Please enable JavaScript.

Coggle requires JavaScript to display documents.

(Local anesthetics, Inhalation anesthetic, Induction time, endogenous…

- - - - 正比
    - - 正比
    - - 需有較高的脂溶性
  - - - frequency-dependent block
    - - intermediate acting amide
      - Spinal or epidural anesthetic
      - 產科不可以使用此藥
    - - Spinal anesthesia
      - 適用於剖腹產的半身麻醉
      - 具有心臟跟 CNS 的毒性
      - (S)-isomer
    - - motor block w/心毒性
  - - - Maintain inactivated state
  - - - AE
        
        Ester form -> PABA
        
        procaine
- - - - hepatic toxicity
      - Best potency -> halothane
      - Best induction -> Desflurane
        
        almost no hepatic toxicity
        
        Cough + sputum
      - Malignant hyperthermia
        
        Genetic susceptibility
        
        ryanodine receptors -> autosomal dominant mutation
        
        Ca2+ cant be retook
        
        解藥:IV Dantrolene
        
        Halothane/ Enflurane
        
        Risk
        
        w/ Succinylcholine(muscle relaxant
  - - - barbiturates
        
        Methohexital(Brietal)
        
        Common in clinical use
        
        stage of excitement = hiccup
        
        Thiamylal (Surital)
        
        Thiopental (Pentothal)
        
        redistribution
        
        FAT
        
        Slow recovery
        
        超短效安眠藥
        
        Contraindication
        
        Porphyria
        
        Shock
        
        Respirator not available
        
        AE
        
        Laryngeal spasm
        
        GABAA receptor -> Cl- channel open time
        
        No pain easing effect
        
        may lower threshold
      - benzodiazepines
        
        Lorazepam (Ativan)
        
        Midazolam (Dormicum)
        
        Common use
        
        Diazepam (Valium)
        
        IM
        
        Benzodiazepine binding site @ GABAA receptor
        
        No pain easing eff.
        
        sedation
        
        AE
        
        Amnesia
        
        Flunitrazepam = 迷姦藥 FM2
        
        解藥 -> flumazenil
      - Dissociative anesthetic
        
        Ketamine(Ketaral)
        
        AE
        
        Nightmare
        
        muscle tone increases
        
        Other usage
        
        Fast-acting anti-depressant
        
        Block thalamus to cortex
        
        IV and good pain easing eff.
      - Ultrashort non-barbiturate hypnotics
        
        ICU & EM
        
        Propofol(Diprivan)
        
        GABA uptake inhibitor
        
        prevent V+
        
        Respiratory and cardiovascular depression
        
        Etomidate (Hypnomidate)
        
        GABA uptake inhibitor
        
        Sedation but no pain easing eff.
      - Neuroleptic Analgesia
        
        Opioids
        
        Droperidol + fentanyl
        
        Opioid receptor agonist
        
        Nausea, vomiting
        
        Droperidol = D2 receptor blocker
        
        Antiemetic
  - - - low induction time
      - No AE on heart (so called)
      - Cons
        
        Low Potency
        
        diffusion hypoxia
        
        N2O pockets
- - - - Pulmonary ventilation
        
        呼吸越快、換氣體積越大,則誘導時間越短
      - Anesthetic concentration
        
        濃度越高、混有誘導期快的麻醉藥物,則誘導時間越短
    - - Blood-gas partition coefficient
        
        在血中的溶解度越大,induction time 越長
      - Pulmonary blood flow
        
        肺部血流越快,induction time 越長
      - Gradient of Parterial/Pvenous
        
        正比
      - Cardiac output
        
        正比
    - - Redistribution
      - Tissue-blood partition coefficient
      - Tissue blood flow
- - - - α-Endorphin(16 a.a.)
      - β-Endorphin(31 a.a.):最強效
      - γ-Endorphin(17 a.a.)
    - - Dynorphin B(13 a.a.)
      - Dynorphin A(17 a.a.):強效
    - - Leucine-enkephalin(5 a.a.)
      - Methionine-enkephalin(5 a.a.):強效
  - - - Endorphin > enkephalin > dynorphin
    - - Dynorphin > endorphin & enkephalin
    - - Enkephalin > endorphin & dynorphin