3.Inhalational
2. Intravenous
1. Inhalational Anaesthetics
Definition?
# Physiological factors
-Alveolar ventilation rate.
-Cardiac output.
The solubility of anaesthetics
-Their solubility in different media is
expressed as partition coefficients,
defined as the ratio of the concentration
of the agent in two phases at equilibrium.
50 Enflurane
Halothane
0
20 40
Minutes
100 Recovery
Alveolar concentration
Percent of initial
Halothane
50 Enflurane
Isoflurane
N2O
0
20 40
Minutes
Pharmacokinetic Properties
Oil: gas partition coefficient, a measure of
fat solubility, the main effect being that high
lipid solubility tends to delay recovery from
the effects of anaesthesia.
1
Nitrous oxide
MAC
0.1
Cyclopropane
Ether 0.01
Halothane
Chloroform
Methoxyflurane
0.001
5000 1000 100 10 1 0.1
Oil/gas partition coefficient (37oC)
Correlation of anaesthetic potency with oil :gas partition coefficient.
Anaesthetic potency is expressed as MAC required to produce surgical
anaesthesia. There is close correlation with lipid solubility, expressed as the
oil : gas partition coefficient.
Factors affecting the rate of equilibrium of inhalation anaesthetics in the
body: The body is represented as two compartments. Lean tissues,
including the brain, have a large blood flow and low partition coefficient for
anaesthetics and, therefore, equilibrate rapidly with the blood. Fat tissues
have a small blood flow and large partition coefficient and, therefore,
.equilibrate slowly, acting as a reservoir of drug during the recovery phase
Properties of individual inhalational anaesthetic agents
Nitrous oxide
Low potency, therefore must be combined with other
agents.
Rapid induction and recovery.
Risk of bone marrow depression with prolonged
administration.
Enflurane
Less metabolism than halothane, therefore less
risk of toxicity.
Faster induction and recovery than halothane
(less accumulation in fat).
Can cause epilepsy-like seizures.
Isoflurane
Similar to enflurane, but lacks epileptogenic
property.
Irritant to respiratory tract.
2. Intravenous Anaesthetics
Thiopental, fentanyl, etomidate, propofol,
ketamine & midazolam.
Blood
Lean tissues
80
Brain &
percent of dose
viscera
60
40
Fat
20
0
0.125 0.5 1 4 16 64 256
Time (min)
Redistribution of thiopental after an intravenous bolus administration.
Etomidate
Similar to thiopental but more quickly metabolized.
Propofol
Very lipid-soluble, acts rapidly and recovery is very rapid.
Midazolam
Used as preoperative sedative for procedures such as
endoscopy where full anaesthesia is not required.
Drug interactions