小儿MRI麻醉的国内外现状简介概要课件.ppt
小儿MRI麻醉的国内外现状简介（magnetic resonance imaging）,国内用药方案,用药种类多，药物组合变化多端给药途径各不相同关注新仪器、新给药系统的使用关注小儿麻醉后的苏醒及副作用,存在问题,全程监测的困难要求绝对制动,但持续给药有困难放疗患儿的处理?,MRI室内对监测仪器的要求,强磁场，所有仪器不能有含铁物质仪器用直流电，同时应予固定不致造成飞射可能测量从磁体周围50G（高斯）磁场距离以外可使用含铁物件?,MRI室内对监测仪器的要求,脉搏氧饱和度仪可用于MRI监测?主机应远离病儿，传感器接线不能围绕肢体以免皮肤灼伤可能，接线应有屏蔽性能 全塑监护仪，但国内尚未普及血压计袖带接管通过塑料衔接管延长自制非金属材料监测设备，如“加长全塑听诊器”、腹带式呼吸监测传感器、全塑Bain回路、全塑高频喷射通气道、面罩等,MRI室内对麻醉设备的要求,可用小儿微量滴管输注异丙酚稀释液代替磁性微泵 异丙酚的总量（mg）=小儿体重（kg）6稀释至100ml 举例：如10 kg的小儿，60 mg异丙酚6ml，然后用94ml晶体液稀释至100ml。滴速约等于心率，如小儿心率为120次/分，滴速为120滴/分，约等于120 ug/（kgmin）异丙酚，然后慢慢地调整维持镇静深度,MRI室内对麻醉设备的要求,麻醉机可置于离病人几米之遥加长输液管道与检查室外的输液泵连接，方便随时加药,儿童镇静方案,美索比妥(Methohexitone，Methohextal),化学名：5-烯丙基-1-甲基-5-巴比妥酸短效巴比妥类静脉麻醉药，药理作用与硫喷妥钠大致相同易通过血脑屏障，故发挥作用更快在体内的再分布时，脂肪组织中并不达到很高浓度适用于全麻的诱导、短小手术的基础麻醉，关节脱位的复原操作肌震颤、咳嗽发生率高于硫喷妥钠有颠痫史或哮喘发作者慎用或不用,国外相关文献,联合用药居多，吸入复合静脉麻醉也有较多报道报道重症患儿行MRI检查的麻醉经验如先天心、肺不张等讨论由谁来给药的问题（麻醉医生/训练护士）,rectal thiamylal in combination with oral triclofos in sedation for pediatric magnetic resonance imaging直肠给硫戊巴比妥口服三氯福司Five hundred forty-six children underwent MRI examination from January of 1997 to December of 2001.Among them,10mg/kg of rectal thiamylal was administrated after oral triclofos in 378 children.Successful sedation was obtained in 321 of 378 patients(85%)after a single rectal administration of thiamylal.Efficacy and adverse effects of rectal thiamylal with oral triclofos for children undergoing magnetic resonance imaging.Brain Dev.2006V28N3 Japan,三氯福司Triclofos,为水合氯醛的衍生物，镇静催眠药作用相似于水合氯醛无其不快气味，且对胃刺激性小,small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge.Nalbuphine provided better results than ketamine七氟醚麻醉结束前予少量KTM或纳布啡Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia.Anesth Analg.2006V102N4 Canada,Combined propofol and remifentanil intravenous anesthesia for pediatric patients undergoing magnetic resonance imaging Paediatr Anaesth.2005V15N5 Canada,Dexmedetomidine and a small dose of propofol were used successfully to sedate a critically ill infant for MRI.More studies are required to determine the role of this unique drug in the pediatric population.Dexmedetomidine sedation in a pediatric cardiac patient scheduled for MRI.Can J Anaesth.2005V52N7 Canada,Dexmedetomidine（右美托咪定）,商品名：Precedex化学名：（R）-4-1-（2，3-二甲基苯基）乙基-1H-咪唑单盐酸盐有效的2-肾上腺素受体激动剂，对2-肾上腺素受体的亲和力比可乐定高8倍，显示出镇静、镇痛和抗焦虑作用 经皮下或肌肉给药后快速吸收，达峰时间1小时 常见的不良反应：低血压，恶心，心动过缓，组织缺氧和心房颤动 2000年3月在美国首次上市，适用于重病监护治疗期间开始插管和使用呼吸机病人的镇静,总结,监测手段仍待完善提倡联合用药，快苏醒给药方式的改进,非常感谢！,
