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Victoria Hofileña, MD, Dpba: Inhalational Anesthetics
Victoria Hofileña, MD, Dpba: Inhalational Anesthetics
INHALATIONAL
ANESTHETICS
INHALATIONAL ANESTHETICS
CLASSIFICATION OF INHALATIONAL
ANESTHETICS
Outdated Gases Volatile Agents
Methoxyflurane Isoflurane
Cyclopropane Sevoflurane
Chloroform Desflurane
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UPTAKE AND DISTRIBUTION OF
INHALATIONAL AGENTS
MECHANISM OF ACTION
▸ unknown
▸ no single, accepted definition of what constitutes the
anesthetic state
▸ Operational Definition:
▸ immobility in response to surgical stimulation
▸ amnesia for intraoperative events
MINIMUM ALVEOLAR CONCENTRATION
= MAC
▸ 1 MAC - Minimum Alveolar Concentration at which 50% of
Humans have no response to surgical stimulus
Halothane 0.74%
Isoflurane 1.17%
Enflurane 1.7%
Sevoflurane 2.05%
Desflurane 6.0%
O2 Hypoxia
CO2 Hypercabia
IV agents yes
Pregnancy yes
▸ PA Pa Pbr
FACTORS THAT DETERMINE ALVEOLAR
PARTIAL PRESSURE (PA)
▸ PI
▸ Alveolar ventilation
▸ Anesthetic breathing system
▸ Solubility
▸ Cardiac Output
▸ Alveolar to venous partial pressure difference
INSPIRED ANESTHETIC PARTIAL
PRESSURE
▸ a high PI is necessary during induction
▸ Concentration Effect
CONCENTRATION EFFECT
▸ the higher the concentration of an inhaled anesthetic, the
faster the alveolar concentration approaches the inhaled
concentration
SECOND GAS EFFECT
▸ The ability of the large volume uptake of one gas (First gas)
to accelerate the rate of rise of the PA of a concurrently
administered vompanion cas (Second gas)
ALVEOLAR VENTILATION
▸ increase alveolar ventilation promotes input of more inhaled
anesthetic uptake into the blood
SOLUBILITY
FACTORS
Most potent
FACTORS
PARTITION CO-EFFICIENTS
FACTORS
FA/FI
▸ Ratio of alveolar agent to inhaled agent
▸ higher the blood/gas partition coefficient (solubility) the
greater the uptake from the alveolus
▸ Brain
▸ decrease brain metabolic rate
▸ decreases cerebral vascular resistance thus increasing
cerebral blood flow
▸ Kidney
▸ dec GFR, dec renal blood flow
EFFECTS
▸ Liver
▸ dec hepatic blood flow
▸ Uterine smooth muscle
▸ halogenated anesthetics are potent ralaxants
▸ lead to increase uterine bleeding
RECOVER
Y FROM
RECOVERY
TISSUE CONCENTRATIONS
▸ serve as reservior
▸ influenced by:
▸ duration of anesthesia
▸ solubility
RECOVERY
METABOLISM
▸ important difference between induction and recovery
▸ impact of metabolism on the rate of the decrease of PA
▸ highly lipid soluble agents (ex methoxyflurane, halothane)
▸ principal determinant of rate of decreaseof PA is
metabolism
RECOVERY
INHALED ANESTHETIC AGENTS
▸ Nitrous Oxide (N2O)
▸ Halothane
▸ Enflurane
▸ Isoflurane
▸ Desflurane
▸ Sevoflurane
▸ Xenon
▸ Ether
▸ Trichloroethylene
▸ Chloroform
NITROUS OXIDE (N20)
▸ History: used by John Culton during the public
demonstration of anesthesia
▸ Use:
▸ labour analgesia
▸ field analgesia
CONTRAINDICATIONS OF N2O
▸ most cardiostable
▸ not metabolised, non flamable
▸ Disadvantage: very costly, needs special equiptment for
delivery, causes bronchospasm
ETHER
▸ most complete anesthetic agent
▸ has max. muscle relaxation
▸ does not depress respiration
▸ causes nausea and vomiting
METHOXYFLURANE
▸ most potent, slowest induction and recovery
▸ most nephrotoxic
CYCLOPROPANE
▸ most flamable and explosive
▸ causes cyclopropane shock
TRICHLOROETHYLENE
▸ most potent analgesic agent
▸ reacts with soda lime: dichloroacetylene - neurotoxic
phosgene - pulmonary toxicity ~ ARDS
CHLOROFORM
▸ 1st agent used for labor analgesia
▸ cardiotoxic ~ ventricular fibrillaton
▸ hepatotoxic, cause profound hyperglycemia
TOXICITIES
CARBON MONOXIDE TOXICITY
▸ all agents react with soda lime to produce CO
▸ DESFLURANE> ENFLURANE> ISOFLURANE>
SEVOFLURANE> HALOTHANE
FLUORIDE NEPHROTOXICITY
▸ Fluoride - nephrotoxic by product of metabolism in liver and
kidney
THANKS FOR
LISTENING…
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