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Inhalational Anesthetic Agents

Nitrous Oxide, N2O ("Lauging Gas")

Physical Properties

 colorless
 odorless

 nonflammable but, like O2, supports combustion

 gas in room temp and ambient pressure; liquid under pressure

Organ System Effects

Cardiovascular
 direct myocardial depressant effect balanced by
 sympathetic nervous system stimulation

 so BP and P stable

 myocardial depression may be unmasked by

o CAD

o hypovolemia

 pulmonary vasoconstriction -> increased PVR

Respiratory
 tachypnea + decreased VT = stable VE and paCO2
 BEWARE: inhibits carotid body hypoxic drive

CNS
 mildly increases CBF, CBV and ICP
 increases CMRO2

 analgesia
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Biotransformation and Toxicity

 eliminated by exhalation
 irreversibly oxidizes cobalt atom of vitamin B12, inhibiting B12-dependent
enzymes:

o methionine synthetase (myelin formation)

o thymidylate synthetase (DNA synthesis)

 so prolonged exposure can lead to

o bone marrow depression (megaloblastic anemia)

o peripheral neuropathy

o pernicious anemia

 controversial:

o emetogenic? (not especially)

o teratogenic (maybe not, but not necessary in early pregnancy, so

usually avoided)

Contraindications

 35 times more soluble in blood than nitrogen, N 2

 so fills and expands any air-containing cavities:

o air embolism

o pneumothorax

o intracranial air

o lung cysts

o intraocular air bubbles

o tympanoplasty

o endotracheal tube cuff (monitor and reduce pressure periodically)

 may exacerbate pulmonary hypertension

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