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    Compilation Anesthesia

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    Norjetalexis Cabrera
    The document discusses the characteristics of ideal general anesthetic agents and the pharmacokinetics of inhalation anesthetics. It describes the factors that influence the onset and recovery from anesthesia when using inhaled agents, such as inspired concentration, alveolar ventilation, solubility, and cardiac output. These determine the rate at which the alveolar and effect site concentrations change. The document also lists commonly used intravenous anesthetic and adjunct agents for balanced anesthesia, and discusses the disadvantages of nitrous oxide as an inhalation anesthetic, such as its lack of potency and rapid uptake and elimination from tissues.

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    Compilation Anesthesia

    Uploaded by

    Norjetalexis Cabrera
    89 views5 pages
    The document discusses the characteristics of ideal general anesthetic agents and the pharmacokinetics of inhalation anesthetics. It describes the factors that influence the onset and recovery from anesthesia when using inhaled agents, such as inspired concentration, alveolar ventilation, solubility, and cardiac output. These determine the rate at which the alveolar and effect site concentrations change. The document also lists commonly used intravenous anesthetic and adjunct agents for balanced anesthesia, and discusses the disadvantages of nitrous oxide as an inhalation anesthetic, such as its lack of potency and rapid uptake and elimination from tissues.

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    The document discusses the characteristics of ideal general anesthetic agents and the pharmacokinetics of inhalation anesthetics. It describes the factors that influence the onset and recovery from anesthesia when using inhaled agents, such as inspired concentration, alveolar ventilation, solubility, and cardiac output. These determine the rate at which the alveolar and effect site concentrations change. The document also lists commonly used intravenous anesthetic and adjunct agents for balanced anesthesia, and discusses the disadvantages of nitrous oxide as an inhalation anesthetic, such as its lack of potency and rapid uptake and elimination from tissues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    89 views5 pages

    Compilation Anesthesia

    Uploaded by

    Norjetalexis Cabrera
    The document discusses the characteristics of ideal general anesthetic agents and the pharmacokinetics of inhalation anesthetics. It describes the factors that influence the onset and recovery from anesthesia when using inhaled agents, such as inspired concentration, alveolar ventilation, solubility, and cardiac output. These determine the rate at which the alveolar and effect site concentrations change. The document also lists commonly used intravenous anesthetic and adjunct agents for balanced anesthesia, and discusses the disadvantages of nitrous oxide as an inhalation anesthetic, such as its lack of potency and rapid uptake and elimination from tissues.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    SWU-Matias H Anzar Memorial College of Medicine

    Department of Pharmacology and Toxicology

    Case No. 53
    Inhalation Anesthetic Agent

    Learning Objectives:
    1. List the characteristics of the ideal general anesthetic agent.

    Intravenous Agent
    = The ideal i.v. anesthetic agent has a rapid onset of action and is quickly cleared from the
    bloodstream and CNS, facilitating control of the anesthetic state (e.g., allowing titration of effect).
    The ideal agent also protects vital tissues, has other desirable pharmacologic effects (e.g., an
    antiemetic effect), does not affect the circulatory system or cause other adverse effects, and is
    inexpensive.

    Inhaled Agent
    = Characteristics of the ideal inhaled anesthetic agent include ample potency, low solubility in
    blood and tissues, resistance to physical and metabolic degradation, and a protective effect in
    and lack of injury to vital tissues. Physical and metabolic degradation can yield compounds that
    cause injury. Other ideal characteristics include the lack of a propensity to cause seizures,
    respiratory irritation, and circulatory stimulation; little or no effect on the ozone layer; and a low
    acquisition cost.

    2. Describe the pharmacokinetic parameters of inhalation anesthetics that influence the onset of and
    recovery from anesthesia.

    PHARMACOKINETICS
    Inhaled anesthetics, volatile as well as gaseous, are taken up through gas exchange in the alveoli.
    Uptake from the alveoli into the blood and distribution and partitioning into the effect compartments are
    important determinants of the kinetics of these agents. An ideal anesthetic should have a rapid onset
    (induction), and its effect should be rapidly terminated. To achieve this, the effect site concentration in the
    CNS (brain and spinal cord) will need to change rapidly. Several factors determine how quickly the CNS
    concentration changes.

