Inhalational anesthetics physiological effects and clinical comparisons
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INHALATIONAL ANESTHETICS PHYSIOLOGICAL EFFECTS AND CLINICAL COMPARISONS. DENNIS STEVENS MSN, CRNA, ARNP SEPTEMBER 2006 FLORIDA INTERNATIONAL UNIVERSITY PHARMACOLOGY OF ANESTHESIOLOGY NURSING NGR 6173. OBJECTIVES. Discuss the discovery and early development of inhalational anesthetics.

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Inhalational anesthetics physiological effects and clinical comparisons l.jpg
INHALATIONAL ANESTHETICSPHYSIOLOGICAL EFFECTSAND CLINICAL COMPARISONS

DENNIS STEVENS MSN, CRNA, ARNP

SEPTEMBER 2006

FLORIDA INTERNATIONAL UNIVERSITY

PHARMACOLOGY OF ANESTHESIOLOGY NURSING

NGR 6173


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OBJECTIVES

  • Discuss the discovery and early development of inhalational anesthetics.

  • Explain theories of anesthetic action related to inhalational anesthetics.

  • Define MAC and respective percentages for volatile anesthetic agents.

  • Compare and contrast the physical properties of inhalational anesthetics and their effects on organ systems.

  • Discuss biotransformation and contraindications related to specific volatile anesthetic agents.


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HISTORY

  • 1840’S

    • Nitrous oxide

    • Diethyl Ether

    • Chloroform

  • 1920’s – 1940’s

    • Ethylene

    • Cyclopropane

    • Divinyl Ether

  • 1950’s

    • Discoveries in fluorine chemistry


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INHALATIONAL AGENTS

  • Nitrous Oxide (N20)

  • Halothane (Fluothane)

  • Enflurane (Ethrane)

  • Isoflurane (Forane)

  • Desflurane (Suprane)

  • Sevoflurane (Ultane)


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CHEMICAL STRUCTURE OFINHALATIONAL AGENTS


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PROPOSED MECHANISMS OF INHALATION ANESTHETIC ACTION

  • General anesthesia is an altered physiologic state characterized by reversible loss of consciousness, analgesia of the entire body, amnesia, and to some degree muscle relaxation

    • Meyer-Overton Rule (Critical Volume Hypothesis)

    • Protein Receptor Hypothesis (Agent Specific Theory)

    • Microcrystaline Theory

    • Alteration in Neurotransmitter Availability


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MINIMUM ALVEOLAR CONCENTRATION

  • MAC defined as

  • MAC mirrors brain partial pressure, allows comparisons of potency between agents, and provides a standard for experimental evaluations

  • Patient specific

  • MAC %:

    • N2O

    • Halothane

    • Ethrane

    • Forane

    • Desflurane

    • Sevoflurane

  • Factors affecting MAC


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NITROUS OXIDE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

    • Gastrointestinal

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


Halothane l.jpg
HALOTHANE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


Ethrane l.jpg
ETHRANE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


Forane l.jpg
FORANE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


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DESFLURANE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


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SEVOFLURANE

  • Physical Properties

  • Effects on Organ Systems:

    • Cardiovascular

    • Respiratory

    • Cerebral

    • Neuromuscular

    • Renal

    • Hepatic

  • Biotransformation and Toxicity

  • Contraindications

  • Drug Interactions


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IDEAL INHALATIONAL ANESTHETIC

  • Rapid onset – rapid recovery

  • Easy to administer

  • Possess clear indication of anesthetic depth

  • No significant effect on organ systems

  • High margin of safety for all age groups

  • Inexpensive


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CLINCAL CASE STUDIES

  • 78 year old male presents to OR from ED diagnosed with a small bowel obstruction. PMH: CHF, CAD, and history of seizures 2 years prior to admission.

  • 26 year old female presents to OR for emergent cesarean section. General anesthesia is initiated due to fetal distress (bradycardia and acidosis). PMH: negative.

  • 47 year old male presents to OR for elective colon resection. PMH: CRFand arthritis.

  • 6 year old female presents to the OR for elective adenoidectomy and tonsillectomy. PMH: negative.


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REFERENCES

  • Morgan, G.E., Mikhail, M.S., and Murray, M.J. (2006). Clinical Anesthesiology. (4th ed.) New York, NY: McGraw-Hill.

  • Stoelting, R.K. (1999). Pharmacology & Physiology in Anesthetic Practice. (3rd ed.) Philadelphia, PA:

    J.B. Lippincott Company.