Sugammadex课件.pptVIP

SugammadexThe PacMan of Reversal Agents Sugammadex * 600 640 680 720 760 800 840 880 920 960 1000 660 930 .01 .1 1 10 Extinction Coefficient (Light Absorbance) Wavelength (nm) reduced oxyhemoglobin methemoglobin oxyhemoglobin carboxyhemoglobin Ribbon model of hemoglobin (/science/Ho/hemoglbn) Known Etiologies of Acquired Methemoglobinemia 0.5 mA/cm2 Chamber and Drug Iontophoresis Power Source Stratum Corneum Near-infrared Vein Viewer The light source emits near-infrared beam. 2. Digital video camera captures the near-infrared light reflected back. 3. Microprocessor projects image back on the skin in real-time. Near-infrared Vein Viewer Complex formation of sugammadex and rocuronium. From: Sorgenfrei: Anesthesiology, Volume 104(4). April 2006.667-674 * * * Three basic theories 1. Repulsive electromotor force. Particles with similar charges repel each other. So anionic drugs are propelled out of the drug chamber and across the skin using a negatively charged electrode. In the case of lidocaine, although the drug exists in a protonated and unprotonated form in equal parts at physiologic pH it only has action at the Na+/K+ channel in the negatively charged form. This negatively charged form of lidocaine is the molecule propelled out of the drug chamber and into the tissues providing superior analgesia. 2. Electric current enhances permeation. Skin is inhibited from performing protective barrier function. 3. The current enhances water penetration into the stratum corneum (electro-osmosis). Dissolved drugs are carried across the skin along with the penetrating water during iontophoresis. In order to complete the circuit there must be an electrode of equal and opposite charge of the drug delivary electrode. Also recall that skin has a slight negative charge. So as expected, cationic drugs more easily cross the skin.