静脉全麻

null第八章 静脉全身麻醉 Intravenous anesthesia第八章 静脉全身麻醉 Intravenous anesthesia1. Introduction1. Introduction Definition General anesthesia maybe produced by many drugs which are administered via intravenous injection and depress the central nervous system. null● Rapid induction of anesthesia ● Non-irritant to the respiratory tract ● No environmental pollution ● Making patient comfortable ● Rapid recovery ● Simply to use Advantagesnull● No muscle relaxation ● Poor control ● Poor analgesia Disadvantagesnull● Intravenous basal anesthesia ● Intravenous induction of anesthesia ● Intravenous maintenance of anesthesia Classificationsnull● Bolus induction of anesthesia, minor operation ● Intermittent injection ● Continuous infusion ● Target-controlled infusion(TCI) Methods 2. Intravenous Anesthesia of Thiopentone Sodium 2. Intravenous Anesthesia of Thiopentone Sodium MethodsMethods ① Bolus（2-2.5%） ◆ short procedures or induction of anesthesia ● adults: 2.5—4.5 mg/kg ● young children: 5-6 mg/kg ● elder: 2.5-3 mg/kg ◆ Basal anesthesia for children : ● 2.5%, 15-20 mg/kg, i.m ---- induce sleep in 5 min ● 5-10%, 44 mg/kg, rectal administration ---- induce sleep in 10-15 min ② intermittent injection② intermittent injection ●首次3-5ml，递增5-10ml，意识消失，睫毛反射消失，疼痛刺激无反应，开始手术 ● 每2-3分钟，注药1-2ml ● 成人总量≤0.5g，最大剂量0.75-1.0g③ Continuous infusion ③ Continuous infusion ● 辅助麻醉，解痉、控制惊厥 ● 0.1%-0.5%，20-100滴/分钟滴注 ● 蓄积、中毒IndicationsIndications● Induction ● Maintenance ● Basal narcosis ● Treatment of status epilepticus and convulsion ● Assistant of other anesthesia ● Reduction of intracranial pressureAbsolute ContraindicationsAbsolute Contraindications● Airway obstruction ● Porphyria ● Previous hypersensitiving reactionPrecautionsPrecautions● Cardiovascular disease (hypovolaemia, myocardial disease, cardiac valvular stenosis ) ● Severe hepatic disease ● Renal disease ● Muscle disease ● Reduced metabolic rate PrecautionsPrecautions● Obstetrics ● Outpatient anesthesia ● Adrenocortical insufficiency ● Extremes of age(neonate, infant) ● AsthmaComplicationsComplications● Phlebitis ● Tissue necrosis ● Intra-artery injection: endarteritis ● Severe cardiovascular and respiratory depression ● Allergic reaction ● Laryngeal spasm ● Bronchospasm ● Coughing and hiccups 3. Intravenous Anesthesia of Ketamine 3. Intravenous Anesthesia of Ketamine MethodsMethods①肌肉注射法(intramuscular injection ) ●Children 4-6 mg/kg，<1year increased to 10mg/kg ● 1-5min起效，维持15-25分钟 ● 追加首量1/2—1/3 ② 静脉注射法（intravenous injection） ●首量 1-2mg/kg，1-2min起效，维持5-10min ● 追加：首量的1/2或全量 ●总量< 6mg/kg ③连续静脉输注法 （continuous intravenous injection） 1-2mg/kg induction,0.1% ketamine，iv by drip,maintenance of anesthesia ③连续静脉输注法 （continuous intravenous injection） 1-2mg/kg induction,0.1% ketamine，iv by drip,maintenance of anesthesia④ 氯胺酮亚分离麻醉 (analgesia without loss of consciousness ) ● 0.5(0.25-0.5)mg/kg,iv ● 50 ng/kg/min Indications Indications● Superficial operation with minor and short procedure ● Basal narcosis in children for regional anesthesia (pediatric anesthesia) ● Induction of anesthesia for children, shock or hypovolemia patient ● Assistant of epidural anesthesia or nerve block(analgesia and sedation) ● Elderly or high-risk patient: may stable circulatory and respiratory system function ● Anesthesia for asthmatic patients Absolute ContraindicationsAbsolute Contraindications● Airway obstruction ● Raised intracranial pressure PrecautionsPrecautionsHypertension Cardiovascular disease,cardiac failure and angina Prolonged operations Hyperthyroid and chromaffinoma epilepticus and mental confusion Blood pressure increased (Bp↑) Intracranial pressure increased (ICP↑) Intraocular pressure increased Agitation, night mares or hallucination Transient apnoea , respiration depress salivation Nausea and vomitting Transient blindness Laryngeal spasm and airway obstructionComplications 4.