Inhalational agents

Are Anesthetic drugs that taken up by inhalational through the lungs MAC Is the minimum alveolar concentration of anesthetic at 1 atmosphere that produces immobility in 50% of those patients exposed to a noxious stimulus

)Nitrous oxide )N2O
Non-irritating, sweet smelling and colorless gas Clinical uses: 3. Obstetric analgesia 4. Relief of pain in acute trauma 5. Burns & painful dressings 6. Dental anesthesia 7. Analgesia during surgery

Adverse effects
• Impurities with higher oxides of nitrogen spc. Nitrogen dioxide )NO2) which lead to laryngospasm, cyanosis , met hemoglobin & pulmonary odema Hypotension if given with benzodiazepines or opioids Aplastic anemia )after 6-24 h) due to inactivation of vit B12 & defect in folate metabolism

1. Neurological defects )after chronic exposure) like motor, sensory, coordination &reflex defects 3. Gestational defects )after chronic exposure) leads to abortion

Halogenated agents
• • • • • Halothane Enflurane Isoflurane Sevoflurane Desflurane

Halothane )Fluothane)
is a colorless liquid with sweet smell Advantages: 2. Non inflammable 3. Potent 4. Non-irritant to the respiratory tract in anesthetic concentrations 5. Low postoperative incidence of nausea and vomiting 6. Widely used in anesthesia for all types of surgeries

Effects
• On respiration: respiratory depressant • On the heart: decrease cardiac contraction, decrease stroke volume, decrease heart rate, dysrhythmias spc. When there is hypercapnia • On Kidney: decrease renal flow because of decrease GFR • On uterus: uterine relaxation

• On skeletal muscles: minimal neuromuscular blocking action • On cerebral blood flow : increase CBF so increase intracranial pressure • Shivering • Can cause malignant hyperpyrexia • On liver: it may cause halothane hepatitis • On cells: interferes with mitosis in cells

Isoflurane
Advantages: 2. Sustains myocardial contractility 3. Does not sensitize the heart to adrenaline 4. Rapid recovery 5. Minimal biotransformation with little risk for hepatic or renal toxicity 6. Ventricular work and oxygen consumption are decreased 7. Produce adequate muscle relaxant for most surgical maneuvers 8. Does not increase CBF at low concentrations

Disadvantages: 2. Its pungent odeur limits its use as an induction agent 3. Coronary vasodilatations with possibility of coronary steal syndrome at high inspired concentrations

Sevoflurane
is non-inflammable and has a pleasant smell Advantages:
• Smooth , fast induction • Rapid recovery • Ease to use & does not cause coronary steal syndrome

Disadvantages:
• Production of potentially toxic metabolites in the body • Instability with CO2 absorbers • Relatively expensive • Trigger for malignant hyperpyrexia

Thank you