INHALATION

ANESTHETICS

Dr. N Raja Sekar

INTRODUCTION
Nitrous oxide, Chloroform and Ether were the first universally
accepted general anesthetics.
Ethyl chloride, Ethylene and Cyclopropane were also used , but the
toxicity and flammability led to their withdrawal from the market.
Mainly 5 inhalation anesthetics agents are used in clinical practice
these days:
1. Nitrous oxide
2.Halothane
3.Isoflurane
4.Desflurane
5. Sevoflurane
Uptake and Distribution of
Halogenated Organic Compounds
Liquid anesthetic is vaporized and mixed with oxygen
Mixture is delivered to the patient via a mask or
endotracheal tube (ET tube)
Mixture travels to lungs (alveoli) and diffuses into the
bloodstream
Diffusion rate is dependent on concentration gradient
(alveoli/capillary) and lipid solubility of the anesthetic
gas
Concentration gradient is greatest during initial
induction
Uptake and Distribution of Halogenated
Organic Compounds
Distribution to tissues is dependent on blood
supply
Tissues with greater blood flow (brain, heart, kidney) are
more quickly saturated with anesthetic gas
Lipid solubility of the gas determines entry into tissues
through cell walls
Maintenance of anesthesia is dependent on
sufficient quantities of anesthetic delivered to the
lungs
Elimination of
Halogenated Organic Compounds
Reducing amount of anesthetic administered reduces
amount in the alveoli
Anesthetic will move from the brain into the blood and
then into the alveoli where it is finally breathed out
Patient wakes up
Physical and Chemical Properties
of Inhalant Anesthetics
Important properties to consider
Vapor pressure
Partition coefficient
Minimum alveolar concentration (MAC)
Rubber solubility
Vapor Pressure
Is the amount of pressure exerted by the gaseous form
of a substance when in equilbrium
i.e. its ability to evaporate

Determines how readily an inhalation anesthetic will

evaporate in the anesthetic machine vaporizer

Temperature and anesthetic agent dependent

 Vapor Pressure
Volatile agents
High vapor pressure- evaporates readily
Isoflurane, sevoflurane, desflurane, and halothane
Delivered from a precision vaporizer to control the delivery
concentration
All precision vaporizers are made to deliver only one specific
halogenated agent
Nonvolatile agents
Low vapor pressure- no need for precision vaporizer
Methoxyflurane

