독사프람
독사프람(Doxapram)은 중추신경계(CNS) 및 호흡 자극제입니다. 수의학에서는 주로 전신 마취 중 또는 마취 후 호흡을 자극하고 각성을 촉진하는 데 사용됩니다. 또한 얕은 마취 상태에서 **후두 기능 평가**(예: 후두 마비 진단)를 할 때 깊은 흡기 노력을 유도하여 피열 연골의 움직임을 쉽게 관찰할 수 있게 해주어 매우 유용합니다. > **임상적 주의사항:** 과거에는 난산이나 제왕절개 후 신생아의 호흡을 자극하기 위해(주로 설하 또는 제대 정맥을 통해) 일상적으로 투여되었습니다. **그러나 현재 이 용법은 큰 논란이 있습니다.** 독사프람은 심근 및 뇌의 산소 요구량을 크게 증가시킵니다. 이미 저산소증 상태인 신생아에게 이는 치명적일 수 있습니다. 현재의 신생아 소생술 가이드라인은 자극제 사용보다 기도 확보, 산소 공급, 양압 환기(기계적 호흡 지원)를 우선할 것을 강력히 권장합니다.
작용 기전: Doxapram is a generalized CNS stimulant. Its respiratory effects are primarily driven by: 1. **Direct stimulation** of the **medullary respiratory centers**. 2. **Reflex activation** of peripheral **carotid and aortic chemoreceptors**. This dual action leads to transient increases in tidal volume and respiratory rate. > **Mechanistic Note:** While doxapram increases respiratory effort, it simultaneously increases the overall work of breathing, metabolic rate, and carbon dioxide production. Consequently, it does not reliably improve arterial oxygenation, which is why it cannot replace mechanical ventilation in severely hypoxic patients.
동물 종별 용량
- Gas anesthesia recovery · 1.1 mg/kg IV · IV · May repeat in 15-20 minutes if necessary · Adjust dosage for depth of anesthesia, respiratory volume and rate.
- Barbiturate anesthesia recovery · 5.5-11 mg/kg IV · IV · May repeat in 15-20 minutes if necessary · Adjust dosage for depth of anesthesia, respiratory volume and rate.
- To initiate or stimulate respirations in neonates after caesarian section or dystocia · 1-2 drops (1-2 mg) SC or sublingually · SC/SL · Once · Depending on severity of respiratory crisis.
- To stimulate respiratory function in neonates · 0.1 mL (2 mg) IV (IM or SL also possible) · IV/IM/SL · Once · Most likely to be beneficial to increase efforts in neonates with low-frequency, gasping, erratic pattern of breathing after receiving oxygen therapy.
- Primary apnea in asphyxic calves when intubation and mechanical ventilation are not feasible · 2 mg/kg IV · IV · Once · Contraindicated in premature calves or other patients with clinical signs indicative of lung immaturity.
- Primary apnea in newborn calves · 2 mg/kg IV · IV · Once
- Halothane, methoxyflurane anesthesia recovery · 0.44 mg/kg IV · IV · May repeat in 15-20 minutes if necessary · Adjust dosage for depth of anesthesia, respiratory volume and rate. ARCI UCGFS Class 2 Drug.
- Chloral hydrate ± magnesium sulfate anesthesia recovery · 0.55 mg/kg IV · IV · May repeat in 15-20 minutes if necessary · Adjust dosage for depth of anesthesia, respiratory volume and rate. ARCI UCGFS Class 2 Drug.
투여 경로
금기
- Patients receiving mechanical ventilation
- Hypersensitivity to doxapram
- Seizure disorders
- Head trauma or cerebrovascular accidents (CVA)
- Uncompensated heart failure
- Severe hypertension
- Respiratory failure secondary to neuromuscular disorders
- Airway obstruction
- Pulmonary embolism
- Pneumothorax
- Acute asthma
- Dyspnea
- Hypoxia not associated with hypercapnia
- Premature calves or patients with clinical signs of lung immaturity
이상반응
- Hypertension
- Arrhythmias
- Tachycardia
- Seizures (at high doses)
- Hyperventilation leading to respiratory alkalosis
- Increased myocardial oxygen demand
- Reduced cerebral blood flow
- Skeletal muscle hyperactivity
약물 상호작용
- General Anesthetics (e.g., halothane, enflurane) · Doxapram may increase epinephrine release and sensitize the myocardium to catecholamines. Use should be delayed for ~10 minutes after discontinuing these anesthetics.
- Muscle Relaxants · Doxapram may mask the effects of muscle relaxant drugs.
- Sympathomimetic Agents · Additive pressor (blood pressure increasing) effects may occur.
모니터링
- Respiratory rate and effort
- Cardiac rate and rhythm
- Blood gases (if available and indicated)
- CNS level of excitation and reflexes
- Blood pressure (if indicated)
과용량
The reported LD50 for IV administration in neonatal dogs and cats is approximately 75 mg/kg. **Clinical signs of overdosage include:** - Respiratory alkalosis - Hypertension - Skeletal muscle hyperactivity - Tachycardia - Generalized CNS excitation, including seizures **Treatment:** Treatment is primarily supportive. Drugs such as short-acting IV barbiturates may be used to help decrease CNS hyperactivity. Oxygen therapy may be necessary.
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