CHNG 2 THUC TC DNG TRN H THN KINH

1. THUC C CH H THN KINH TRUNG NG 1.1. THUC M: (GENERAL ANESTHETICS) nh ngha: Thuc m l cht khi cp vo c th s tc ng ln h thn kinh trung ng sinh ra trng thi ng, u tin l s mt thc v cm gic, k n l s gin ngh hon ton ca c vn, nhng khng lm xo trn cc hot ng ca h tun hon v h hp. ngha ca vic dng thuc m : Dng trong phu thut Dng chng shock, co git Dng trong gy ng, gim au S la chn thuc m cho cc loi gia sc : Tru b: Ketamine Ch mo: Zoletil, Ketamine, Barbital sodium Heo: Pentobarbital, Thiopental sodium Nga: Ketamine Cc giai on xy ra trong lc gy m Giai on 1: Hng phn ty . Co git Nhp tim nhanh, mnh H hp nhanh, su Mng mt dn Tit nhiu nc bt C th tiu, tiu tin Giai on 2: Hng phn khng ty Bt u vi s suy yu ca trung tm v no, th mt dn thc vi cc biu hin sau : Pht ting ku trong hng Bn chn c ng kiu nga phi H hp su v chm M mt m rng, ng t dn C th i ma ( ch) nu khng cho nhn n 6 gi trc khi gy m Cn phn x chn (chn co rt khi kch thch au) Giai on 3: M gii phu Giai on ny tc dng ca thuc m lan rng t v no, trung no, n ty sng; thc, cm gic au v phn x ty sng bin mt. Cc c dn v khng cn chuyn ng. Phn x chn Phn x gic mc cn, ng t co rt li H hp tr nn chm v u n Nhp tim v huyt p bnh thng M su t c dng trong th y. S dng qu liu thuc m s dn ti m su. 9

H hp u nhng chm C hon ton dn, th mm nhn Phn v nc tiu bi thi ra ngoi Mt phn x m mt Nhit c th gim, th run v co mch Giai on 4: T lit hnh ty Cc trung tm iu ho s sng ca hnh tub t lit. H hp ngng. Tim p rt yu, ri ngng c vng hu mn v bng quang dn hon ton. Nhng tai bin lc gy m v cch phng Chy nc bt, nn ma: Cho th nhn i ti thiu 12 gi trc phu thut Tim Atropin lm gim tit nc bt Shock: vi c im tt huyt p, th dy da do tu sng b c ch. Can thip: Tng huyt p bng cch truyn mu, truyn dch, dng cc loi thuc kch thch thn kinh nh: Nikethamide, Amphetamin, Cafein, Camphorate H thn nhit. Cn gi m th lc gy m (Dng n hng ngoi si m. Cc loi thuc m dng trong th y: BARBITURATES L cht chuyn ho ca acid barbituric, bao gm nhiu loi thuc c tc dng gy m di hoc ngn. Phenobarbital sodium di Barbital sodium di Amobarbital sodium trung bnh Pentobarbital sodium ngn Secobarbital sodium ngn Thiopental sodium rt ngn Thiamalyl sodium rt ngn Thialbarbitone sodium rt ngn c tnh ca barbiturates: Tim qu nhanh, hoc qu liu Try h hp, phi cp cu bng th oxy huyt no, mng no. Suy gan trn cc th b bnh gan khi dng nhm barbiturates tc ng ngn Khng dng cho th s sanh do khong an ton hp, v thi gian tc ng ko di Liu lng v cch s dng: Pentobarbital sodium: Chng co git, lm m du trn i gia sc: 0,6 1,2 g / con, tim tnh mch Lm m du trn heo: 20 mg / kg th trng Tiu gii phu trn heo: 2 4 mg / kg th trng, tim tnh mch, sau gy t vng gii phu Thiopental sodium: Liu gy m cho tiu gia sc: 20 35 mg / kg, tim tnh mch

