Inhalation anesthesia

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Inhalation anesthesia

• ??.???????? ???????????????,??.,??.????????????
• ???????????????????
• ????????????????????????????????????????????

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????????????

• ????????????????????????
• ?????????????????????????????(Inspired
  concentration,FI)
• Concentration effect
• Second gas effect
• Alveolar ventilation(VA)
• ??????????????????????????????????????????
• ?????????????????????????(solubility)
• Cardiac output
• ???????????????????????????????????????????(PV-P
  A)
• ????????????????????????????????????
• Diffusion hypoxia

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???????????????????????????????????

• ??????????????????????????????????????????????????
  ????????(???????)?????????????????????????????????
  ???????????????????????????????????????
• ?????????????????????????????????
• (Uptake and distribution)

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???????????????????????????????????

• ??????????????????????????????????????????????????
  ??????????
• ??????????????????????????????????????????????????
  ???????????????????????????????????????

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????????????????????????

• ??????????????????????????????????????????????????
  ??????????
• ???????????????????????
• ??????????????????????????????????????????

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1.???????????????????????

• 1.1 Inspired concentration,FI
• ??????????FI ??????? FA????????????????????????
  
• ????????FI ???????????
• ???????????????????????? vaporizer
• ?????? FGF ????
• ????? concentration effect ??? second gas effect
  
• ?????????????? FA /FI 1 ????????????????????????
  ????????????

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1.2 Concentration effect

• 
  
  
• N2O
  
• take up
• 25 ml
  
• 100 ml

• O2
• ml
• N2O 25 ml

O2 50 ml N2O 50 ml
O2 50 ml N2O 25 ml
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1.2 Concentration effect

• ????????????????????????????
• Alveolar volume ??????????????

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second gas effect

• ???????????? N2O ??????????????????????
• N2O ????????????????????????????????????? ???????
• ?????????????????? concentration effect

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Alveolar ventilation(VA)

• ??????????????? VA ????????????????????????
  ??????????????????? FA /FI ???????? 1
  ????????????????????????????????? solubility
  ???????????????????? solubility ???
  ???????????? ????????????????????????????????????
  ???? FRC ??????????????? FRC ??????? COPD
  ??????????????????????????? FA ????

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??????????????????????????????????????????

• Anesthetic uptake ????????????????????????????????
  ????????????????????????????????????????????
  ?????????????????????????????????????
• solubility
• cardiac output
• ???????????????????????????????????????????????
• PV - PA

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• ?????????????????????????(solubility) ?
• cardiac output Q
• PV -PA

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• x Q x (
  )
• Anesthetic uptake _________________
• barometric pressure

PV -PA
?
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??????????????????? ?????????????????????????????
?????????????????????????????? 3 ??????

• ?????????????????????????(solubility)
• ????????????????????????????????
• ??????????????????????????????????????????????????
  ???????????????????????

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Solubility(partition coeffecient)

• ??????????????????????????????????????????????????
  ?? 2 ???? ???? blood/gas ???? tissue/gas
• ????? partial pressure ???????????????????????????
  ???? ????????????????????????????????????????????
  ????

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Solubility(partition coeffecient)

• ??????????????? blood/gas solubility ??? ???????
  ???????????????????????????(?????????????????????
  ???????) ????????????????????????????????????????
  ?? ??????????????????????????????????????
  ????????????????

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???????? solubility
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Cardiac output(Q)

• ??????????????????????????? ?????????????????????
  ??????????????
• ??? CO ??? ?????????????????????????????

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PV -PA

• ?????????????????????????????????
  ????????????????? ????? FA ???????????
  ??????????????????????
• ?????????????????????????????????????????????????
  ?????????????????????????????????????????????????
  ?????
• ????????????????????? 4 ?????

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????????? tissue group
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????????????????????????????????????

• ????????????????????????????
• ?????????????????????????????????????????????????

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????????????????????????????????????

• Fresh gas flow ?????? ???????????????????????????
  ????? non-rebreathing ???????????????????????????
  ?
• Alveolar ventilation ???
• blood/gas solubility ??? ??????????
• cardiac output ??? ??????????
• ????????????????????????????????????????????? ???
  Pv ??????????????

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Diffusion Hypoxia

• ??????????? hypoxia ??????????????????????????????
  ? ???????????????????????????????????????????????
  ????????????? 34 ???? ??????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?????

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Diffusion Hypoxia

• ????? CO2 ???????????????????? ????CO2
  ?????????????????????????????????
  ????????????????????
• ??????? 5-10 ??????????????? N2O
• ????????????????? 100 O2 5-10 ???????????????????
  ??? N2O

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Pharmacodynamics of Inhalational anesthetic

• Anesthetic potency of inhalational
• agents correlates directly with their
• lipid solubility

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MAC

• Minimum Alveolar Concentration (MAC)
• ??????? ????????????????????(partial
  pressure)???????????? alveoli ??????????????? 50
  ????????????? noxious stimuli(prevent skeletal
  muscle movement) ??? 1 atm

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MAC(???)

• ??? MAC ???????? potency ????????
• ???????? ?????? MAC ??? ? potency ???
• MAC ??? ? potency ????

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MAC (???)

• - ??? MAC ????????????????????????????????????
• ??????????? ( additive)
• - ????????? 1.3 MAC ? 95 no movement
• - 0.3 0.4 MAC ? MAC awake

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??????? Inhalational anesthetics ???????????

