Dexmedetomidine 用於降低小儿Sevoflurane麻醉後躁动课件.pptVIP

Dexmedetomidine 用於降低小兒Sevoflurane麻醉後躁動 徐永偉 醫師馬偕紀念醫院麻醉科2006.12.1 Learning Objectives 學習目標 什麼是 Dexmedetomidine Dexmedetomidine 的藥理作用 Dexmedetomidine 用於麻醉的臨床報告 Dexmedetomidine用於降低小兒Sevoflurane麻醉後躁動的研究：實證醫學的應用 Medetomidine 動物鎮靜麻醉 Ketamine (K他命）和 Midazolam 混合 Medetomidine Medetomidine混合dextro-medetomidine levo-medetomidine Dexmedetomidine (Precedex?) Dexmedetomidine (Precedex?) 有關 Dexmedetomidine 的研究 a2腎上腺素接受器 Regulate release of neurotransmitters Control epinephrine, norepinephrine release Modulate sympathetic response “negative feedback loop” Dexmedetomidine作用機轉 Dexmedetomidine作用部位 作用部位 Brain (locus ceruleus)第4腦室底上角之色素隆凸 Spinal cord 脊髓 交感神經 中樞神經之作用 Sedation 鎮靜 Anxiolysis 抗焦慮 Analgesia 止痛 交感神經之作用 ? Sympathetic activity ? BP, ? HR Precedex 在呼吸以及止痛方面的研究 Dexmedetomidine 的使用 (Adult) Heart block 心房心室傳導阻滯的病患，要小心使用 Administer loading dose slowly 第1個劑量要慢慢給 Transient vasoconstriction mediated by α2B-adrenoceptors will ↑ BP loading : 1 mcg/kg over 10 min maintenance : 0.2 to 0.7 mcg/kg/hr Onset: 5 -10 min Reduced effect: 30 min Duration: 2 hour Dexmedetomidine使用於麻醉 Severe respiratory compromise Obesity “cooperative sedation” Craniotomy Interventional procedures under LA e.g. vascular Painful procedures Fiberoptic intubation Decrease cough during emergence Stable hemodynamic with prone position Effect on emergence agitation 實證醫學 實證醫學在 Dexmedetomidinem 預防 emergence agitation 的應用 Dexmedetomidine for emergence agitation What Did They Said About Dexmedetomidine for emergence agitation 0.3, 0.5, 1 ug/kg Dexmedetomidine after sevoflurane induction Decrease emergence agitation to about 5~10% Time at PACU (POR): No delay Dexmedetomidine for emergence agitation 實證醫學的實行:五個步驟Five steps to practice EBM Asking an answerable question提出可回答的臨床問題 Tracking down the best evidence搜尋最佳實證文獻資料  Critical appraisal 謹慎的文獻評讀 Integrating the appraisal with clinical expertise and patients’ preference 臨床應用  Evaluation the effectiveness and efficiency in executing steps 1-4 評估改善