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Liu gy m cho i gia sc: 10 15 mg / kg, tim tnh mch Thiabarbitone sodium: Liu gy m cho , mo : 72 88 mg / kg, tim tnh mch Liu gy m cho nga : 22 33 mg / kg, tim tnh mch. Nu cha m su c th tng n 44 mg / kg, nhng phi tim tht chm. CHLORAL HYDRATE p dng lm sng Lm thuc ng cho th ln Lm thuc tin m Gy m cho gia sc Liu dng : Ung: vi mc ch an thn Nga, b: 25 45 g Heo: 2 4 g Ch: 0,3 1 g Mo: 120 600 mg Tim tnh mch vi mc ch gy m: 6 9 g / i gia sc Tim tnh mch vi mc ch gy ng: t n 2/3 liu gy m KETAMIN Tc dng: gy m ngn, gim au, Tc dng ph: Tng tit nc bt do cn dng Atropin lm cht tin m (1 mg/10 kg th trng). Ri lon tm thn (phng nga bng Diazepam) Tng nh nhp tim v tng huyt p Liu dng : tim tnh mch 2 5 mg / kg th trng liu u Liu duy tr bng liu u, cch nhau 8 10 pht. Thuc dng cho cc loi gia sc. ZOLETIL Thuc m dng cho tiu gia sc (Ch mo) Tin m bng Atropin liu 1 mg / 10 kg th trng Sau 10 pht chch Zoletil Liu dng : Ch : 725 mg/kg th trng (tim bp), 510 mg/kg th trng (tim tnh mch) Mo : 1015 mg/kg th trng (tim bp), 7,5 mg/kg th trng (tim tnh mch) 1.2. THUC AN THN THUC NG V CHNG CO GIT Dng liu cao s gy ng, cao hn na chng co git Barbiturates: c tc dng trn an thn kinh v gy ng nu dng liu thp. Thuc thng dng l Phenobarbitone : ch ln 90 mg / ln, ngy 3 ln ; ch nh : 30 mg / ln, ngy 3 ln Bromides: Dng cho ch vi mc ch trn an thn kinh, chng co git ch, liu dng : 0,3 1 g / ln (ung)

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Chlorbutol: Dng cho ch : 0,13 0,6 g / con / ln. Cho ung. Chlorpromazine: Liu ung : 1 2 mg / kg th trng , 2 4 ln / ngy Tim bp : 0,5 1 mg / kg th trng , 2 4 ln / ngy Tim tnh mch : 0,5 mg / kg th trng , 2 4 ln / ngy Bnh Colic nga : 1,5 mg / kg th trng tim bp Diazepam: Thuc tim : 2 ml = 10 mg Liu dng tim bp : 0,2 mg / kg th trng Acepromazine: Dng ung : dng cho ch, mo Liu dng : 1 3 mg / kg th trng Dng chch : Komisirastress Liu dng : 0,05 0,1 mg / kg th trng 1.3. THUC GIM AU - H ST - CHNG VIM: C tc dng lm gim nhit c th, thng qua s tng thi nhit, c ch sinh nhit, v c tc dng gim au trung bnh. Tc dng tng thi nhit bao gm : Dn mch mu ngoi bin Gia tng bi tit m hi Gia tng tc h hp Gim sinh nhit do tc ng c ch hot ng trung khu sinh nhit h tng th gic, hoc gim tc oxy ho cc m 1.3.1. Salicylates: gm Sodium Salicylic v Aspirin Sodium Salicylic: Nga, b: 15 - 120 g / con / ln Cu, heo: 1 - 4 g / con / ln Ch: 0,3 - 1 g / con / ln Mo: 3 - 30 mg / con / ln Aspirin: Tc dng : c ch men Cyclo-oxygenase, lm gim tng hp Prostaglandin, do c tc dng h st, gim au v chng vim. Liu dng Ch: 0,3 - 1 g / con / ln Mo: 0,1 - 0,3 / con / ln Ngy ung 3 ln 1.3.2. Paracetamol: L cht chuyn ho ca Phenacetine C tc dng gim au, h st rt tt, tuy nhin khng c tc dng chng vim Trn gia sc hiu qu ca paracetamol khc nhau Tc dng tt trn gia cm, t tc dng trn heo, i gia sc

