dr. rupak bhattarai. introduction nitrous oxide, chloroform and ether were the first universally...
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Dr. Rupak Bhattarai
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INTRODUCTIONNitrous 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 oxide2.Halothane3.Isoflurane4.Desflurane5. Sevoflurane
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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)
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MAC VALUE OF INHALATION ANESTHETICS AGENTSNitrous oxide: 105%Halothane: 0.75%Isoflurane : 1.2%Desflurane: 6%Sevoflurane: 2%
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NITROUS OXIDEPhysical properties:It is a laughing gas.It is only inorganic anesthetic gas in clinical
use.Colorless and odorlessNon Explosive and Non InfammableGas at room temperature and can be kept as
a liquid under pressure.It is relatively inexpensive.
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Effects of Nitrous Oxide on Organ System1. 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.
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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.
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CONTRAINDICATION OF N2OAir embolismPneumothoraxAcute Intestinal ObstructionTension PneumocephalusTympanic membrane grafting
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HALOTHANEPhysical Properties:It is halogenated alkene.Non Inflammable and Non explosive.Least expensive .
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EFFECTS ON ORGAN SYSTEM1. 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 dronchodilator.
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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.
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CONTRAINDICATIONUnexplained liver dysfunction.Intra-cranial mass lesions.Hypo-volemic patient with severe cardiac
diseases.
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ISOFLURANEIt 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.
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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
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CONTRAINDICATIONNo such contraindication.Patient with severe hypovolemia may not
tolorate its vasodilating effects.
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DESFLURANEStructure much similar to that of isoflurane.Recovery time are approximately 50 % less
than those of Isoflurane. Pungent SmellTEC 6EFFECTS ON ORGAN SYSTEM:1.CARDIOVASCULAR SYSTEM:Similar to Isoflurane( Increases HR and BP
when increased MAC rapidly)Dilates coronary arteries.
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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
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CONTRAINDICATIONSevere hypo-volemia.Intracranial hypertension.Malignant hyperthermia.
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SEVOFLURANEIt 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
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3. CEREBRAL:Increases CBF and intra-cranial pressure.4. RENAL SYSTEM:Slightly decreases renal blood flow. Higher
Conc Causes Nephro-toxicity5. HEPATIC:Decreases portal vein blood flow but
increases hepatic artery blood flow thus maintaining total hepatic blood flow.
6.NEUROMUSCULAR:Adequate muscle relaxation.
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CONTRAINDICATIONSevere hypo-volemia.Intracranial hypertension.Malignant hyperthermia.
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ETHERW.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.
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Induction very slow, pungent smells and may causes laryngeal spasm
Very good analgesic.Very good muscle relaxants.
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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.
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STAGES OF ETHER ANESTHESIASTAGE 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.
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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.
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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.