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No receptors have been found to interact with the anesthetic 4. Nitrous Minimal C.O Little effect but BP and Minimal effect
No
andreceptors have been found
no neurotransmitters to interact
are involve in theirwith the anesthetic
action. oxide combination with a total
and no neurotransmitters are involve in their action. more potent Peripheral
KINETICS OF ANESTHESIA anesthetic leads to resistance
Kinetics of Anesthesia
1. Induction 2. Maintenance 3. Recovery sympathetic when in
Kinetics of Anesthesia stimulation Combination
of more
A Induction and Recovery
Three from
stages of Anesthesia
Anesthesia Potent
Induction – is theThree stages
period of Anesthesia
of time from onset of administration of the anesthetic
anesthetic to the development of effective surgical anesthesia in the
1. Induction
patient. 2.fast
It depends on how Maintenance 3. Recovery
the anesthetic reaches the brain. Comparison of the different Pharmacologic effects of Inhaled
1. Induction
Recovery – is the time 2. Maintenance
form discontinuation of adm.3.ofRecovery
anesthetic until General Anesthetics
consciousness is regained .It depends on how fast the anesthetic is
removed from the brain. Other Differences
drugs administered by inhalation; the rate of onset & recovery are Potency/induction Muscle relaxation Organ toxicity and other
influenced by the following factors: recovery onset – Analgesia adverse effect
1. Solubility of anesthetic – this is expressed as the blood / gas concentration
of gas in the blood, relative to the gas equilibrium phase. The greater the Halothane Potent Good muscle Extensively metabolize and
relaxation but Biotransformation
blood / gas partition coefficient the more soluble is the anesthetic agent in
lacks significant intermediates may result to
the blood. Analgesia hepatotoxic metabolites – “
a. If a drug has a low solubility (low-blood / gas partition coefficient) little Halothane Hepatitis”
-malignant hyperthermia
of the drug is dissolve in the blood. Therefore the equilibrium between
Comparison
Enflurane of thethan
Less potent different
Good Pharmacologic
muscle 2% is effects of Inhaled
me tabolized to fluoride
inhaled anesthetic and arterial blood is rapidly achieve, and only a few
additional molecules of the anesthetic is required to raise the arterial halothane but itGeneral Anesthetics
relaxation relaxes ion which is excreted by the
produces more the uterus kidney
tension. This results to rapid induction and short recovery. Other Differences
rapid induction -contraindicated in pnts with
Example – Nitrous Oxide (NaO) = 0.47 B/G coefficient and recovery
Potency/induction Muscle relaxation OrganRenal Failure.
toxicity EEC pattern –
and other
recovery onset – Analgesia char. ofeffect
adverse seizure activity – may
lead to Frank Seizure
b. If the anesthetic has high solubility – it is more dissolve
completely in the blood – so greater amounts of the Isoflurane More potent than Good muscle Low biotransformation low
Enflurane relaxation organ toxicity
anesthetic and longer periods of time are required to raise
arterial tension. This results in increase times of induction Nitrous Not very potent Poor surgical May diffuse into body cavities
Oxide when use alone anesthetic if use – the pressure or expand
and recovery also slower to changes in the cone of the
but produce the alone but good the volume of gas in air
inhaled drug. Ex. Halothane – 2.3 B/G coefficient fastest induction Analgesic pockets may lead to:
2. Rate of ventilation – an increase rate of delivery of anesthetic gas and recovery a. Distention of the bowel
to the lungs results in most anesthetic being delivered to the b. Expansion or rupture of a
alveoli. This increases the rate at which the arterial blood pulmonary cyst
c. Rupture of the tympanic
approaches equilibrium. The effect of - ventilation is most
membrane in an occluded
pronounced for anesthetics with high solubility in blood. middle ear
3. Increase alveolar blood flow – high blood flow causes more of the d. Pneumoce phalus
anesthetic agent to be removed from the alveoli hastening -when it is dissolve in the blood
anesthesia. may enlarge the volume
of air emboli
B. Maintenance of Anesthesia – maintenance is the time during which
the patient is surgically anesthetized, anesthesia is usually
maintained by the administration of gases or volatile anesthetics
since these agents offer good minute to minute control over the depth
of anesthesia.
Properties of Halogenated Inhalation Anesthetics
Summary of Therapeutic Advantages and Disadvantages
of Anesthetic Agents
Inhalation Advantages Disadvantages
Halothane Enflurane Isoflurane Sevoflurane Desflurane Anesthetics
Induction speed 2.3 1.8 1.4 0.7 0.4 1. Nitrous - good analgesia -Diffusion hypoxia and
( λ) Oxide - rapid onset/recovery other complications
-safe non-irritating - Incomplete anesthesia
Irritation of Low Low Moderate Low Moderate -no muscle relaxation
respiratory tract -must be use with other
Muscle Low Moderate Moderate Moderate Moderate anesthesia for surgical anesthesia
relaxation
Myocardial High Moderate Low High Low -best agent in -reduces hepatic and
depression 2. Halothane Pediatric pnts renal flow
Sensitization of High Moderate Low Low Low -prod. Bronchodilatation -hepatotoxic, malignant
myocardium Summary ofgood
Therapeutic
for AsthmaticsAdvantages and Disadvantages
hyperthermia
Treatment or Remedy – administration of 100% O2 for a short time at the 4. Isoflurane -good muscle relaxation -significant resp depression.
termination of Nitrous Oxide Anesthesia. -rapid recovery
-stability of cardiac output
N2O is also associated with high incidence of post-operative nausea & -does not raise intracranial
vomiting. pressure
N2O – can cause leucopenia & Megaloblastic anemia due to in activation 5.Thiopental -rapid onset -no analgesia
of Vit. B12 -little muscle relaxation
-laryngospasm
Methoxyflurane – fruity odor – most potent (MAC 0.16) but high blood – gas
coeff about 12 results to prolonged induction and recovery. High renal toxicity – 6. Ketamine -potent analgesia -disorientation hallucination
(High output Renal Failure) due to liberation of significant amount of Fluoride ion changes in perception
as Biotransformation product.
Diethyl ether – highly flammable & explosive; sympathetic activity,
bronchodilatation but may cause laryngospasm. It is a myocardial depressant –
but C.O and B.P is due to the sympathetic activity.
Pre-Anesthetic Medications :