    UPTAKE & DISTRIBUTION


    A. Inspired Concentration and Ventilation

    The driving force for uptake of an inhaled anesthetic is the alveolar concentration. Two
    parameters that can be controlled by the anesthesiologist determine how quickly the alveolar
    concentration changes:

    1. Inspired concentration or partial pressure


    -Increases in the inspired partial pressure increase the rate of rise in the alveoli and thus accelerate
    induction. The increase of partial pressure in the alveoli is usually expressed as a ratio of alveolar
    concentration (F A ) over inspired concentration (F I ); the faster F A /F I approaches 1 (1 representing
    the equilibrium), the faster anesthesia will occur during an inhaled induction.
    2. Alveolar ventilation
    - The other parameter that directly controls the rate by which F A /F I approaches 1 is alveolar
    ventilation. An increase in ventilation will increase the rate of rise. The magnitude of the effect varies
    according to the blood:gas partition coefficient.

    B. Factors Controlling Uptake


    -The increase of F A /F I , which is an important determinant of the speed of induction, is opposed by the
    uptake of anesthetic into the blood, which is determined by pharmacokinetic parameters unique to the
    anesthetic agent as well as patient factors.

    1. Solubility
    One of the most important factors influencing the transfer of an anesthetic from the lungs to the
    arterial blood is its solubility characteristics. The blood:gas partition
    coefficient is a useful index of solubility and defines the relative affinity of an anesthetic for the blood
    compared with that of inspired gas.

    2. Cardiac output
    Changes in pulmonary blood flow have obvious effects on the uptake of anesthetic gases from the
    alveolar space. An increase in pulmonary blood flow (ie, increased cardiac
    output) will increase the uptake of anesthetic, thereby decreasing the rate by which F A /F I rises, which
    will decrease the rate of induction of anesthesia. An increase in cardiac output and pulmonary blood flow
    will increase uptake of anesthetic into the blood, but
    the anesthetic taken up will be distributed in all tissues, not just the CNS. Cerebral blood flow is well
    regulated and the increased cardiac output will therefore increase delivery of anesthetic to other tissues
    and not the brain.

    3. Alveolar-venous partial pressure difference


    The greater this difference in anesthetic gas tensions, the more time it will take to achieve equilibrium
    with brain tissue.

    ELIMINATION
    A. Ventilation
    Two parameters that are useful in controlling the speed of induction of and recovery
    from inhaled anesthesia:

    1. Concentration of anesthetic in the inspired gas


    - cannot be reduced below

    2. Alveolar ventilation
    -only way to speed recovery

    B. Metabolism
    -Modern inhaled anesthetics are eliminated mainly by ventilation and are only metabolized to a very
    small extent; thus, metabolism of these drugs does not play a significant role in the termination of their
    effect.
    -Have important implications for their toxicity.
    -Hepatic metabolism may also contribute to the elimination of and recovery from some older volatile
    anesthetics

    (Source: Katzung Basic and Clinical Pharmacology 12th edition page 430)
    3. List the advantages and disadvantages of commonly used inhalation
    anaesthetic agents

    4. List the commonly used intravenously administered


    anesthetic agents and adjunct agents used in balanced
    anesthesia.
    INTRAVENOUS ANESTHETIC AGENTS
    Barbiturates
    Benzodiazepines
    Dexmedetomidine
    Etomidate
    Ketamine
    Propofol
    Opioids
    BALANCED ANESTHESIA
    Induction Agent
    fentanyl
    lidocaine
    propofol
    succinylcholine

    Maintenance
    Agent
    Sevoflurane,
    Desflurane,
    Isoflurane
    Fentanyl, Morphine,
    Diluadid, Demerol
    Rocuronium,
    Vecuronium,
    Mivacurium
    Nitrous oxide
    Propofol

    5. Discuss the disadvantage of nitrous oxide as an inhalation anesthetic agent.


    Disadvantages of nitrous oxide/oxygen inhalation may include:

    Lack of potency/ a weak general anesthetic


    Dependant largely on psychological reassurance
    Patient must be able to breathe through the nose
    Poorly soluble in blood and other tissues, allowing it to move rapidly in and
    out of the body

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