• Nitrous oxide ( N2O )
• Halothane ( F3 )
• Methoxyflurane ( ??????????????? )
• Enflurane ( ??????????????? )
• Isoflurane
• Sevoflurane
• Desflurane

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Nitrous oxide (N2O)(laughing gas)

• -??????????????????????????????? gas
• -???? gas ???????????????????????
• -MAC 105
• -????????????????????????? ??????????????????????
  ??????????
• -?????????????????????????????????????
• -metabolism ????????? 0.004
• -prolong exposure bone marrow depression,
• teratogenic effect
• -Diffusion hypoxia

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Nitrous oxide (???)

• contraindication
• -air embolism
• -pneumothorax
• -acute intestinal obstruction
• -intraocular air bubble

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2.Halothane(Fluothane)(F3)

• physical properties
• -halogenated alkane
• -thymol preservative , amber-colored
• bottle.
• -?????????? (volatile)
• -MAC 0.75

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Halothane(???)

• Effect on organ system
• a) cardiovascular
• -Hypotension ???????? myocardium
• depression
• -???????????????? arrhythmia ???
• adrenaline

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Halothane(???)

• b) respiratory
• -rapid RR but shallow breathing ? PaCO2
  ?????????
• -potent bronchodilator
• -best bronchodilator (?????????????
• volatile ???????)

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Halothane(???)

• c) cerebral
• -dilate cerebral vessel ? increase
• CBF
• -inhibit autoregulation
• d) neuromuscular
• -relax skeletal muscle ,?????????????
• muscle relaxant
• -trigger for MH

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Halothane(???)

• e) renal
• -decrease renal blood flow ,
• decrease GFR
• f) hepatic
• -decrease hepatic blood flow

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Halothane(???)

• Biotransformationtoxicity
• -20 metabolite ??????
• -metabolite ????????????????? trifluoroacetic
• acid ???????????????? hapten ? Halothane
• hepatitis
• -Halothane hepatitis (135,000)

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Halothane(???)

• contraindication
• -liver disease
• -pheochromocytoma ? arrhythmia
• ??????
• - Hx of MH

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3.Methoxyflurane(Penthrane)

• -?????????????????????????
• -MAC 0.16 (most potent)
• -50 ? Metabolism ????????? (liver)
• -metabolite ? Nephrotoxicity

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4.Enflurane(Ethrane)

• -?????????????????????????
• -MAC 1.7
• -??????????????????????? tonic clonic seizure
• -metabolite ? Nephrotoxicity

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5.Isoflurane(Forane)

• physical properties
• -pungent odor
• -isomer ??? Enflurane
• -MAC 1.2

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Isoflurane(???)

• Cardiovascular
• - increase HR
• - BP drop ????????????? SVR
• -coronary steal syndrome
• ( increase HR, dilate coronary vessel
• ? shunt blood ??? coronary artery
• ??????????)
• -??????????????????????????? CAD ????????

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Isoflurane(???)

• respiratory
• -??????????????????? ?????? induction ???????
• ???????????? irritate airway ? ?
• ? laryngospasm???
• -??????? bronchodilator ??????????????? F3
• -?????????????????

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Isoflurane(???)

• cerebral
• -??? impair autoregulation??? brain
• ?????????????????????????
• -increase CBF ? increase ICP
• (??????????????????????? hyperventilation)

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Isoflurane(???)

• neuromuscular
• -relaxes skeletal muscle
• renal
• -decrease renal blood flow, decrease-
• GFR
• hepatic
• -decrease hepatic blood flow
• (hepatic arteryportal vein) ??????????????? F3

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Isoflurane(???)

• metabolism
• - 0.2 ?????????????????????????????????????????
  
• ????? liver dysfunction ???????
• contraindication
• -? CAD ? coronary steal syndrome
• -Hx of MH

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6.Sevoflurane(Sevorane)

• physical properties
• -blood/gas partition coefficient0.65
• ???????????????????? induction
  ????????????????????
• ????????
• -?????????????
• -?????????????????? inhalation induction
• -vapor pressure 160 mmHg ??????????
• ???????????? vaporizer ???????????
• -MAC 2

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Sevoflurane(???)

• cardiovascular
• -BP ???????? stable ??????????
• respiratory
• -??????? bronchodilator ??????????????
• Isoflurane
• cerebral
• -increase CBF

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Sevoflurane(???)

• neuromuscular
• -relax skeletal muscle
• metabolism
• -2 metabolism
• -Sevoflurane ?????? Sodalime ? degrade
• sevoflurane ? compound A(nephro-
• toxicity)(????????????)??????????????????????
• -????????? flow???????? 2L/min

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Sevoflurane(???)

• contraindication
• -Hx. Of MH
• -?? Hx. Of renal disease

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7.Desflurane(Suprane)

• physical properties
• -vapor pressure ??????????? 20oC 681mmHg
• ?????????????? vaporizer?????????(TEC6)
• -?????blood/gas partition coefficient???
• 0.42 ????????????????????????????????????????
  ???
• (rapid wash-in and wash-out)
• -????????????????????? ? irritate airway ?
• ? laryngospasm ???? coughing,salivation ??????
• -MAC 6

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Desflurane(???)

• cardiovascular
• -????? HR ???????????????????????????????
• ????????????????????????????
• respiratory
• -airway irritation???????????????????
• -?????????? (PaCO2 ?????????)

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Desflurane(???)

• cerebral
• -increase CBF,increase ICP ??????????
• ???????????? hyperventilation
• neuromuscular
• -relax skeletal muscle

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Desflurane(???)

• metabolism
• -lt0.1
• -Desflurane?degrade?sodalime ???????
• ?carbonmonoxide ????????
• -??????????????????? sodalime ??????????????
• contraindication
• -Hx. Of MH
• -case ?????????????? sodalime ???????

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