THERAPEUTIC GASES

THERAPEUTIC GASES
• General anaesthetics
• Oxygen
• Carbondioxide
• Helium
• Nitric oxide
 OXYGEN
When fully saturated each gram of hemoglobin
binds about 1.3ml of oxygen
Hypoxia- Impaired oxygenation to tissues.
Causes:
Pulmonary hypoxia - mismatch between
ventilation and perfusion [ARDS,BA,pneumonia]
Anaemic hypoxia- inadequate con. Of O2 in arterial
blood
Tissue hypoxia- tissues unable to utilize the oxygen
 USES
1) Correction of hypoxia
underlying cause as Narcotic overdose ,
airway obstruction anaemia should be
treated
A]Chronic bronchitis, emphysema- low con
used
B]Status asthmaticus- high con

2)Reduction of partial pressure of an inert

gas- decompression sickness
• 3]As a diluent- with GAs
• 4] hyperbaric oxygen therapy
• Co and Cyanide poisoning
• infective conditions,
• tissue graft
 ADVERSE REACTIONS
• Due to formation of reactive O2
species.
• [superoxide anion, H2O2, OH radical]
• Lipid peroxidation, cell injury and death
RS
• Damage to pulmonary epithelium &
inactivate surfactant secreted by the
alveoli
• producing atelectasis
• Respiratory distress in neonates.
• CNS disturbances PP of inspired
oxy>2atm
• paraesthesia,
• mental disturbance, twitching,
• loss of consciousness,
• convulsions.
• Tunnel vision, hearing difficulties
• Eye
• Photophobia
• Retrolental fibroplasia Occlusive
proliferate arterial disease leading to
blindness.
• CO2 narcosis – In COPD, poliomyelitis,
myasthenia, poisoning, head injury 
alveolar ventilation is inadequate.
• ↑ hypercapnea
• Abolition of this hypoxic drive – apnoea.
HYPERBARIC OXYGEN:-
• Oxygen administered at higher pressure more
than atmospheric pressure.
• Administered using special chamber and face
mask.
• Causes reduction in heart rate, cardiac output.
• Produces vasoconstriction peripherally
• Causes retrolental fibroplasias
USED IN:
– Respiratory disease of newborn
– Carbon monoxide and Cyanide poisoning
– Decompression sickness
– Infective conditions -Enhances bactericidal activity
of leucocytes and bacteriostatic
– Anaerobic infections
– Aerobic infections
– Circulatory disturbances
– Surgery  open heart surgeries
– Crush injury,organ transplantation
– Malignancy.
• METHOD OF ADMINISTRATION OF
OXYGEN:-
• High concentration > 60% of inspired air –
Oxygen tent , Aeronasal masks

• Less than 35% of inspired air  Nasal cannula

catheter

• Ventimasks
• Airwaytubes- critically ill patients
CARBON DIOXIDE:
• Produced in the body during tissue metabolism
• EFFECTS:-
• Respiration - ↑ rate & tidal column of respiration
• Circulation - ↓ heart rate and myocardial force of
contraction
• Relaxes vascular smooth
muscle producing vasodilatation
• Potent cerebral vasodilator
• CNS:- Stimulates cerebral cortex and ↓ seizure
threshold
• SIDE EFFECTS:-
• Head ache,
• mental confusion,
• palpitation,
• dyspnoea, ↑ BP
• loss of consciousness
USES:-

• Carbon monoxide poisoning  stimulates

respiration, washes carbon monoxide, ↓ blood pH.

• Hiccup – Inhalation of 10-25% CO2 is useful.

• Used to treat Anxiety neurosis & personality

maladjustment.
 Local uses of CO2
• used to destroy warts & naevi.
• Used to increase the speed of induction
and emergence from anaesthesia.
• Prevents postoperative atelectasis.
• Used to study cerebral blood flow.
• Used as carminatives and to mask
unpleasant taste in saline purgatives
 Helium
• Pulmonaty function testing
• Rs obstruction – 80%He + 20% O2
• Laser airway surgery
• Pul MRI
 NO
• Vasodilator
• Use- persistant PHT

• ADR-methhemoglobinaemia
Treatment of cough
 INTRODUCTION
• Cough is a protective reflex, its purpose
being expulsion of respiratory
secretions or foreign particles in the air
passage.
• It occurs due to stimulation of
mechano- or chemoreceptors in throat,
respiratory passage or stretch receptors
in the lungs.
 MANAGEMENT OF COUGH:
PHARYNGEAL DEMULCENTS:
– Lozenges,
– cough drops,
– linctus syrup.
– sooth the throat  promote salivation –
symptomatic relief in dry cough.

.
EXPECTORANTS
MOA :
Increase bronchial secretion  reduce
viscosity  removal by coughing.
DIRECTLY ACTING
• sodium & potassium citrate

• guaiacol  100-200 mg (guaiphenesin) ,

• Tolu Balsum, vasaka syrup

REFLEXLY ACTING
• Ammonium salts , Syrup ipecaca

• Potassium iodide  secretes bronchial

glands  increase volume of dangerous
to patient sensitive to iodine

• Prolong use can induce goiter

MUCOLYTICS:

BROMHEXINES
• capable of inducing thin copious bronchial
secretion

• liberates lysosymal enzymes breaks the fibres

of tenacious sputum.

• Side effect – Rhinnorrhea & lacrymation

ACETYL CYSTEINE
opens disulfidebonds in mucoproteins) –
tracheal installation

CARBOCYSTEINE
(250-750mg tabs) available in combination
with antibiotics
ANTIHISTAMINES:-
• reduce secretion by anti cholinergic action.
• No expectorant action.
• Chlorpheniramine, Diphenhydramine &
promethazine
BRONCHODILATORS:-
• Brochospasm can induce and aggravate cough.