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General Anesthetics Jieyu Fang The First Affiliated Hospital 房洁渝 中山大学附属第一医院
Principles of General Anesthesia ,[object Object],[object Object],[object Object]
 
What are General Anesthetics? ,[object Object],[object Object]
Background ,[object Object],[object Object],[object Object]
Anesthetics divide into 2 classes: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypotheses of General Anesthesia ,[object Object],[object Object],[object Object],[object Object]
Other Theories included ,[object Object],[object Object],[object Object],[object Object],[object Object]
GABA receptors  gamma- aminobutyric  acid   ,[object Object],[object Object],[object Object],[object Object]
GABA receptors ,[object Object]
NMDA receptor ,[object Object],[object Object],[object Object],[object Object]
Mechanism of Action ,[object Object],[object Object],[object Object],[object Object]
Mechanism ,[object Object],[object Object],[object Object],[object Object]
Intravenous Anesthetics  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacology of intravenous (IV) anesthetics  ,[object Object],[object Object]
Pharmacology of intravenous (IV) anesthetics ,[object Object]
Pharmacology of intravenous (IV) anesthetics ,[object Object]
[object Object],[object Object]
Propofol ,[object Object]
 
propofol ,[object Object],[object Object],[object Object],[object Object]
propofol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Properties of Intravenous Anesthetic Agents-propofol ,[object Object],[object Object],[object Object],[object Object]
Dosages of commonly used IV anesthetics  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
propofol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Benzodiazepines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Flumazenil   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ketamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ketamine ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ketamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ketamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ketamine ,[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Properties of Intravenous Anesthetic Agents Drug Induction and Recovery Main Unwanted Effects Notes thiopental Fast onset (accumulation occurs, giving slow recovery) Hangover Cardiovascular and respiratory depression Used as induction agent declining. ↓ CBF and O2 consumption Injection pain etomidate Fast onset, fairly fast recovery Excitatory effects during induction  Adrenocortical suppression Less cvs and resp depression than with thiopental,  Injection site pain propofol Fast onset, very fast recovery cvs and resp depression  Pain at injection site. Most common induction agent. Rapidly metabolized; possible to use as continuous infusion. Injection pain. Antiemetic ketamine Slow onset, after-effects common during recovery Psychotomimetic effects  following recovery, Postop nausea, vomiting ,  salivation Produces good  analgesia  and amnesia. No injection site pain midazolam Slower onset than other agents Minimal CV and resp effects. Little resp or cvs depression. No pain. Good amnesia.
Non-barbiturate induction drugs effects on BP and HR Drug Systemic BP Heart Rate propofol ↓ ↓ etomidate No change or  slight ↓ No change ketamine ↑ ↑
 
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object]
Opioids ,[object Object],[object Object],[object Object]
Naloxone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Naloxone ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacology of inhalation anesthetics ,[object Object]
minimum alveolar concentration ,[object Object],[object Object],[object Object],[object Object],[object Object]
MAC and Lipid Solubility 1.85 53 sevoflurane 105 1.4 nitrous oxide 1.90 65 ether 1.68 98 enflurane 0.76 224 halothane MAC Lipid/Gas Coefficient Agent
inhalation anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
inhalation anesthetics ,[object Object],[object Object],[object Object],[object Object]
Uptake, Distribution and Elimination of Anesthetic Gases,  p29 0.74 1.68 1.15 2.05 104 MAC 3 1.4 Isoflurane 4 1.9 enflurane 6 12.1 ethyl ether 5 2.3 halothane 2 0.69 sevoflurane 1 0.47 N 2 O Rapidity of Onset Blood/Gas ( λ ) Agent
inhalation anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
inhalation anesthetics ,[object Object],[object Object],[object Object]
inhalation anesthetics ,[object Object],[object Object],[object Object],[object Object]
inhalation anesthetics ,[object Object],[object Object],[object Object],[object Object]
Figure 11.2. Ratio of alveolar to inspired gas concentration (FA/FI) ,[object Object]
Nitrous oxide   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Volatile anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Volatile anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Volatile anesthetics ,[object Object],[object Object],[object Object],[object Object]
Volatile anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object]
Volatile anesthetics ,[object Object],[object Object],[object Object]
Nitrous oxide ,[object Object],[object Object]
Nitrous oxide ,[object Object],[object Object],[object Object],[object Object],[object Object]
Desflurane ,[object Object],[object Object]
Sevoflurane ,[object Object],[object Object]
Enflurane ,[object Object]
Inhalation Anesthetic Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
yes Marked Yes Yes  Respir depression No Significant  Significant No Respir irritation Slightly reduced Stable Slightly reduced Reduced Cardiac output Stable Increased Increased Reduced Heart rate Significant Significant Significant Moderate Muscle relax 3 – 6% 0.02% 0.2% 12 – 25% Metabolism No No No Yes Hepatotoxic Fast Very fast Moderate Slow Recovery Fast Fast Moderate Slow Alveolar equilibration sevoflurane Desflurane Isoflurane Halothane
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
 
