INHALATION ANESTHETICS
M ZEESHAN KHAN
SUPERIOR UNIVERSITY LHR
INTRODUCTION
Nitrous oxide, Chloroform and Ether were the first
universally accepted general anesthetics.
Ethyl chloride, Ethylene and Cyclopropane were also
used , but the toxicity and flammability led to their
withdrawal from the market.
Mainly 5 inhalation anesthetics agents are used in clinical
practice these days:
• 1. Nitrous oxide
• 2.Halothane
• 3.Isoflurane
• 4.Desflurane
• 5. Sevoflurane
MINIMUM ALVEOLAR
CONCENTRATION (MAC)
DEF: The minimum alveolar concentration of
an inhaled anesthetics is the alveolar
concentration that prevents movement in
50% of patient in response to a
standardized stimulus (e.g Surgical
Incision)
MAC VALUE OF INHALATION
ANESTHETICS AGENTS
• Nitrous oxide: 105%
• Halothane: 0.75%
• Isoflurane : 1.2%
• Desflurane: 6%
• Sevoflurane: 2%
NITROUS OXIDE
Physical properties:
It is a laughing gas.
It is only inorganic anesthetic gas in
clinical use.
Colorless and odorless
Non Explosive and Non Infammable
Gas at room temperature and can be kept
as a liquid under pressure.
It is relatively inexpensive.
Effects of Nitrous Oxide on Organ System
1. CARDIOVASCULAR SYSTEM
• Stimulate sympathetic nervous system.
• Directly depresses myocardial
contractility.
• Arterial blood pressure ,heart rate and
cardiac output are slightly increased.
2. RESPIRATORY SYSTEM:
• Increases respiratory rate with decreases
tidal volume.
• Minimal change in minute ventilation.
3. CEREBRAL:
• Increases CBF thus increasing intracranial
pressure.
4. RENAL SYSTEM:
• It decreases renal blood flow thus leads to drop
in glomerular filtration rate and urinary output.
5. HEPATIC SYSTEM:
• Decreases the Hepatic blood flow but to a lesser
extent than other inhalation agents.
6. GASTROINTESTINAL:
• It causes post operative Nausea and Vomiting.
CONTRAINDICATION OF N2O
• Air embolism
• Pneumothorax
• Acute Intestinal Obstruction
HALOTHANE
• Physical Properties:
• Non Inflammable and Non explosive.
• Least expensive .
EFFECTS ON ORGAN SYSTEM
1. CARDIOVASCULAR:
Dose dependent reduction of arterial blood pressure
by direct myocardial depression.
It is a coronary artery vasodilator.
It causes slowing of SA node conduction resulting in
bradycardia.
2. RESPIRATORY SYSTEM:
Causes rapid ,shallow breathing.
Decrease in alveolar ventilation and Paco2 elevated.
Potent bronchodilator.
3. CEREBRAL:
• It increases cerebral blood flow.
4. NEUROMUSCULAR:
• Relaxes skelatal muscle and potentiates
Non depolarizing neuro-muscular blocking
agents.
5.RENAL:
• Reduces renal blood flow, glomerular
filtration rate and urinary output.
6. HEPATIC:
• Decreases hepatic blood flow.
CONTRAINDICATION
• Unexplained liver dysfunction.
• Intra-cranial mass lesions.
• Hypo-volemic patient with severe cardiac
diseases.
ISOFLURANE
It is non flammable volatile with a pungent smell.
EFFECTS ON ORGAN SYSTEM:
1. CARDIOVASCULAR:
Causes minimal cardiac depression.
Rapid increase in MAC lead to increase in HR and
BP.
Dilates coronary arteries.
2. RESPIRATORY SYSTEM:
Respiratory depression .
Acts as a good bronchodilator.
3. CEREBRAL:
If con> 1 MAC causes increase in CBF and
Intracranial pressure.
4. NEUROMUSCULAR:
Relaxes skeletal muscles.
5. RENAL:
Decreases renal blood flow , glomerular
filtration rate and urinary output.
6. HEAPTIC:
Reduces hepatic blood flow.