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c trung bnh trn ch, rt c trn mo Liu dng: Ung : 10 mg / kg th trng, ngy 3 ln. Chch bp: 7 - 8 mg / kg th trng, ngy 2 ln Chng ch nh: Mo, ch 1.3.3. Phenylbutazone: Tc dng h st , gim au, v chng vim. Tuy nhin tc dng h st chm, tc dng chng vim yu hn Aspirin Tc dng ph: bun nn, au bng, to bn, chong nh. Liu dng: (ng chch bp) 15 mg / kg th trng, ngy 2 - 3 ln 1.3.4. Codein phosphate: Tc dng gim au yu hn Morphin, nhng mnh hn cc thuc gim au h st khc Codein cn c dng lm gim ho Tc dng ph: Gy to bn, c ch h hp. Dng lu c th gy nghin. Khng dng cho trng hp ho c nhiu m v gy tch m ph qun. Liu dng: (cho ung) 0.3 -0.6 mg /kg th trng. Ngy 3 ln. 2. THUC KCH THCH H THN KINH TRUNG NG 2.1. NIKETHAMIDE. (CORAMIN) Tc dng: Trn h thn kinh: - Kch thch trung khu h hp. - Kch thch trung khu vn mch T c tc dng tng huyt p, ci thin huyt p khi tt huyt p. Thuc c dng trong nhng ca suy h hp. Do thn kinh trung ng b c ch qa . Liu dng: Nga , tru ,b: 2.5-6 g / con Ch: 0.25-0.75 g / con. Mo: 0.25-0.5 g / con. ng cp thuc: ung hoc tim di da. 2.2. AMPHETAMINE SUPHATE Tc dng: Tng huyt p. Kch thch trung khu h hp lm th nhanh, su. p dng lm sng : tru h hp, tt huyt p. Liu dng: (tim di da) Nga , b: 1000-300 mg /con. Tiu gia sc: 1.1-4.4 mg /kg th trng. 2.3. CAFEIN L cht kch thch h thn kinh trung ng, tc dng mnh trn trung khu vn ng lm gia tng trng lc c, v cc vng nhn cm ti v no, trung khu h hp, trung khu vn mch v thn kinh vagus. p dng lm sng.

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Kch thch tng cng v tn s tim, c th phi hp vi digitalis, hoc strychnin. Kch thch c trong trng hp c yu. Lm hi tnh hot ng no. Li tiu trong bnh ph thn, gan do suy tim. Liu dng : ung hoc chch di da 1-2 ln/ngy. Tru ,b: 1-4 g/con /ln Heo: 0.3-1.5 g /con /ln. Ch: 50-250 mg con /ln. Nga: 0.5 g /con /ln. Chng ch nh: - Trong trng hp cao huyt p - Bnh vim thn cp trong cao huyt p. - Cn thn khi dng trn nga c mang. 2.4. STRYCHNINE Tc dng: c ch men acetylcholinesterase , ngn phn gii acetylcholine - gy nn s tch t acetylcholine trn b mt neuron lm tng trng lc c trn ,c vn. V ng ca strychnine: gia tng bi tit dch tiu ha, tng trng lc d dy, kch thch nhu ng rut. p dng lm sng: - Tr thn kinh, nh ci thin cc phn x v gia tng nhng phn ng thn kinh. - Tr sc , kch thch tiu ha, ngon ming trong cc trng hp bnh ang trong giai n phc hi. Liu dng: Gia sc Ung / con / ln Tim di da/ngy. B Heo, d cu Ch Mo Nga 150 mg 5 mg 1 mg 0,5 mg 100 mg 150 mg 5 mg 1 mg 0,5 mg 100 mg Ng c strychnine: Co git do phn x , c thi k yn ngh, s ng chm , ting ng, s gy co git tr li. Th cht do ngt th v co c ph qun. iu tr ng c: - Tim tnh mch Barbiturate i vi th nh - Cho ung hoc tim tnh mch Chloralhydrate