羟丁酸钠静脉麻醉 药物特点：低毒、催眠作用强，作用时间长， 循环、呼吸、肝肾功能影响小4.羟丁酸钠静脉麻醉 药物特点：低毒、催眠作用强，作用时间长， 循环、呼吸、肝肾功能影响小麻醉方法 术前用药：阿托品足量 麻醉诱导： 成人 50-80mg/kg 儿童可达100mg/kg 麻醉维持： 复合应用，作用时间60-90min,1-2小时追加半量适应症与禁忌症 适应症与禁忌症 适应症： 麻醉诱导 辅助麻醉或基础麻醉 禁忌症 严重高血压 心脏传导阻滞或左束支传导阻滞 心动过缓 癫痫和惊厥病人 并发症并发症锥体外系兴奋现 低钾血症 幻觉、激动、兴奋、躁狂 恶心、呕吐、甚至大小便失禁 5. Intravenous Anesthesia of Propofol 5. Intravenous Anesthesia of Propofol ● Rapid induction ● Favorable recovery ● Short lasting duration ● Antiemetic effect ● Rapid induction ● Favorable recovery ● Short lasting duration ● Antiemetic effectAdvantagesDosage and AdministrationDosage and AdministrationInduction： 2 mg/kg iv Maintenance： 2 mg/kg iv 50-150 μg/kg/min 4-12 mg/kg/hr Sedation： 25-75 μ g/kg/min IndicationsIndications● Induction of anesthesia ● Total venous anesthesia ● Outpatient anesthesia ● Sedation in ICU ● Sedation during surgery (Regional analgesic and endoscopy) Cardiovascular depression Respiratory depression Excitatory phenomena Pain on injection Allergic reactionDisadvantagesAbsolute ContraindicationsAbsolute Contraindications● Airway obstruction ● Hypersensitivity ● < 3 years old 5. Intravenous Anesthesia of Etomidate 5. Intravenous Anesthesia of Etomidate ● Rapid acting and recovery ● Less depression of cardiovascular and respiratory ● Short duration of action ● Rapid acting and recovery ● Less depression of cardiovascular and respiratory ● Short duration of action AdvantagesDisadvantages● Depression of the synthesis of cortisol by the adrenal glandDosage and AdministrationDosage and AdministrationInduction： 0.3 mg/kg (0.1-0.4 mg/kg ) Maintenance： Administration sole only for short proceduresIndicationsIndications● Induction of anesthesia ●Anesthesia for compromised cardiovascular system, cardiac failure, shock patient ● Outpatient anesthesiaContraindicationsContraindications● Airway obstruction ● Porphyria ● Adrenal insufficiency ● Long-term infusion Pain on injection Nausea and vomitting Venous thrombosis Restlessness and delirium during recovery Myopalmus, myoclonia or convulsion Complications 6. Intravenous Anesthesia of Fentanyl 6. Intravenous Anesthesia of Fentanyl ● Analgesia potency is powerful ● Onset of action is rapid ● Cardiovascular depression is slight ● Analgesia potency is powerful ● Onset of action is rapid ● Cardiovascular depression is slight AdvantagesDosage and AdministrationDosage and AdministrationInduction of anesthesia 6-8 μg/kg 10-20 μg/kg for cardiovascular surgery Maintenance of anesthesia Total dosage may up to 50-100 μg/kg for cardiovascular surgery DisadvantagesDisadvantages● HR↓, Bp↓(large doses) ● Chest wall rigidity ● Delayed respiratory depression ● intraoperative awarenessIndicationsIndications● Induction of anesthesia ● Sedation and analgesia ●Cardiovascular anesthesia ● Trauma ● General Surgery ● Neurosurgery 7. Intravenous Anesthesia of Midazolam 7. Intravenous Anesthesia of Midazolam ● Water-soluble benzodiazepine ● Slightly more rapid onset and action ● Short duration of action Elimination half-life is 1.5-2.5h, in some critically ill patients is prolonged up to 21h and greatly delayed recovery consciousness. ● Water-soluble benzodiazepine ● Slightly more rapid onset and action ● Short duration of action Elimination half-life is 1.5-2.5h, in some critically ill patients is prolonged up to 21h and greatly delayed recovery consciousness. AdvantagesnullDosage and administrationSedation: 2.5-7.5 mg iv in adult 2.5 mg iv in elderly patients induction: 0.1-0.4 mg/kg, lower dosage maintenance: amnesia Preventing intraoperative awareness IndicationsIndications● Induction of anesthesia ● Maintenance of anesthesia ● Sedation ● Premedication Cardiovascular depression in the hypovolemic patients Respiratory depression in elderly Recovery is prolonged in critically ill patients Complications