Nonbarbiturate Anesthetics 非巴比妥类麻醉药
The other parenteral drugs used for intravenous administration in anesthesia are nonbarbiturates with a wide variety of effects. Such anesthetics include droperidol (Inapsine), etomidate (Amidate), ketamine (Ketalar), midazolam, and propofol (Diprivan).
麻醉时用于静脉注射的其他非口服类药物为具有多种效应的非巴比妥类药。此类麻醉药包括氟哌利多 (Inapsine )、依托咪酯 (Amidate )、氯胺酮 (Ketalar )、咪达唑仑和异丙酚 (得普利麻)。
Therapeutic Action and Indications 治疗作用和适应症
Midazolam is the prototype nonbarbiturate anesthetic. It is a very potent amnesiac. These drugs are thought to act in the reticular activating system and limbic system to potentiate the effects of gamma-aminobutyric acid. Midazolam’s amnesiac effects occur at doses below those needed to cause sedation. It is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures. Midazolam can also be used to induce anesthesia and to provide continuous sedation for intubated and mechanically ventilated patients.
Droperidol produces marked sedation and produces a state of mental detachment. It also has antiemetic effects, reducing the incidence of nausea and vomiting in surgical and diagnostic procedures.
氟哌利多产生显著的镇静作用，产生精神超脱状态。同时也具有止吐效应，减少手术和诊断操作时恶心和呕吐的发生。
Etomidate is used as a general anesthetic and is sometimes used to sedate patients receiving mechanical ventilation.
依托咪酯作为全麻药物使用，有时用于镇静机械通气患者。
Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous.
Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is also used to maintain patients on mechanical ventilation.
丙泊酚经常用于短期操作，因为该药清除极为迅速，宿醉效应小得多，而且可以迅速恢复。该药还用于机械通气患者的维护。
Pharmacokinetics 药代动力学
Midazolam has a rapid onset but does not reach peak effectiveness for 30 to 60 minutes. Droperidol has an onset of action within 3 minutes and an ultrashort recovery period. Etomidate has an onset within 1 minute and a rapid recovery period within 3 to 5 minutes. Ketamine has an onset of action within 30 seconds and a very slow recovery period (45 minutes). Propofol is a very short-acting anesthetic with a rapid onset of action of 30 to 60 seconds.
Midazolam is more likely to cause nausea and vomiting than are some of the other anesthetics, and so it should be used with caution in any patient who could be compromised by vomiting. It has been associated with respiratory depression and respiratory arrest, and so life support equipment should be readily available whenever it is used. Droperidol should be used with caution in patients with renal or hepatic failure and should be used with extreme care in patients with prolonged QT intervals or who are at risk for prolonged QT intervals. Etomidate is not recommended for use in children younger than 10 years of age.
Patients receiving any general anesthetic are at risk for skin breakdown because they will not be able to move. Care must be taken to prevent decubitus ulcer formation. Patients receiving midazolam should be monitored for respiratory depression and CNS suppression. During the recovery period, droperidol may cause hypotension, chills, hallucinations, and drowsiness. It may also cause QT prolongation, which puts the patient at risk for serious cardiac arrhythmias. During the recovery period with etomidate, many patients experience myoclonic and tonic movements, as well as nausea and vomiting. Ketamine crosses the blood–brain barrier and can cause hallucinations, dreams, and psychotic episodes. Propofol often causes local burning on injection. It can cause bradycardia, hypotension, and in extreme cases pulmonary edema.
nonbarbiturates – n. 非巴比妥类
droperidol – n. 氟哌利多
Inapsine – n. 氟哌利多商品名
etomidate – n. 依托咪酯
Amidate – n. 依托咪酯商品名
ketamine – n. 氯胺酮
Ketalar – n. 氯胺酮商品名
midazolam – n. 咪达唑仑
Versed – n. 咪唑安定
propofol – n. 异丙酚
Diprivan – n. 得普利麻
potentiate – vt. 赋与力量，使可能
gamma-aminobutyric acid –γ-氨基丁酸
amnesiac – a. 遗忘的，健忘的
detachment – n. 分离，超然
bizarre – a. 怪异的，希奇古怪的
ultrashort – a. 超短的
尽快地从茫然中理清复习思路，准确地抓住复习重点，这一愿望，“ISPN考试复习要点提示”帮您实现！
★Video ★
Inhaled Anesthetics
★Test ★
1. The nurse evaluates the effectiveness of an analgesic by observing the patient for decreased sensation to what?
A. Pressure
B. Spasm
C. Touch
D. Pain 2. The nurse understands that which of the following is/are used for induction of anesthesia in balanced anesthesia.
A. propofol and short-acting barbiturate
B. short-acting barbiturate and neuromuscular agents
C. nitrous oxide
D. opioids
奥医教育ISPN / NCLEX-RN “在线自测”题库，复习、练习、效果检验一站完成
答案 Answers
1. D. Pain Rationale: The term analgesia refers to loss of sensibility to pain, whereas anesthesia refers to loss of pain, touch, temperature, and taste. During general anesthesia, all sensation is lost, and consciousness is also lost. 2. A. propofol and short-acting barbiturate Rationale: Balanced anesthesia is a technique that employs more than one drug to ensure that induction is smooth and rapid and that analgesia and muscle relaxation are adequate. Agents used most commonly include propofol and short-acting barbiturates for induction of anesthesia, neuromuscular blocking agents for muscle relaxation, and opioids and nitrous oxide for analgesia.
当前位置：