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2.5. CAMPHORE Tc dng : - Kch thch h thn kinh trung ng - Tng hot ng tim, tng huyt p - Tng hot ng h hp S tng hot ng tim, tng huyt p xy ra nh tc dng lm tng tm thu, phc hi nhp tim, do Camphor c dng lm thuc phc hi hot ng tim lc tim b nhim c cp, ng c thc n ng dng lm sng: Kch thch ton thn trong trng hp h thn kinh trung ng b c ch lm gim h hp, ri lon tun hon do trng c hoc nhim trng Tng cng hot ng tim khi tim b suy yu lc m, phng h huyt p t ngt Lu : khng dng cho gia sc sp m tht, v lm tht c mi long no Liu dng : (chch di da) Gia sc Du long no 20% Dung dch long no 10% Nga, tru b Heo, d cu Ch 40 ml 6 ml 2 ml 100 ml 20 ml 6 ml 3. THUC TC NG TRN DY THN KINH NGOI BIN (THUC T - LOCAL ANESTHETICS) 3.1. nh ngha : Thuc t l nhng dc phm c th tm thi lm gim hoc mt cm gic ni tip xc. c bit l cm gic au do hy b tnh cm ng v tnh dn truyn ca thn kinh hay cc dy tn cng ca thn kinh. 3.2. Cc phng php gy t: T b mt : lm mt cm gic do chm tn cng ca dy thn kinh cm gic b t lit. Phng php ny c p dng rng ri khi gy t mng nhy mt, mi, ming, da b try st. Khng tc dng trn da nguyn vn v biu b sng ha, thuc t khng th thm vo T thm : tim nhiu ln,cc th tch nh vo m. Thuc khuych tn chung quanh ni chch lm t chm tn cng ca dy thn kinh. Gy t mng cng hoc ngoi mng cng ty sng (Epidural Etraduran anesthesia) Bm thuc vo trong khong trng mng cng ca pha sau ty sng (gia cc xng ct). Thuc tc dng ln dy thn kinh ty sng pha sau, trc khi dy ny ra khi ct ty sng v phn chia khp c th. 3.3. C ch tc ng: S truyn xung ng thn kinh l do s gia tng t ngt kh nng thm thu ca mng t bo thn kinh vi nhng ion K trong t bo vi ion Na ngoi t bo. S khuych tn ny gy nn

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s thay i in th gia bn trong v bn ngoi mng t bo, lm in th m lan rng nhanh chng dc theo dy thn kinh khi xung ng lan truyn Thuc t khi vo m c tnh kim nh, s b thy gii chm, phng thch base alkaloid, tc dng gim kh nng thm thu ca mng t bo thn kinh, s thay i in th mng b ngn chn. 3.4. Cc loi thuc t: Cocain hydrochloride: Nh mt nga, ch chun b khm mt hoc gii phu. Dng dung dch 3 5 % nh thng vo mt, 2 5 git. Gy t mng nhy mi, thanh qun, khoang ming th ln hoc th nh bng cch nh mi, bm vo ming Khng dng gy t thm hoc mng cng ty sng Procain hydrochloride: c s dng rng ri do c tnh thp, hiu qu tc th Tuy nhin thi gian gy t ngn do cn kt hp vi cc thuc co mch, hoc thuc tr hon hp thu ko di thi gian gy t nh Adrenaline. Chuyn ha: xy ra gan, procain b thy gii thnh PABA v diethylamino etanol. c tnh: xy ra khi tim tnh mch tc nhanh. Liu 44 mg / kg th trng gy cht mo nu tim nhanh (trng hp tim chm liu gy cht ln n 440 mg / kg) do lm h huyt p. p dng lm sng: Gy t thm gii phu ngoi bin, thin th c Nng 2% dng trn th nh Nng 4% dng trn th ln t dng gy t b mt do hiu qu km hn cocaine, butacaine. Dng gy t mng cng ty sng, dung dch 2%. Lindocaine: Vi cng nng thuc c tc dng nhanh v mnh hn 2 ln so vi Procaine. Gy t ti ch: dung dch 0,5% th nh; 1% th ln. Gy t mng cng ty sng: 1 2% th nh 2 3% th ln (Nn dng chung vi dung dch Adrenaline 1/100.000 ko di thi gian gy t) c tnh: tim qu nhiu m khng kt hp vi Adrenaline thuc hp thu qu nhanh lm suy yu h thn kinh trung ng gy bun ng, c th gy co rt c, h huyt p, i ma. Tetracaine: Tc dng gy t mnh hn Procaine Cch dng : Gy t mt : 0,5% th nh, 1% th ln. Gy t b mt mng nhy : 2% Gy t thm : 1% cho th nh, 2% th ln. Butacaine: Ch dng gy t b mt do c tnh cao. Cch dng : gy t b mt nim mc mt, mi, ming, cung hng : dung dch 2% cho th nh, 4 5% cho th ln.

