Anesthesia 5th year, 3rd & 4th lectures (Dr. Aamir)

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The lecture has been given on Oct. 12th & 19th, 2010 by Dr. Aamir.
  • 1. Inhalational agents Are Anesthetic drugs that taken up by inhalational through the lungs MAC Is the minimum alveolar concentration of anesthetic at 1 atmosphere that produces immobility in 50% of those patients exposed to a noxious stimulus
  • 2. Nitrous oxide (N2O) <ul><li>Non-irritating, sweet smelling and colorless gas </li></ul><ul><li>Clinical uses: </li></ul><ul><li>Obstetric analgesia </li></ul><ul><li>Relief of pain in acute trauma </li></ul><ul><li>Burns & painful dressings </li></ul><ul><li>Dental anesthesia </li></ul><ul><li>Analgesia during surgery </li></ul>
  • 3. Adverse effects <ul><li>Impurities with higher oxides of nitrogen spc. Nitrogen dioxide (NO2) which lead to laryngospasm, cyanosis , met hemoglobin & pulmonary odema </li></ul><ul><li>Hypotension if given with benzodiazepines or opioids </li></ul><ul><li>Aplastic anemia (after 6-24 h) due to inactivation of vit B12 & defect in folate metabolism </li></ul>
  • 4. <ul><li>Neurological defects (after chronic exposure) like motor, sensory, coordination &reflex defects </li></ul><ul><li>Gestational defects (after chronic exposure) leads to abortion </li></ul>
  • 5. Halogenated agents <ul><li>Halothane </li></ul><ul><li>Enflurane </li></ul><ul><li>Isoflurane </li></ul><ul><li>Sevoflurane </li></ul><ul><li>Desflurane </li></ul>
  • 6. Halothane (Fluothane) is a colorless liquid with sweet smell <ul><li>Advantages: </li></ul><ul><li>Non inflammable </li></ul><ul><li>Potent </li></ul><ul><li>Non-irritant to the respiratory tract in anesthetic concentrations </li></ul><ul><li>Low postoperative incidence of nausea and vomiting </li></ul><ul><li>Widely used in anesthesia for all types of surgeries </li></ul>
  • 7. Effects <ul><li>On respiration: respiratory depressant </li></ul><ul><li>On the heart: decrease cardiac contraction, decrease stroke volume, decrease heart rate, dysrhythmias spc. When there is hypercapnia </li></ul><ul><li>On Kidney: decrease renal flow because of decrease GFR </li></ul><ul><li>On uterus: uterine relaxation </li></ul>
  • 8. <ul><li>On skeletal muscles: minimal neuromuscular blocking action </li></ul><ul><li>On cerebral blood flow : increase CBF so increase intracranial pressure </li></ul><ul><li>Shivering </li></ul><ul><li>Can cause malignant hyperpyrexia </li></ul><ul><li>On liver: it may cause halothane hepatitis </li></ul><ul><li>On cells: interferes with mitosis in cells </li></ul>
  • 9. Isoflurane <ul><li>Advantages: </li></ul><ul><li>Sustains myocardial contractility </li></ul><ul><li>Does not sensitize the heart to adrenaline </li></ul><ul><li>Rapid recovery </li></ul><ul><li>Minimal biotransformation with little risk for hepatic or renal toxicity </li></ul><ul><li>Ventricular work and oxygen consumption are decreased </li></ul><ul><li>Produce adequate muscle relaxant for most surgical maneuvers </li></ul><ul><li>Does not increase CBF at low concentrations </li></ul>
  • 10. <ul><li>Disadvantages: </li></ul><ul><li>Its pungent odeur limits its use as an induction agent </li></ul><ul><li>Coronary vasodilatations with possibility of coronary steal syndrome at high inspired concentrations </li></ul>
  • 11. Sevoflurane is non-inflammable and has a pleasant smell <ul><li>Advantages: </li></ul><ul><li>Smooth , fast induction </li></ul><ul><li>Rapid recovery </li></ul><ul><li>Ease to use & does not cause coronary steal syndrome </li></ul><ul><li>Disadvantages: </li></ul><ul><li>Production of potentially toxic metabolites in the body </li></ul><ul><li>Instability with CO2 absorbers </li></ul><ul><li>Relatively expensive </li></ul><ul><li>Trigger for malignant hyperpyrexia </li></ul>
  • 12. <ul><li>Thank you </li></ul>
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