[麻醉讀書筆記 78-day Anesthesia Secrets] Day 01 - Autonomic Nervous Systemic System

 

Anesthesia Secrets 78 Chapter, Day 01

🙀There are no shortcuts, only hard work. 💪


Day 01 ANS, Autonomic nervous system

[Anatomy]

Sympathetic / Parasympathetic, neuro transmitter



[End-Organ effect of Adrenergic Receptor]

End organ effects of Adrenergic R.


[談談 Sympathomimetic drug / 就是合成的東西啦]

天然的: NE, Epi, DA vs. 合成的主要分成兩種
  • Direct-acting: 直接 target 到 Receptor
    • Phenylephrine
      • 作用在 alpha-1: 所以 vasoconstriction → SVR ↑ (→  reflex bradycardia), 讓 BP ↑
      • 💊 IV dose: 50-200 mcg, Infusion: 10-20 mcg/min
    • Isoproterenol
    • Dobutamine
  • Indirect → stimulate release of NE
    • Ephedrine
      • 作用在 Alpha-1: SVR↑
      • 作用在 Beta-1: HR ↑
      • 💊 IV dose: 5-25 mcg (repeated dose 會↓ response, tachyphylasix)
      • ⛔ 禁止, 病人有再吃 (-) reuptake of NE  (TCA, MAOI) 的話不能用 → 會 severe HTN


[談談 Anticholinergic (muscarinic antagonist) 就是 (-) 副交感那裏的 Ach R.]

所以會造成
  • ↑ HR
  • Bronchodilation
  • (-) Secretion

常用的藥物
  • Atropine
  • Scopolamine
  • Glycopyrrolate: 手術前手術中用以減少唾液, 不過 BBB
  • Ipratropium bromide: for bronchodilate
    • 病房常吸的 Atrovent

[嘿嘿 Pheochromocytoma 💥]

基本知識
  • Catecholamine-secreting tumor
    • mostly intra-renal
      • extra-renal 最常見在 w/in bladder wall
    • 10% malignant
  • Diagnosis
    • ↑ plasma/urine catecholamine and metabolites

麻醉相關
  • 注意
    • Often 為 Volume depleted
    • risk of ↑ HTN
  • Pre-OP (🚧待完整建構中🚧)
    • Rehydration
    • 先用
      • Phenoxybenzamine, a non-selective alpha blocker, 口服, is the most common medication used to alpha block patients prior to pheochromocytoma resection.
      • Selective alpha blockers such as doxazosin are also commonly used to alpha block patients prior to pheochromocytoma resection.
    • 再用
      • beta-blocker (常用 Labetalol)
  • Intra-OP
    • tumor 拿掉之前
      • IV alpha-blocker: phentolamine
      • Vasodilator: Nitroprusside
    • tumor 拿掉之後
      • Fluid
      • Alpha-agonist: pnehylphrine


[豆🥜知識]

  • beta-blocker: OP 當天要吃
    • beta 1-blocker: ↓ cardiac output, O2 requirement 所以 benefit in Ischemic heart disease，也可以防止停掉的 risk of rebound
  • Clonidine (alpha-2 blocker) OP 當天也要吃
    • 也是要小心停掉 rebound HTN
  • Peri-induction 的 HypoTN
    • IV fluid
    • Direct-acting sympathomimetics: e.g. Phenylephrine

Ref: Anesthesia Secrets, 4th edition. Chapter 01


By 破掉的雞蛋, 🥚🥚🥚

💬 E-mail: mata.assembled@gmail.com

 

0 Comments