Chapter 8

Inhaled Anesthetics:

-some are gaseous state at room temp: NO, xenon, cyclopropane

-volatile anesthetics (liquids @ room temp): converted to gas via vaporizer diethyl ether,
halothane, enflurane. Current – sevoflurane, isoflurane. + Desflurane (properties of gas and
volatile anesthetic – boiling point @ 24)

-blood:gas partition coefficient – determines speed of anesthesia induction, recovery.

 Larger blood:gas coefficient = takes longer for blood to become saturated; theres more
anesthesia to dissolve and takes longer to reach the partial pressure needed to produce
anesthesia.
-oil:gas partition coefficient – measure of lipid solubility; higher coefficient = more potent
anesthetic and lower partial pressure (concentration) needed to achieve anesthesia

FA (alveolar anesthetic concentration)/FI (inspired anesthetic concentration) – faster with agents

with low blood:gas partition coefficient aka low solubility (NO, sevoflurane, desflurane).
 High minute ventilation = inc anesthetic to alveoli
 Low cardiac output (hypovolemia) = blood saturated with anesthetic more quickly bc
less blood available
-concentration effect – higher inhaled concentration = faster rise of FA/FI – inc rise of alveolar
ventilation
-overpressurization: use of higher FI than desired FA to achieve faster rise in FA/FI
-second gas effect: if you add two gases, augments concentration of both; this speeds induction
or deepens level of anesthesia

-anesthesia distribution: vessel rich (brain, heart, lung, liver)  muscle (rate limiting to when
anesthesia wears off)  fat (slow)

MAC: (minimum alveolar concentration): 1 mac = concentration of inhaled anesthetic at which

50% of pts do not move in response to surgical stimulation.
 MAC values are additive
 At least .7 MAC end tidal concentration of inhaled anesthetic required to prevent recall/
intraop awareness
 Concomitant admin of opioids/sedatives reduces MAC
 MAC inc with: chronic alcohol use, hyperthermia, hypernatremia, MAOI, acute
dextroaphetamine admin, cocaine, ephedrine, levodopa
 MAC dec with: age, barbiturates, benzos, opioids, ketamine/verapamil/Li, acute alcohol
intox, clonidine/dexmedetomidine, hypothermia/hyponatremia, pregnancy
 Newer inhaled anesthetics produce LOC/amnesia at low MAC (25-30%)
o High potency of anesthetic = high cerebral blood flow = high ICP; cerebral
protection from ischemia/hypoxia. Only for isoflurane/halothane. Not
sevo/desflurane.
-all inhaled anesthetics: depression of visual evoked, sensory, motor evoked potentials

-all inhaled anesthetics: dose dependent myocardial depression, dec systemic BP

(reduced systemic vascular resistance). Can have some rebound tachy/SNS stimulation in
desflurate/isoflurane/sevoflurane.
-can be protective against ischemic injury to heart, and also kidneys, liver, brain

Respiratory Effects: PaCO2 inc due to respiratory depression – dec in tidal volume, minute
ventilation. RR increases.
-isoflurane, desflurane can cause airway irritation  coughing, laryngospasm, bronchospasm
-can cause bronchodilation (except desflurane – bronchoconstriction)

Effects on Other Organ Systems:

-relax skeletal muscles, potentiate actions of nondepolarizing blocking agents
-all except NO/xenon precipitate malignant hyperthermia
-depress uterine muscle/vascular smooth muscle: can cause excess uterine bleeding in
abortion/csection when MAC>1.
-all new agents (iso, desflurane, sevo) – maintain or inc hepatic artery flow, no change to portal
vein blood flow
-b/c of dec CO/myocardial depression  can cause decrease in renal blood flow
-PONV

Toxicity:
-sevoflurane  vinyl ether (compound A) by CO2 absorbent. This can be inc if low total O2/NO
used and CO2 absorbent is warm.
-desflurane can be degraded to CO.

Non Volatile Anesthetics:

-NO: weak, readily diffuses into closed air spaces, high PONV, can be toxic to embryo
(interferes in folate metabolism). Can lead to endothelial dysfunction, oxidative stress,
destabilizes arterial plaque.
 Still use 50:50 O2/NO (Entonox) for peds dentistry, labor analgesia, burn dressing
changes
-Xenon: rare noble gas. Rapid onset/offset (low blood:gas partition coefficient). Minimal effect
on cardio, neuronal, respiratory systems. Does NOT trigger malignant hyperthermia. Can be
used as low analgesia (via N methyl D aspartate). HIGH COST.