Chapter13GeneralAnesthetics第13章药学系药理教研室祝晓光全身麻醉药1、㈠CNS2、reversibleunconsciousness3、lossofpainandreflexes,musclerelaxation;4.Used:asanadjuncttosurgicalprocedures.1IntroductionDefinition理想全麻药的条件肌松完全、镇痛良好、深度易控、不良反应小[classification]1、inhalationalanesthetics;2、intravenousanestheticshistoryofanesthetics:Physicalmethods1、strangulation勒绞法2、blowtothehead棒击法3、packingalimbintheice冷冻、ormakeitischemic放血法Chemicalmethods扁鹊毒酒:迷死三日剖胃探心投以神药既悟如初华佗麻沸散WellsNitrousoxide氧化亚氮,(笑气)1842年:CrawfordLong(USA)首次应用乙醚麻醉进行手术,麻醉从此进入历史新纪元。1847年:苏格兰产科医生JamesSimpson首次使产妇吸入氯仿以无痛分娩。50年代中期:氟烷问世,开始了氟化麻醉药的时代。我国:华佗的麻沸散,刮骨疗毒2inhalationalanesthetics[character]1、highlyliposoluble,volatilizatio,2、similaritymechanismofaction;3、obviousstagesofanaesthesia.[stagesofanaesthesia]I.Stageofanalgesia;Ⅱ、Stageofexcitement;Ⅲ、Stageofsurgicalanesthesia;IV、Stageofmedullarydepression.Ⅰ、Stageofanalgesia:anaesthesiabeginningunconsciousness(lossofpainfulfeelfeelinghearing)〔stagesofanaesthesia〕Ⅱ、Stageofexcitement;unconsciousnesslossofpainfulfeelStageofsurgicalanesthesia(Reflexes、HR、BP、pupil)、involvesNO.1NO.4Ⅲ、StageofsurgicalanesthesiaexcitementcalmIV、Stageofmedullarydepression.(BP、HR、pupillossofreflexes)ProcessinthebodyrespiratorytractlungBloodCNSbrain/blood分配系数大脑中浓度高麻醉深blood/gas分配系数大血中溶解度高难饱和不易麻醉诱导期长InfluencefactorofAnestheticsactionbodydrugA、局部组织血流量B、肺通气量A、最小肺泡浓度B、血/气分布系数与脑/血分布系数MAC(minimalalveolarconcentration):1)at1.01×105Pa2)concentrationwhichresultsinanalgesiain50%ofpatients,meaning:1、comparisonforpotencyofgeneralanestheticagentsMACanestheticpotency2、MAC=ED50ofgeneralanestheticagentsHalothane氟烷1、action:narcotismmightiness;2、analgesiaandmusclerelaxation3、noburn,noexplode;4、chemicalfeature:unstableCommondrugs:enflurane,isoflurane[characteristics]1、propertystable,safe;2、anestheticrapid、cometoconsciousnessfast;3、actionmightiness,musclerelaxation,widelyuse;4、sidereactionlitter。3intravenousanaestheticspentothalsodium硫喷妥钠characteristics1、anestheticbarbiturates2、highlyliposoluble;3、actiontransitoriness.4、analgesia,musclerelaxationofincompletion;Use1)inductionanesthesia、2)basalanesthesia,3)operation(shortterm);5、(-)respiratory,note:newbornandinfantKetamine氯胺酮characteristics1、dissociationanaesthesia1)Cerebralfunctionseparate、2)consciousness–feeldissociativeform。2、anaesthesiaactionrapid、brevity,3、(+)cardiovascular;4、use:pediatricprocedureprohibituse:hypertention、psychosis。∮4combinationanaestheticsConcept≥2dopeorotheradjunctanestheticscommonmethod(P.123-124)1、premedication。1)phenobarbital2)atropin3)diazepam4)morphine2、Basalanaesthesiaphenobarbital3、inductionofanaesthesia1)thiopental2)nitrousoxide4.combinewithagentsofmuscularrelaxation5.hypothermalanesthesia6.controlledhypotetion7.neuroleptanalgesia