肌松药残余作用的预防.ppt

Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,2007,麻醉年会 专题报告,(肌松药残留作用的预防),Residual Paralysis:,-,clinical consequences-incidence-strategies to prevent,Claude Meistelman,M.D.,Professor and Chair,Dept.of Anesthesia and Intensive Care Medicine,School of Medicine,Nancy University,FRANCE,Swallowing and residual paralysis,L.I.Eriksson,Anesthesiology,1997;87:1035,Sundman et al Anesthesiology 2000;92:977,residual paralysis&pulmonary inhalation,L.I.Eriksson et al.,Acta Anaesthesiol Scand 1992,36:710,clinical consequences,incidence,strategies to prevent,Residual paralysis in PACU(%),TOF ratio 2hrs of deep block at recovery of T2,Eriksson et al.,Sugammadex reversal 2.,maximum reversal,Effective at both superficial and deep blocks,of Anesthesia and Intensive Care Medicine,Dose(mg/kg)Time(Median(range),Minimal side effects,6 mg/kg rocuronium and Org 25969,A,MG TOF R at MMG recovery to 0.9:,0.95(0.86 1.0),MMG TOF R at AMG recovery to 0.9:,0.83(0.65 1.0),TOF-Watch to detect residual paralysis,Anesthesiology,2004,AMG-,TOFR,calibrated,Not,calibrated,0.9,37,40,0.95,70,60,1.0,77,AMG TOFR:,negative predictive value,(%),97,European approach is possible,but.,Calibrated&continuous measurement,T4/T1,1,(hand adapter),if T4/T1 360,m,M,b,-cyclodextrin,29.0%,360,m,M,g,-cyclodextrin,94.1%,34.6,m,M,ORG 29569,a Selective Relaxant Binding Agent(SRBA),Bom.,Angew Chem,2002:41;265.,WHICH CYCLODEXTRIN FITS BEST?,maximum reversal,EC,50,g,-cyclodextrin,94.1%,34.6,m,M,sugammadex,95.1%,1.2,m,M,ORG 25969 specificity,plasma rocuronium in equilibrium with tissue,start of injection of Org 25969,Rocuronium0.,propofol anaesthesia,assess speed of,Anesthesiology,2004,May help in reducing PORC,TOF-Watch to detect residual paralysis,maximum reversal,of Anesthesia and Intensive Care Medicine,WHICH CYCLODEXTRIN FITS BEST?,NMM to detect patients who,Heart rate and Systolic Arterial Pressure,Atropine 15 g/kg,more rocuronium molecules are bound,Limits of visual fade detection,Eriksson et al.,plasma concentration of free rocuronium molecules=0,this creates a gradient between tissue and plasma,more rocuronium molecules are bound to Org 25969,Org 25969 molecules are moving into the tissue,more rocuronium molecules are bound,Sugammadex in volunteers,0.1-8.0 mg/kg doses,Without prior rocuronium,Administered 3 min after rocuronium,Neuromuscular measurements,Safety Assessments,1.0 mg/kg Org 25969,(23 min),Pl,acebo(45 min),2.0 mg/kg Org 25969(13 min),4.0 mg/kg Org 25969(3.2 min),TOF recordings after administration of,0.6 mg/kg rocuronium and Org 25969,Gijsenbergh F,et al.2002 ASA MeetingA-1008,Rocuronium0.6 mg/kg,Time of antagonism:Appearance of T2,Dose of sugammadexPlacebo,0.5,1.0,2.0,3.0 or 4.0 mg/kg,Sugammadex 4 mg/kg,Placebo,Rocuronium 0.6 mg/kg followed by sugammadex at reappearance of T2,21,Rocuronium 0.6 mg/kg followed by increments to maintain deep block at 2hrs of deep block at recovery of T2,Doses of Org 25969,0.5,1.0,2.0,4.0 and 6.0 mg/kg,Times to TOF ratio of 0.9 with reversal at T2 after deep block for 2 hours,Dose(mg/kg)Time(Median(range),0.55:29(4:50-11:26),1.02:42(1:49-3:40),2.01:46(1:00-2:31),4.01:04(0:57-2:19),6.02:41(1:08-3:56),Rocuronium reversal with sugammadex during propofol or sevoflurane anaesthesia,propofol anaesthesia,Sugammadex,sevoflurane anaesthesia,Sugammadex,Reversing a high dose deep rocuronium block with sugammadex,1.0 or 1.2 mg/kg of rocuronium,Reversal at 3 or 15 min after rocuronium,Doses of Org 25969,2.0,4.0,8.0,12.0 and 16.0 mg/kg,Reversal of 1.0 mg/kg rocuronium 3 min after relaxant administration,2.0 mg/kg Org25969,ROC,ROC,8.0 mg/kg Org25969,Sugammadex for early reversal of high dose rocuronium block,Dose of Org 25969(Sugammadex),Time to TOF ratio of 0.9(min(SD),8.0 mg/kg,3.2(1.0),12.0 mg/kg,2.1(0.9),16.0 mg/kg,1.3(0.4),Dose of rocuronium:1.2 mg/kg,Time of reversal:3 min after rocuronium,Sugammadex reversal 2.0 mg/kg,V,Vecuronium,Rocuronium,Org 25969 at reappearance of T2,(Time to TOF ratio of 0.9),Rocuronium,(0.6 mg/kg),Vecuronium,(0.1 mg/kg),0.5 mg/kg,3.7(1.0),7.7(2.6),1.0 mg/kg,2.3(0.6),2.5(0.8),2.0 mg/kg,1.7(0.6),2.3(0.8),4.0 mg/kg,1.1(0.3),1.5(0.5),Heart rate and Systolic Arterial Pressure,Sugammadex,Effective at both superficial and deep blocks,Excellent relaxation until the end of surgery,May help in reducing PORC,No observable muscarinic/vagolytic effects,No significant side effects,(based on more than 1000 administrations),End of case,2,1,cannot intubate-cannot ventilate(3 minutes),after short case surgery,or at deep block or at light block,Roc,Org 25969,2,Rescue,Org 25969,1,Potential use of Org 25969,