Inhalation

INHALATIONAL
ANESTHETICS
Prepared by: Dr. Mohammed Aboamona.
Supervised by: Dr. Hesham Elzinati.
Introduction
Inhalational anesthetics divided into 2 groups:
Volatile anesthetics: have low vapor pressures and high
boiling points, meaning they are liquids at room temperature
and so require vaporizers during administration.
Non-volatile anesthetics: have high vapor pressures and low
boiling points, meaning they are in gas form at room
temperature.
Physicochemical properties:
1- Vapor pressure.
2- Saturated vapor pressure.
3- Boiling point.
4- Minimal Alveolar Concentration.
5- Oil/Gas partition coefficient.
6- Blood/Gas partition coefficient.
Physicochemical properties:
Vapor pressure: The pressure exerted by the gas in contact
with its liquid or solid form in closed container at a given
temperature.
Saturated vapor pressure: The vapor pressure at which the
gaseous phase of a substance can coexist with the liquid or
solid phase in equilibrium at a given temperature.
Boiling point: The temperature at which the vapor pressure of
a substance is equal to the atmospheric pressure.
Minimal Alveolar Concentration: is the alveolar concentration
that prevents movement in 50% of patients in response to a
standardized stimulus (eg, surgical incision).
MAC can be altered by several physiological and
pharmacological variables.
Oil/Gas partition coefficient (Meyer–Overton theory): showed a
close relationship between the lipid solubility of the
inhalational agent and its potency of anesthetic activity; the
more lipid soluble the agent (represented by a higher oil/gas
partition coefficient), the greater the potency.
Blood/gas partition coefficient: is the ratio of the amount of an
anesthetic agent in blood and gas when the two phases are of
equal volume and pressure and in equilibrium at 37C; the
higher the blood/gas coefficient, the more soluble an agent is
in blood, the longer it takes for the partial pressure of the
agent in blood to rise and the slower its anesthetic effect and
recovery.
Properties of the ideal inhalational
anesthetic agent
Physical properties:
1- Stable compound (unaffected by light or heat).
2- Non-flammable.
3- SVP high enough to allow easy vaporisation and production
of a clinically relevant concentration.
4- Cheap to manufacture and Environmentally friendly.
5- Non-irritant and non-pungent (to allow gaseous induction).
Properties of the ideal inhalational
anesthetic agent
Chemical properties:
1- Low blood/gas coefficient (to allow rapid onset/recovery).
2- High oil/gas coefficient (high potency).
3- Minimal metabolism with pulmonary excretion (i.e.
unaffected by renal/hepatic impairment).
4- Non-toxic/non-allergenic, not trigger for malignant
Hyperthermia.
5- Not teratogenic or carcinogenic.
Individual anesthetic agents
1) Isoflurane:
Physical Properties:
Non-flammable, clear and colourless volatile anesthetic with a
pungent odor.
MAC (in Air/in 70% N2O): 1.15/0.5.
1) Isoflurane:
Effects on Organ Systems:
Res.: Irritation, ↓ TV and ↑ RR.
CVS: ↓ (BP and SVR) and ↑ HR.
CNS: ↑ (CBF and ICP) and ↓ CMR.
Renal: Decrease blood flow.
Hepatic: Decrease blood flow.
2) Sevoflurane:
Non-flammable with pleasant smell and rapid increases in
alveolar anesthetic concentration make sevoflurane an
excellent choice for smooth and rapid inhalation inductions in
pediatric and adult patients.
MAC (in Air/in 70% N2O): 1.7/0.7.
2) Sevoflurane:
Res.: Not irritation, ↓ TV and ↑ RR (less Res. Depression).
CVS: ↓ BP, SVR and CO (doesn't change HR).
3) Halothane:
Non-flammable colourless liquid with a relatively pleasant
smell. In the presence of moisture, it corrodes aluminium, tin,
lead, magnesium and alloys. It is known to corrode metals in
vaporisers and breathing systems.
MAC (in Air/in 70% N2O): 0.75/0.29.
3) Halothane:
Res.: Not irritation, ↓ TV and ↑ RR (dose dependent).
CVS: ↓ BP, HR and CO (doesn't change SVR)(arrhythmias).
4) Desflurane:
Non-flammable colourless agent, stable in the presence of
soda lime but should be protected from light. Need special
vaporiser (TEC 6) which heats the desflurane to 39°C and
pressurizes it to 2 atmospheres.
MAC (in Air/in 70% N2O): 5.7-10.6/1.7-7.7.
4) Desflurane:
Res.: Irritation, ↓ TV and ↑ RR.
CVS: ↓ BP and SVR.
5) Nitrous oxide:
The only commonly use non-volatile inhalational agent.
Non-irritating and colourless gas.
Cannot be used as a sole anesthetic, but it does have unique
advantages when used as a carrier gas.
MAC (alone): 105.
Advantages:
1- Reduces the MAC and speeds up the onset of clinical
effects of concomitantly administered volatile agents.
2- Has analgesic properties.
3- Partially reverses the cardiopulmonary effects of volatile
agents.
Disadvantages:
1- Expansion of closed air spaces.
2- Increase pulmonary vascular resistance.
3- Increase postoperative nausea and vomiting.
4- Causes megaloblastic anemia and peripheral neuropathy in
prolonged exposure.
5- Impair chemotactic responses and neutrophil motility.
5) Nitrous oxide:
Res.: ↓ TV and ↑ RR.
CVS: Mild effects.
CNS: ↑ CBF, ICP and CMR.

Inhalation

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INHALATIONAL

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