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4. THUC TC DNG LN H THN KINH T TR 4.1. Tng quan v h thn kinh t tr: Phn loi : h thn kinh t tr c chia lm 2 nhm : Nhm ph giao cm Nhm giao cm Thn kinh ph giao cm : xut pht t trung no, hnh ty, xng cng ct sng. Dy thn kinh Vagus l dy ph giao cm chnh ca c th. Thn kinh giao cm : xut pht t min ngc, thc lng ca ct sng Nhm ph giao cm v giao cm sau khi xut pht u phn chia v i n tn cc c quan, nhm iu khin s hot ng ca tt c cc c quan trong c th. Hai nhm ny thng c tc dng i nghch nhau nhm gi cho cc c quan hot ng trng thi cn bng. Th d: kch thch h giao cm : tim p nhanh kch thch h ph giao cm : tim p chm Cht trung gian ho hc: H giao cm : Adrenaline v Noradrenaline, hj cm ng vi n c gi l Adrenergic H ph giao cm : Acetylcholine, h cm ng gi l cholinergic 4.2. Thuc kch thch dy thn kinh giao cm Adrenaline Tc dng ln tim mch : tim p nhanh , co bp mnh, cung lng mu tng, tng huyt p. Co mch mu ngoi bin nhng dn mch ni tng. Tc dng ln h hp : dn kh qun (cha hen suyn), gy co mch mu nim mc kh qun Tc dng ln tiu ha : gim nhu ng rut. Tc dng ln s chuym ha : tng nng glucose huyt. c tnh gy tng nhp tim, tng huyt p d dn ti cc tai bin tim mch. Gy hoi t ch tim. Nu dng dung dch nng 1/1.000 do co mch ko di ti vng tim. p dng lm sng: Trong gy t : ko di thi gian gy t do tc dng co mch, thng phi hp vi thuc t theo t l 9 phn thuc t vi 1 phn dung dch adrenalin 1/10.000 trong trng hp gy t thm. Cm mu ti ch : phun vo mng nhy mi hoc m nng 1/20.000 cho th nh, 1/10.000 cho th ln Chng shock trong phn ng qu mn tc khc Chch di da nng 1/1.000 : 0,5 ml / heo con Chng ngng tim : nng 1/1.000 chch thng vo tim : t 0,5 1 ml / th. Liu dng : Tim di da, tim bp (dung dch 1/10.000) Nga, b : 20 80 ml Cu, heo : 10 30 ml Ch, mo : 1 5 ml Tim tnh mch (dung dch 1/10.000) Liu cp t 1/5 n liu chch bp 4.3. Thuc lit giao cm: L thuc c tc dng phong b hiu qu ca giy thn kinh giao cm, hay ni cch khc l phong b tc ng kiu adrenaline

