3李民-右美托咪定在清醒插管中的应用PPT.pptxVIP

右美托咪啶在清醒插管中的应用 北京大学第三医院麻醉科 李民清醒气管插管的适应症可能发生反流误吸的患者评估可能存在困难气道患者麻醉诱导后可能气道梗阻的患者诱导后插管可能发生或加重脊髓损伤的患者清醒插管的要素镇静在表面麻醉过程中及气管插管过程中实施镇静非常重要平静、舒适的患者在操作过程中更容易与麻醉医师配合阿片类药物优点具有镇痛作用 有助于抑制气道反射，尤其是呛咳反射芬太尼因血流动力学稳定、价格低廉、临床医生最为熟悉而最常用，建议的最低剂量(0.5～2 mcg/kg)瑞芬太尼因起效迅速、可持续或靶控输注，近年来应用逐渐增多。缺点无遗忘作用常引起明显的呼吸抑制清醒插管镇静的药物瑞芬太尼七氟醚泄露造成环境污染药物选择咪达唑仑丙泊酚右美托咪啶Dex抗焦虑易被唤醒镇静α2受体激动剂无呼吸抑制镇痛抑制唾液分泌Ebert TJ, et al. Anesthesiology.2000Venn RM, et al. Crit Care, 2000Dex + midazolam verse midazolam Dex +midazolam verse midazolam Dex +midazolam verse midazolam Dex +midazolam verse midazolam Dex+ midazolam verse midazolam Dex + with midazolam verse midazolam Dex +midazolam verse midazolam Dex versus propofol target-controlled infusionForty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery.Dexmedetomidine group (1.0 μg.kg-1 ) over 10 min (n = 20) Propofol target controlled infusion group (n = 20), initial target effect site concentration (Ce) was set at 3μg.ml-1. This was adjusted by 1.0 μg.ml-1 according to patient comfort during the procedure.Dex versus propofol target-controlled infusionDex versus propofol target-controlled infusionDex versus propofol target-controlled infusionConclusion: Both dexmedetomidine and propofol target-controlled infusion are effective for fibreoptic intubation. Dexmedetomidine allows better tolerance, more stable haemodynamic status and preserves a patent airway.Dex verse fentanylDex verse fentanylDex verse fentanylNasal Intubation score (1–5) representing condition for intubation was significantly better in the Dex group [2(1–3)] than in the Control group [3(2–5)] (P0.001).satisfaction score (1: excellent, 2: good, 3: fair, 4: poor).Dex verse fentanylDex verse remifentanilMethods 40 patients undergoing elective awake fiberoptic nasotracheal intubationDex： loading dose (1.5 μg.kg-1 ) + a continuous infusion of 0.7 μg.kg-1 h-1.Remifentanil：initial target was 3.0 ng/ml, and the TCI was adjusted by 0.5 ng/mlDex verse remifentanilNumber