 
 
 
 
 
Thank you!
 
 
Overview of Discussion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Historical Perspective ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],19 th  Century physician administering chloroform
Definition of General Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Body and General Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cellular Mechanism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Structures ,[object Object],[object Object],Propofol Etomidate Ketamine Halothane Isoflurane Sevoflurane
Molecular Actions: GABA A  Receptor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Molecular Actions: GABA A  Receptor ,[object Object],[object Object],[object Object],[object Object]
Molecular Action: GABA A  Receptor
Molecular Action: GABA A  Receptor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism of Propofol ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism of Propofol ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism of Propofol ,[object Object],[object Object],[object Object],[object Object]
Metabolism and Toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adverse Effects of Propofol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Latest Discoveries:  Implications for the Medicinal Chemist ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inhaled Anesthetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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3 general anethesia

  • 1. General Anesthetics Jieyu Fang The First Affiliated Hospital 房洁渝 中山大学附属第一医院
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  • 42. Properties of Intravenous Anesthetic Agents Drug Induction and Recovery Main Unwanted Effects Notes thiopental Fast onset (accumulation occurs, giving slow recovery) Hangover Cardiovascular and respiratory depression Used as induction agent declining. ↓ CBF and O2 consumption Injection pain etomidate Fast onset, fairly fast recovery Excitatory effects during induction Adrenocortical suppression Less cvs and resp depression than with thiopental, Injection site pain propofol Fast onset, very fast recovery cvs and resp depression Pain at injection site. Most common induction agent. Rapidly metabolized; possible to use as continuous infusion. Injection pain. Antiemetic ketamine Slow onset, after-effects common during recovery Psychotomimetic effects following recovery, Postop nausea, vomiting , salivation Produces good analgesia and amnesia. No injection site pain midazolam Slower onset than other agents Minimal CV and resp effects. Little resp or cvs depression. No pain. Good amnesia.
  • 43. Non-barbiturate induction drugs effects on BP and HR Drug Systemic BP Heart Rate propofol ↓ ↓ etomidate No change or slight ↓ No change ketamine ↑ ↑
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  • 57. MAC and Lipid Solubility 1.85 53 sevoflurane 105 1.4 nitrous oxide 1.90 65 ether 1.68 98 enflurane 0.76 224 halothane MAC Lipid/Gas Coefficient Agent
  • 58.
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  • 60. Uptake, Distribution and Elimination of Anesthetic Gases, p29 0.74 1.68 1.15 2.05 104 MAC 3 1.4 Isoflurane 4 1.9 enflurane 6 12.1 ethyl ether 5 2.3 halothane 2 0.69 sevoflurane 1 0.47 N 2 O Rapidity of Onset Blood/Gas ( λ ) Agent
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  • 78. yes Marked Yes Yes Respir depression No Significant Significant No Respir irritation Slightly reduced Stable Slightly reduced Reduced Cardiac output Stable Increased Increased Reduced Heart rate Significant Significant Significant Moderate Muscle relax 3 – 6% 0.02% 0.2% 12 – 25% Metabolism No No No Yes Hepatotoxic Fast Very fast Moderate Slow Recovery Fast Fast Moderate Slow Alveolar equilibration sevoflurane Desflurane Isoflurane Halothane
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