Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auAnesthesia Cardiovascular Therapeutics UnitHeartweb.com.auOrgan Function 器官功能Time时间Effects of Anaesthesia on Organ Function 麻醉对于器官功能的影响Liver肝脏Kidney Gut肾脏，消化道Vascular resistance血管阻力 Contractility收缩力 Respiration呼吸 Consciousness意识Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auAre the effects reversible - e.g.brain? 这些影响可逆转吗 例如：脑？Organ Function 器官功能Time时间Eye opening睁眼 Orientation定向 Emotional情感 Cognitive认知Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auRecovery differences-other organs 恢复的差别 其他器官Organ Function 器官功能Time时间Respiratory 呼吸Cardiovascular 心血管Nausea + Vomiting恶心和呕吐Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auRange of recovery 恢复的范围Organ Function 器官功能Time时间Expectation 期望值Range范围Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auCan anaesthetics cause harm? 麻醉是有害的吗？HarmProtectionAnaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auDo you practice anaesthesia with the firm belief, that when you switch off the anaesthetic, that the effects are fully reversible and that no harm is done to the patients? 实施麻醉时您是否坚信在停药后 麻醉药物的影响是否可以完全逆 转而对病人没有伤害？Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auIf you said yes then why do we get 如果你的回答是“YES”，那么为什么我们 还会遇到 prolonged nausea and vomiting 术后长时间的恶心和呕 吐 agitation躁动 disorientation定向障碍 postoperative cognitive dysfunction (POCD)术后认知功 能障碍 sometimes prolonged hypotension有时发生长时间的低 血压 cases of good versus bad recovery患者恢复有好有坏Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auWhat we do know 我们所知的： Anaesthetics alone can cause POCD in mice after repeated exposure反复使用麻醉药这一单一因素即可导致小鼠术 后认知功能的障碍 Anaesthetics can alter hippocampal gene expression lasting weeks, indicating that longer term intracellular changes occurs麻醉药能够持续数周改变海马基因的表达，提示 发生了远期的细胞内改变Bianchi SL, Tran T, Liu C et al. Brain and behavior changes in 12-month-old Tg2576 and nontransgenic mice exposed to anesthetics. Neurobiol Aging 2007. Culley DJ, Yukhananov RY, Xie Z et al. Altered hippocampal gene expression 2 days after general anesthesia in rats. Eur J Pharmacol 2006;549:71-8.Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auWhat we dont know- what is the trigger for harm我们不知道的 导致伤害的诱因 是什么？ Drug药物 Dose剂量 Depth麻醉深度 Duration用药时间 Repeated exposure反复用药 Patient susceptibility病人的易感性 Importance of co-morbidities并存疾病的重要性 Are all anaesthetics equal?所有的麻醉药都一样吗？Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auAre all anaesthetics all equal? 所有的麻醉药都一样吗？Harm伤害Protection保护Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auWe should not assume that all anaesthetics are equal, nor should we assume that all drugs from the same class are the same既不能假设所有的麻醉药是一样的，也不应该假 设同类药物中所有的药是相同的HarmProtection?Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auExample - effect on contractility 举例 对心肌收缩力的影响Royse CF, Liew DF, Wright CE et al. Persistent depression of contractility and vasodilation with propofol but not with sevoflurane or desflurane in rabbits. Anesthesiology 2008;108:87-93Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auExample- effect on MAP 举例 对平均动脉压的影响Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auConcept of organ protection 器官保护的概念 Requires a potential organ injury存在潜在 的器官损害因素 Ischaemia and reperfusion缺血和再灌注 Trauma创伤 Chemical / drug toxicity化学/药物毒性 Different organs may have different effects 对不同的器官可能有不同的影响 Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auModel of organ protection Drugs with no organ protection器官保护药物本身并无 直接的器官保护作用：模型说明Organ Function 器官功能Time时间Organ Insult器官损伤Drug that causes Harm造成伤害的药物Drug with minimal Harm造成伤害很小的药物Perceived organ protection 表现出（相对的）器官保护作用Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auOrgan protection器官保护Organ Function 器官功能Time时间Organ Insult器官伤害Actual Organ Protection 实际的器官保护Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auOrgan protection器官保护Harm伤害Protection保护Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auMechanisms机制Organ Protection 器官保护receptor effects受体效应stabilize mitochondrial membranes 稳定线粒体膜preserved membrane integrity保护膜的完 整性lower oxygenconsumption 降低氧耗free radical Scavenging 清除自由基reduce inflammatorycascades 减轻多级炎症反应Anaesthesia and Pain Management Unit; Cardiovascular Therapeutics UnitHeartweb.com.auReceptors受体 Protective volatiles保护性 的（挥发性气体） ATPase K+ iNOS dependent Modulation of glutamate transport谷氨酸盐的转运 调节 GABA