课件：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.ppt

臨床試驗計劃: Dexmedetomidine對於止血帶所引起術中高血壓的療效及藥理機轉之探討,Presenter:勞萱之醫師 Correspondence: 黃俊仁主任,Part : Introduction of Dexmedetomidine,Medetomidine,動物鎮靜麻醉 Ketamine (K他命）和 Midazolam 混合 Medetomidine Medetomidine混合 dextro-medetomidine levo-medetomidine,Dexmedetomidine,Alpha-2 Agonist 1999 美國FDA 核准使用,Dyck, Shafer. Aneasth Pharm Review. 1993,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。,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,腎上腺素接受器 Adrenergic receptors,a1,b1,平滑肌,節前Pre- synaptic,氣管平滑肌,心臟,a2,b2,擴張,心跳 心搏量,收縮,抑制 新腎上腺素NE 分泌,a2腎上腺素接受器,負回饋,Regulate release of neurotransmitters Control epinephrine, norepinephrine release Modulate sympathetic response “negative feedback loop”,Dexmedetomidine作用機轉,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, HR,Spinal Cord,LOCUS CERULEUS,FOURTH VENTRICLE,PONS,CEREBRUM,CEREBELLUM,Mechanism for 2-induced sedation/ hypnosis in the rat locus coeruleus,Dexmedetomidine: Side Effects,Bradycardia Hypotension Transient hypertension Dry mouth Limited amnestic effect Excessive sedation Reduction in CBF/CMRO2 in animal model,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 2B-adrenoceptors will BP loading : 1 mcg/kg over 10 min maintenance : 0.2 to 0.7 mcg/kg/hr Onset: 5 -10 min Reduced effect: 30 min Duration: 2 hour,Tournique induced hypertension,Incidence: 30% Tourniquet time 60 min Associated with severe pain and augmented sympathetic outflow Difficult treatment Unknown mechanism,Previous study data,Ketamine ( Satsumae et al. A&A, 2001) Clonidine ( Zalunardo et al. A&A, 2002) Dextromethrophan ( Yamashita et al. A&A, 2004) Stellate ganglion blockade ( Arai et al. Acta Anesthesiol Scand, 2004) Dexmedetomidine?,Exclusion and Inclusion Crietria,Exclusion Criteria 貧血 (Hct 20) 肥胖 (BMI 40) 肝或腎功能異常者 心律不整,AV Block,或是心臟鬱血性衰竭 對dexmedetomidine或其他2 agonist過敏者 預期下肢止血帶使用會超過150分鐘或低於60分鐘,Inclusion criteria ASA I-II 20 至75 歲 預期接受骨科下肢常規手術而會打止血帶超過60分鐘者 不論半身或全身麻醉,Grouping,Control group Dexmedetomidine (continuous infusion) Loading:(0.8 g/kg) Continuous infusion rate:(0.4 g/kg/h) Dexmedetomidine (single dose) 1ug/kg for over 10 mins Dexmedetomidine (continuous infusion) Loading:(0.5 g/kg) Continuous infusion rate:(0.4 g/kg/h),Anesthetic standard procedure,General Anesthesia Pre-op : IV 1.5-2 mg Midazolam Induction medication: fentanyl 2 ug/ml, propofol 2mg/kg, and recuronium 0.6 mg/kg. Maintenance medication: sevoflurane which concentration is adjusted to keep BIS 40-45. TOF Rescue (BP) : Perdipine 1ml/ 5min,Combined Spinal-Epidural Anesthesia Pre-op : IV 1.5-2 mg Midazolam Spinal bupivaccaine dosage: 12-15 mg Epidural dosage: 0.25% bupivacaine with continuous rate of 4-8 ml/h. Level 15 min Rescue: fentanyl 1ml/15mn,Monitoring,血液 NE & Epi 濃度(2 times x 10 ml) Post-induction (1 MAC) & tourniquet inflation 60 min Finometer and HRV recordings preinduction, postinduction, inflation for 30 and 60 min, after deflation, and POR,Thank You!,We are small, but we think big!,后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析,主要经营：课件设计，文档制作，网络软件设计、图文设计制作、发布广告等 秉着以优质的服务对待每一位客户，做到让客户满意！ 致力于数据挖掘，合同简历、论文写作、PPT设计、计划