INDICATIONS- For Cardiac and Neuro-
Surgery
CONTRAINDICATION
• No such contraindication.
DESFLURANE
Structure much similar to that of isoflurane.
Recovery time are approximately 50 % less than
those of Isoflurane. Pungent Smell
EFFECTS ON ORGAN SYSTEM:
1. CARDIOVASCULAR SYSTEM:
Similar to Isoflurane( Increases HR and BP when
increased MAC rapidly)
Dilates coronary arteries.
2. RESPIRATORY SYSTEM:
• Causes decrease in tidal volume and increase in
resp rate.
• Pungency and airway irritation so causes
coughing and sometime bronchospasm.
3. CEREBRAL:
• Increases CBF and Intracranial pressure.
4. NEUROMUSCULAR:
• Relaxes skeletal muscle.
5. RENAL AND HEPATIC SYSTEM:
• No any evidence has been documented.
INDICATION- For Hepatic and Renal Surgery
CONTRAINDICATION
• Severe hypo-volemia.
• Intracranial hypertension.
• Malignant hyperthermia.( uncontrolled increase in skeletel
muscle metabolism triggered in susceptible individuals by commonly used by general
anesthetics(iso,sevo,desflurane,halothane,succinylcholine)
SEVOFLURANE
• It is Non pungency.
EFFECTS ON ORGANS:
1.CARDIOVASCULAR SYSTEM:
• Mildly depresses myocardial contractility.
2. RESPIRATORY SYSTEM:
• Depresses respiratory rate.
3. CEREBRAL:
• Increases CBF and intra-cranial pressure.
4. RENAL SYSTEM:
• Slightly decreases renal blood flow. Higher
Conc Causes Nephro-toxicity
5. HEPATIC:
• increases hepatic artery blood flow
6.NEUROMUSCULAR:
• Adequate muscle relaxation.
CONTRAINDICATION
• Severe hypo-volemia.
• Intracranial hypertension.
• Malignant hyperthermia.
ETHER
• W.T.G Morton on 16th Oct 1846 used for
removal of jaw tumor.
PHYSICAL PROPERTIES:
• Pungent smelling liquid, decomposes in
presence of light, air, heat.
• Highly inflammable and explosive.
• Highly irritant vapour.
• Very Cheap (low price).
• Also called as Complete Anesthetic
agents.
• Can be used by less experience hands.
• Induction very slow, pungent smells and
may causes laryngeal spasm
• Very good analgesic.
• Very good muscle relaxants.
• Cardiovascular: Does-not depresses
myocardium but stimulates sympathetic
system.
• Respiratory system: Does-not depresses
respiration.
It is a potent bronchodilator.
Tracheo-bronchial secretions is markedly
increased.
• GIT: Nausea and vomiting.
• Cerebral: Increases intracranial pressure.
STAGES OF ETHER ANESTHESIA
STAGE I: (Stage of analgesia) (From
analgesia to loss of consciousness)
• Respiration is regular with small tidal
volume.
• Pupil is normal in size.
STAGE II : (Stage of Excitement): ( From
loss of consciousness to rhythmic
respiration)
• Respiration is irregular.
• Pupil is Mild dilated.
• Eyelashes reflex absent.
STAGE III : ( Stage of Anesthesia):
• Plane I: ( From rhythmic resp to cessation of eye
movement)Respiration is regular with large
volume. Pupil is normal in size. Eyelashes reflex
absent, Pharyngeal and vomiting reflex lost.
• Plane II: (From cessation of eye movement to
resp paresis)Respiration is regular with large
volume , Pupil is mild dilated with corneal
reflexes lost.
• Plane III: ( Resp paresis to Paralysis)From
Respiration is regular with small volume, Pupil is
moderate dilated with laryngeal reflexes absent .
• Plane IV: (Diaphragmatic Paralysis)Respiration
is irregular with small volume, Pupil dilated and
• Stage IV: (Stage of overdose) (Medullary
Paralysis)
• Apnea
• Pupil dilated and non reacting to light.
NOTE: Withdrawal of anesthetic agents
and administration of 100% oxygen
lightens anesthesia with recovery.
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