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Tc dng : dn mch - h huyt p. Cc loi thuc lit giao cm t c ng dng trong th y 4.4. Thuc kch thch ph giao cm: CARBACHOL: Tc dng: Trn d dy - rut : tng nhu ng rut, tng trng lc d dy (dng cho th nhai li trong bnh lit d c) Kch thch tng bi thi nc bt Trn t cung: co bp c t cung, tng sn dch (khng dng trn th mang thai) Trn c ph qun: co c, lm gim ng thng kh ng dng lm sng: (tim di da) Tr colic (au bng do nghn rut, lit rut hoc chng hi (Tympany) hoc au bng do nghn manh trng - kt trng. Dng liu nh 1 - 2 mg, c 30 pht lp li, sau khi cho ung thuc x Tr lit d c: Dng 1 liu duy nht 4 mg / 500 kg th trng, c th gy c do nn chia lm 2 ln trong 30 - 60 pht. Tng sn dch bnh vim t cung heo 2 mg / ni / ln, chch di da Gy i ma ch trong tng hp n phi cht c 0,25 - 1 ml dung dch 1% PILOCARPIN NITRATE: Tc dng: Kch thch bi tit nc bt, m hi Kch thch tng trng lc d dy - rut Dng tr bnh chung hi, khng tiu, lit d c, tt d l sch. Liu dng: tim di da Nga: 100 - 200 mg B: 200 - 400 mg Kch thch nhai li , hi : 50 - 60 mg Heo: 2 - 50 mg Ch: 5 - 20 mg Mo: 1 - 3 mg c tnh: Gy kh th do co c kh qun Gy ngng tim Tiu chy - au bng d di Gii c bng thuc i khng Atropin cho tng liu nh. 4.5. Thuc lit ph giao cm: Thuc lit ph giao cm c tc dng ngn Acetylcholin pht sinh hiu qu trn nhng c quan c dy hu hch phn b n. Atropin sulphate: Tc dng: ngn cn tng tc ca acetylcholin v ni tip thu trn t bo hiu ng.

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 Trn h thn kinh : kch thch nh h hp do tc ng nh ln h thn kinh trung ng Trn tim mch : Liu iu tr thng thng khng nh hng n tim mch. Tuy nhin trong trng hp tim b c ch do dy thn kinh Vagus b tc ng bi Ammoniac hoc Chloroform , Nicotine Atropin c tc dng lm tng nhp tim do tc ng lm c ch dy thn kinh Vagus. Trn kh qun : H ph giao cm c tc ng lm tng tit cht nhy, co rt c ph qun. Atropin phong b xung ng thn kinh ph giao cm, do lm dn ph qun, gim s bi tit cht nhy, do thng c s dng trong trng hp shock do dng thuc (gy co tht c ph qun) Trn d dy - rut : Atropin phong b hiu ng lm co tht c trn ca Acetylcholin, lm gim nhu ng rut, chng co tht rut, do i khi c s dng trong trng hp au bng do co tht rut, tiu chy qu nng gy mt nc c tnh: Triu chng ng c : Kh ming, kht nc Kh nut To bn Tim p nhanh, th nhanh - su Ri lon vn ng Run c Co git Suy yu h hp - cht. Gii c Atropin: Nu ng c qua ng ung : dng thuc gy i ma, kt hp ra d dy Nu ng c qua ng tim di da : dng cc loi thuc tc ng kiu choline gii c nh morphin chlohydrate tim di da gii c Atropin p dng lm sng: Cha ph phi gia sc Gim co tht kh - ph qun trong shock hoc do d ng Chng co tht c trn c ch bi tit nc bt v cht nhy kh qun do thng c dng nh cht tin gy m Dng cha tr cc trng hp ng c : Pilocarpin Arecoline Dipterex Morphine Chloroform Cc loi thuc tr su, phospho hu c Liu dng : Tin gy m : 0,05 - 0,1mg / kg th trng , chch di da c ch bi tit, chng co tht c trn v cc mc ch khc (chch di da) Nga : 10 - 80 mg Tru b : 30 - 100 mg Heo : 10 - 30 mg Ch : 1 mg

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