*Vaporizers are specific to that gas, and is unacceptable to combine

agents in the same vaporizer. Although it is safe to switch patient from
one gas to another
Blood:Gas Partition Coefficient
The measure of the solubility of an inhalation
anesthetic in blood as compared to alveolar gas (air)
Indication of the speed of induction and recovery for
an inhalation anesthetic agent
Low blood:gas partition coefficient
Agent is more soluble in alveolar gas than in blood at
equilibrium
Agent is less soluble in blood
Faster expected induction and recovery
Blood:Gas Partition Coefficient
High blood:gas partition coefficient
Agent is more soluble in blood than in alveolar gas at
equilibrium
Agent is less soluble in alveolar gas
Agent is absorbed into blood and tissues (sponge effect)
Slower expected induction and recovery
Blood:Gas Partition Coefficient
Blood: gas partition coefficient determines the clinical
use of the anesthetic agent
Induction: Can a mask be used?
Maintenance: How fast will the anesthetic depth change
in response to changes in the vaporizer setting?
Recovery: How long will the patient sleep after
anesthesia?
MINIMUM ALVEOLAR
CONCENTRATION (MAC)
DEF: The minimum alveolar concentration of an inhaled
anesthetics is the alveolar concentration that prevents
movement in 50% of patient in response to a
standardized stimulus (e.g. Surgical Incision)
MINIMUM ALVEOLAR
CONCENTRATION (MAC)
The measure of the potency of a drug
Used to determine the average setting on the vaporizer that will
produce surgical anesthesia
The lower the MAC, the more potent the anesthetic
agent and the lower the vaporizer setting
MAC may be altered by age, metabolic activity, body temperature,
disease, pregnancy, obesity, and other agents present
Every patient must be monitored as an individual
Age, disease, temperature, pregnancy, obesity, pre medications
MAC VALUE OF INHALATION ANESTHETICS
AGENTS
Nitrous oxide: 105%
Halothane: 0.75%
Isoflurane : 1.2%
Desflurane: 6%
Sevoflurane: 2%
NITROUS OXIDE
Physical properties:
It is a laughing gas.
It is only inorganic anesthetic gas in clinical use.
Colorless and odorless
Non Explosive and Non Infammable
Gas at room temperature and can be kept as a liquid
under pressure.
It is relatively inexpensive.
Effects of Nitrous Oxide on Organ
System
1. CARDIOVASCULAR SYSTEM
Stimulate sympathetic nervous system.
Directly depresses myocardial contractility.
Arterial blood pressure ,heart rate and cardiac
output are slightly increased.
2. RESPIRATORY SYSTEM:
Increases respiratory rate with decreases tidal
volume.
Minimal change in minute ventilation.
3. CEREBRAL:
Increases CBF thus increasing intracranial pressure.
4. RENAL SYSTEM:
It decreases renal blood flow thus leads to drop in
glomerular filtration rate and urinary output.
5. HEPATIC SYSTEM:
Decreases the Hepatic blood flow but to a lesser extent
than other inhalation agents.
6. GASTROINTESTINAL:
It causes post operative Nausea and Vomiting.
CONTRAINDICATION OF N2O
Air embolism
Pneumothorax
Acute Intestinal Obstruction
Tension Pneumocephalus
Tympanic membrane grafting
HALOTHANE
Physical Properties:
It is halogenated alkene.
Non Inflammable and Non explosive.
Least expensive .
EFFECTS ON ORGAN SYSTEM
1. CARDIOVASCULAR:
Dose dependent reduction of arterial blood pressure
by direct myocardial depression.
It is a coronary artery vasodilator.
It causes slowing of SA node conduction resulting in
bradycardia.
2. RESPIRATORY SYSTEM:
Causes rapid ,shallow breathing.
Decrease in alveolar ventilation and Paco2 elevated.
Potent Bronchodilator.
3. CEREBRAL:
It increases cerebral blood flow.
4. NEUROMUSCULAR:
Relaxes skelatal muscle and potentiates Non
depolarizing neuro-muscular blocking agents.
5.RENAL:
Reduces renal blood flow, glomerular filtration rate
and urinary output.
6. HEPATIC:
Decreases hepatic blood flow.
CONTRAINDICATION
Unexplained liver dysfunction.
Intra-cranial mass lesions.
Hypo-volemic patient with severe cardiac diseases.
ISOFLURANE
It is non flammable volatile with a pungent smell.
EFFECTS ON ORGAN SYSTEM:
1. CARDIOVASCULAR:
Causes minimal cardiac depression.
Rapid increase in MAC lead to increase in HR and BP.
