Transcript Chapter 10 Local Anaesthetics

Chapter 10 Local Anaesthetics
introduction

1.definition:
abolish pain
without producing unconsciousness
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2.chemistry
Basic structure: three parts
芳香基团: 决定亲脂疏水性
中间链: 决定代谢途径及作用强度
胺基团: 决定亲水疏脂性
3. classification:
ester(酯类): pseudo-ChE
amide(酰胺类)
Basic actions
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1.local anaesthetic action
Mechanism: block the Na+ channel
characteristics:
2. effects after absorption: toxic reaction
(1)CNS:excitation---inhibition
(2)CVS:inhibition
Pharmacokinetics

1.absorption
(1) location
(2) vasoconstrictor
2.distribution
(1) tissue perfusion
(2) PH
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3. Elimination:
Clinical uses
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1. surface anaesthesia（表面麻醉）
2. infiltration anaesthesia (浸润麻醉）
3. conduction anaesthesia（传导麻醉）
4. subarachnoidal anaesthesia（蛛网膜下
腔麻醉, 腰麻）
5. epidural anaesthesia（硬膜外麻醉）
adverse reactions
1. toxic reaction
CNS, CVS
 2. allergic reaction
Prevention and treatment
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酯类局麻药
Procaine（普鲁卡因,novocaine,奴佛卡因）
[Characteristics]
1. not fit for surface anaesthesia
2. avoid combining with sulfonamides
3. allergic reaction
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酯类局麻药
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tetracaine（丁卡因, dicaine ,地卡因）
[Characteristics]
1. local anaesthetic action: strong
2. toxic reaction :strong
3. surface anaesthesia, not used in infiltration
anaesthesia
酰胺类局麻药
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lidocaine（利多卡因, xylocaine,塞罗卡因）
[Characteristics]
1. local anaesthetic action:
rapid, strong, long
2. low toxicity
3. all-round anaesthetic
酰胺类局麻药
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Bupivacaine(布比卡因，marcaine,麻卡因)
[Characteristics]
Stronger and long duration