INHALATION

ANESTHETICS
Minimum Alveolar Concentration (MAC)
 Concentration of anesthetics gas
needed to eliminate movement among
50% of patients challenged by a
standardized skin incision
 % of gas in a mixture required to achieve
the effect
 Inversely proportional to the potency of
the anesthetics
 Halothane
 Prototype

Effects:
 Respiratory depression
 Marked reduction in arterial BP
 Sensitization of the heart to catecholamines
 Direct relaxation of cerebral vasculature
 Relaxation of skeletal muscle
 Halothane Hepatitis

 Immune response to hepatic proteins that become

trifluoroacetylated as a consequence of halothane
metabolism
 Characterized by fever, anorexia, nausea &
vomiting
 Can be accompanied by a rash & peripheral
eosinophilia
 Rapid progression of hepatic failure
 Halothane
 DOC in children
 not hepatotoxic in pediatric patients
 Pleasant odor
Enflurane
 less potent than halothane, but it produces rapid
induction & recovery
 depresses respiration
 exhibits the ff. differences from halothane:
 fewer arrythmias
 less sensitization of the heart to catecholamines
 greater potentiation of muscle relaxant
Enflurance
 metabolized to fluoride ion, which is excreted by the
kidney
 contraindicated in patients with kidney failure
Isoflurance
 Structural isomer of enflurence & produces similar
pharmacological properties:
 some analgesia
 some neuromuscular blockade
 depressed respiration
Isoflurane
 considered a particularly safe anesthetics in
patients with IHD
 cardiac output is mintained
 coronary arteries are dilated
 myocardium does not appear to be sensitized
to the effects of cathecholamines
Isoflurane
 causes transient & mild tachycardia by direct
sympathetic stimulation
 particularly important in the management of
patients with myocardial ischemia
 least metabolized
 lack of metabolites credited for hepatic & renal
safety
Methoxyflurane
 Most potent inhalational anethetic agent
 high solubility in lipid
 rarely used outside of obstetric practice
 finds use in child-birth because it does not
relax the uterus when briefly inhaled
 Oxidative metabolism results in the production of
oxalic acid & fluoride
Sevoflurane
 most recently introduced inhalation anesthetic
 has low tissue & blood solubility
 allows for rapid induction & emergence
 makes it useful for outpatient & ambulatory
procedures
Sevoflurane
 has the advantage of not being pungent
 permits a smooth inhalation induction
 allow rapid uptake without irritating the airway
during induction
 particularly useful in pediatric anesthesia
 does not directly produce tachycardia
 useful alternative to consider in patients with
myocardial ischemia
 causes hypertension
Desflurane
 shares most of the pharmacological properties
of isoflurane
 popular for outpatient procedures
 rapid onset
 prompt elimination from the body by
exhalation
 irritates the respiratory tract
 not preferred for induction of anesthesia
using an inhalational technique
Desoflurane
 causes:
 a decrease in BP
 an increase in the rate of vantiliation
Nitrous oxide
 laughing gas
 potent analgesic, weak genaral anesthetics
 combined with the more potent volatile
anesthetics

Nitrous oxide at 80% (without other adjunct agents

cannot produce surgical anesthesia.
Nitrous oxide
 does not depress respiration nor does it
produce muscle relaxation
 has the least effect on the CVS & on
increasing cerebral blood flow
 least hepatotoxic of the inhalation
anesthetics
Nitrous oxide
 25-40% (lower inspired concentration):
 prosuce CNS depression without excitation
 more safely used clinically
 25%: gas’s maximum analgesic effect
* used in dentistry & occasionally for selected
painful surgical procedure
 Causes diffusion hypoxia
Nitrous oxide
 least soluble in blood
- excreted rapidly by expiration of
unmetabolized gas