( Coronary Steal)
Dilates coronary arteries.
2. RESPIRATORY SYSTEM:
Respiratory depression .
Acts as a good bronchodilator.
3. CEREBRAL:
If con> 1 MAC causes increase in CBF and Intracranial
pressure.
4. NEUROMUSCULAR:
Relaxes skeletal muscles.
5. RENAL:
Decreases renal blood flow , glomerular filtration rate
and urinary output.
6. HEAPTIC:
Reduces hepatic blood flow.
INDICATIONS- For Cardiac and Neuro- Surgery
CONTRAINDICATION
No such contraindication.
Patient with severe hypovolemia may not tolorate its
vasodilating effects.
DESFLURANE
Structure much similar to that of isoflurane.
Recovery time are approximately 50 % less than those
of Isoflurane. Pungent Smell
TEC 6
EFFECTS ON ORGAN SYSTEM:
1. CARDIOVASCULAR SYSTEM:
Similar to Isoflurane( Increases HR and BP when
increased MAC rapidly)
Dilates coronary arteries.
2. RESPIRATORY SYSTEM:
Causes decrease in tidal volume and increase in resp
rate.
Pungency and airway irritation so causes coughing
and sometime bronchospasm.
3. CEREBRAL:
Increases CBF and Intracranial pressure.
4. NEUROMUSCULAR:
Relaxes skeletal muscle.
5. RENAL AND HEPATIC SYSTEM:
No any evidence has been documented.
INDICATION- For Hepatic and Renal Surgery
CONTRAINDICATION
Severe hypo-volemia.
Intracranial hypertension.
Malignant hyperthermia.
SEVOFLURANE
It is Non pungency.
EFFECTS ON ORGANS:
1. CARDIOVASCULAR SYSTEM:
Mildly depresses myocardial contractility.
May prolong QT interval, but no significance.
2. RESPIRATORY SYSTEM:
Depresses respiratory rate.
It reverses broncho-spasm
3. CEREBRAL:
Increases CBF and intra-cranial pressure.
4. RENAL SYSTEM:
Slightly decreases renal blood flow. Higher Conc
Causes Nephro-toxicity
5. HEPATIC:
Decreases portal vein blood flow but increases hepatic
artery blood flow thus maintaining total hepatic blood
flow.
6.NEUROMUSCULAR:
Adequate muscle relaxation.
CONTRAINDICATION
Severe hypo-volemia.
Intracranial hypertension.
Malignant hyperthermia.
ETHER
W.T.G Morton on 16th Oct 1846 used for removal of jaw
tumor.
PHYSICAL PROPERTIES:
Pungent smelling liquid, decomposes in presence of
light, air, heat.
Highly inflammable and explosive.
Highly irritant vapour.
Very Cheap.
Also called as Complete Anesthetic agents.
Can be used by less experience hands.
Induction very slow, pungent smells and may causes
laryngeal spasm
Very good analgesic.
Very good muscle relaxants.
Cardiovascular: Does-not depresses myocardium, but
stimulates sympathetic system.
Respiratory system: Does-not depresses respiration.
It is a potent bronchodilator.
Tracheo-bronchial secretions is markedly increased.
GIT: Nausea and vomiting.
Hepatic and renal: Well preserved.
Cerebral: Increases intracranial pressure.
May causes Hyperglycemia.
STAGES OF ETHER ANESTHESIA
STAGE I: (Stage of analgesia) (From analgesia to loss of
consciousness)
Respiration is regular with small tidal volume.
Pupil is normal in size.
STAGE II : (Stage of Excitement): ( From loss of
consciousness to rhythmic respiration)
Respiration is irregular.
Pupil is Mid dilated.
Eyelashes reflex absent.
 STAGE III : ( Stage of Anesthesia):
Plane I: ( From rhythmic resp to cessation of eye
movement)Respiration is regular with large volume.
Pupil is normal in size. Eyelashes reflex absent,
Pharyngeal and vomiting reflex lost.
Plane II: (From cessation of eye movement to resp
paresis)Respiration is regular with large volume , Pupil
is mid dilated with corneal reflexes lost.
Plane III: ( Resp paresis to Paralysis)From Respiration
is regular with small volume, Pupil is moderate dilated
with laryngeal reflexes absent.
Plane IV: (Diaphragmatic Paralysis)Respiration is
irregular with small volume, Pupil dilated and
centrally placed.
Stage IV: (Stage of overdose) (Medullary Paralysis)
Apnea
Pupil dilated and non reacting to light.

NOTE: Withdrawal of anesthetic agents and

administration of 100% oxygen lightens
anesthesia with recovery.
Thank You
For the Smooth Iduction, Maintanance and Recovery.

If you remember anything then its bad Anaesthesia,

If you didnt remember anything then its Good
Anaesthesia,
If you had emergence delirium, I am responsible for that
and I am Sorry