4 英文椎管麻醉8年制
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4 英文椎管麻醉8年制
HISTORY
1885 Corning - First attempt with epidural cocaine 1891 Quincke - Describes the lumbar puncture technique 1901 use of cocaine as an epidural agent for humans and dogs reported
Segmental level required for surgery
Segmental level required for surgery
Operative Site -----------------------------Level
• Lower extremities
T-12
• Hip
procaine, bupivacaine , etidocaine
• spinal(subarachnoidal) anaesthesia——
lidcaine, tetracaine, procaine
• epidural anaesthesia ——lidcaine, tetracaine,
procaine, bupivacaine ,ropivacaine, etidocaine
• Recovery in reverse order
Local Anesthetics
• surface anaesthesia——tetracaine • infiltration anaesthesia——procaine,
lidcaine etidocaine, ropivacaine,
• conduction anaesthesia——lidcaine,
operative pain service Interest wanes as inhalant anesthesia gains favor
Cousins & Bridenbaugh, 3rd Edition
Contraindications
• Absolute
– Patient refusal. – Localized infection at skin puncture site. – Generalized sepsis (e.g., septicemia, bacteremia). – Coagulopathy – Increased intracranial pressure.
Local Anesthetics
• Effects based on myelination and size • Smaller sensory and ANS fibers affected 1st • Sensation disappears in following order:
– Pain – Cold – Warmth – Touch – Joint – Deep pressure
Alternative to general anesthesia 1921 Pagis - First lumbar anesthesia for surgery 1927 E.R. Frank describes use of procaine as a successful alternative
1947 Lidocaine commercially available 1949 Curbelo - First continuous lumbar analgesia with ToFra Baidu bibliotekhy needle
1963 Bupivicaine commercially available 1979 Cousins - Epidural opioids provide analgesia 1983 Yaksh - Different spinal receptor systems mediating pain 1985 University of Kiel, Germany, Anesthesiology managed acute post-
Contraindications
• Relative
– Localized infection peripheral to regional technique site.
– Hypovolemia. – Central nervous system disease. – Chronic back pain. – Inexperience of operator
T-4
Local Anesthetics
Aminoamide-linked drugs: Bupivicaine, lidocaine Aminoester-linked drugs: procaine , tetracaine
• Agents reversibly bind to neuronal voltage-gated sodium channels and block nerve impulse conduction
Spinal anesthesia
• Spinal anesthesia involves administering local anesthetic into the subarachnoid space.
• Affect segmental nerve roots • Individual pharmacodynamics of agents depend on
lipid solubility, dissociation constant, protein-binding characteristics
T-10
• Vagina, uterus
T-10
• Bladder, prostate
T-10
• Lower extremities with tourniquet T-8
• Testis, ovaries
T-8
• Lower intraabdominal
T-6
• Other intraabdominal
HISTORY
1885 Corning - First attempt with epidural cocaine 1891 Quincke - Describes the lumbar puncture technique 1901 use of cocaine as an epidural agent for humans and dogs reported
Segmental level required for surgery
Segmental level required for surgery
Operative Site -----------------------------Level
• Lower extremities
T-12
• Hip
procaine, bupivacaine , etidocaine
• spinal(subarachnoidal) anaesthesia——
lidcaine, tetracaine, procaine
• epidural anaesthesia ——lidcaine, tetracaine,
procaine, bupivacaine ,ropivacaine, etidocaine
• Recovery in reverse order
Local Anesthetics
• surface anaesthesia——tetracaine • infiltration anaesthesia——procaine,
lidcaine etidocaine, ropivacaine,
• conduction anaesthesia——lidcaine,
operative pain service Interest wanes as inhalant anesthesia gains favor
Cousins & Bridenbaugh, 3rd Edition
Contraindications
• Absolute
– Patient refusal. – Localized infection at skin puncture site. – Generalized sepsis (e.g., septicemia, bacteremia). – Coagulopathy – Increased intracranial pressure.
Local Anesthetics
• Effects based on myelination and size • Smaller sensory and ANS fibers affected 1st • Sensation disappears in following order:
– Pain – Cold – Warmth – Touch – Joint – Deep pressure
Alternative to general anesthesia 1921 Pagis - First lumbar anesthesia for surgery 1927 E.R. Frank describes use of procaine as a successful alternative
1947 Lidocaine commercially available 1949 Curbelo - First continuous lumbar analgesia with ToFra Baidu bibliotekhy needle
1963 Bupivicaine commercially available 1979 Cousins - Epidural opioids provide analgesia 1983 Yaksh - Different spinal receptor systems mediating pain 1985 University of Kiel, Germany, Anesthesiology managed acute post-
Contraindications
• Relative
– Localized infection peripheral to regional technique site.
– Hypovolemia. – Central nervous system disease. – Chronic back pain. – Inexperience of operator
T-4
Local Anesthetics
Aminoamide-linked drugs: Bupivicaine, lidocaine Aminoester-linked drugs: procaine , tetracaine
• Agents reversibly bind to neuronal voltage-gated sodium channels and block nerve impulse conduction
Spinal anesthesia
• Spinal anesthesia involves administering local anesthetic into the subarachnoid space.
• Affect segmental nerve roots • Individual pharmacodynamics of agents depend on
lipid solubility, dissociation constant, protein-binding characteristics
T-10
• Vagina, uterus
T-10
• Bladder, prostate
T-10
• Lower extremities with tourniquet T-8
• Testis, ovaries
T-8
• Lower intraabdominal
T-6
• Other intraabdominal