhadorderedapenicillintofightinfection.Instead,thenurseadministeredTracr
113、ium.243DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Hebecamerestless,complainedofshortnessofbreath,stoppedbreathingandsufferedcardiacarrest.244DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛d.Vecuroniumbromide(Norcuron)Thishasashorterdurationofactionthanpancuronium(recoveryis95%complete45minut
114、estoonehourafterinjection).245DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Itslackofsignificantcardiovasculareffectsandlackofdependenceongoodkidneyfunctionforeliminationprovideadvantagesoverotherneuromuscularblockingagents.246DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Overall,theextentofad
115、verseeffectsonthenondepolarizingneuromuscularblockersdependsonthespecificagent.247DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Theolderdrugs(i.e.tubocurarine,pancuronium)tendtohavemorecardiovascularactions(bloodpressureandheartratechanges)aswellashistaminerelease,andmoredifficultywiththeircontro
116、lledreversal.248DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thenewerdrugs(i.e.vercuronium)tendtohaveminimaltonocardiaceffects,slighttonohistaminerelease,andaneasierreversal.249DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛2.DepolarizingDepolarizingagentsarealsostructurallysimilartoacetylchol
117、ineandfunctionascompetitiveinhibitors.250DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛However,whentheybindtothenicotinicreceptor,theycausethesodiumchannelsinthemembranetoopen,leadingtodepolarizationofthereceptor.251DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thesesodiumchannelsonlyopenbrief
118、lyandcannotbeopenedagainuntilthemembraneisrepolarized.252DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Depolarizingneuromuscularblockersactaspersistentagonistsatnicotinereceptors,butunlikeacetylcholine,theirrelativelyslowerdegradationrateresultsinparalysis.253DRUGSUSEDFORANESTHESIAMUSCLERELAXATIO
119、N用于麻醉的药物肌肉松弛Generationofanactionpotentialrequiresarapidchange (increase)ofmembranepotentialfromanegativestate.254DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Asthesedrugsareeventuallyclearedandreceptorsbecomeunoccupied,theyreverttotheoriginalactivestate.255DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用
120、于麻醉的药物肌肉松弛Succinycholineistheonlydruginthisclassthatisusedbyanesthesiaproviderstoday.256DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛257DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thedurationofactionofsuccinylcholineisveryshort,becauseitismetabolizedinthebodyveryquicklybyanenzymecalledplasm
121、acholinesterase.258DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thisshortdurationofactionmakessuccinylcholineausefuldruginsituationswheremusclerelaxationisneededforonlyashorttimesuchastofacilitateintubation.259DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Sideeffectsofsuccinycholineinclude:fa
122、sciculations(smallmusclemovementscausedwhenthedrugbindstoreceptors)260DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛myalgias(musclesorenesswhichmaybetheresultofthefasciculations)261DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛cardiacrhythmdisturbancesincreasesinocularandgastricpressure,262DRU
123、GSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛hyperkalemiainat-riskpatients263DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛malignanthyperthermia:adramaticincreaseinbodytemperature,acidosis,electrolyteimbalanceandshock264DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛Thesyndromeisthoughtobeduetoareductioninthereuptakeofcalcium,whichisnecessaryforterminationofmusclecontraction.Consequently,musclecontractionissustained.265DRUGSUSEDFORANESTHESIAMUSCLERELAXATION用于麻醉的药物肌肉松弛
