Base of Inhalation Anaesthesia

Inhalation Anaesthesia

Basic knowledge
Anesthsie Et Ranimation, Jean Atto 2003

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 Base of Inhalation Anaesthesia

Definitions:

Anaesthesia: Reversible elimination of all sensation

Analgesia: Reversible elimination of the sensation of pain

Local Anaesthesia: Reversible, deliberately produced, loss of

all sensation in apart of the body.

Local Analgesia : reversible, deliberately produced, loss of

the sensation of pain in a part of the body.

General
Anaesthesia: Reversible loss of all sensation,
deliberately produced for therapeutic
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purposes, in which the reflex responses

to stimuli are diminished or eliminated.

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 Base of Inhalation Anaesthesia

Applications:

Intravenous
Anaesthesia: Anaesthesia induced and / or maintained by
the intravenous administration of one or
more drugs.

Paravertebral
Anaesthesia: (Spinal anaesthesia) conduction anaesthesia
Produced by deposition of a suitable agent
on or near the spinal nerves at or near the
intervertebral foramina.
Anesthsie Et Ranimation, Jean Atto 2003

Inhalation
Anaesthesia: Anaesthesia induced and / or maintained by pulmonary
ventilation with anaesthetic vapours and / or gases.

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 Base of Inhalation Anaesthesia

Goals of General Anaesthesia:

1- To ensure that the surgical procedure is safe and it

creates as little stress or discomfort to the patient
as possible.

2- To provide the surgeon with the best working

environment possible with minimal side effects
from the Anaesthesia.

The vital functions (e.g., heart, circulation)

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are maintained !

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 Base of Inhalation Anaesthesia

The four Components of General Anaesthesia:

- Unconsciousness:
Hypnosis (Loss of Consciousness, sleeping)

- Painless:
Analgesia (Loss of sensitivity to pain)

- Depression of autonomic reflexes:

Loss of protective reflexes
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- Muscle relaxation:
Relaxation (loss of muscle tension)

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 Base of Inhalation Anaesthesia

Single Anaesthesia:

A single anaesthetic, for example, ether, ketanest, produces

All the four important components (sleep, insensitivity to pain,
muscle relaxation and depression of autonomic system activity) of
general anaesthesia, with however, strong associated side effects.
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 Base of Inhalation Anaesthesia

Combined Anaesthesia:

Each of the four components (Hypnotic, Analgesic,

Relaxant and Vagolytic and sympatholytic) of the
General Anaesthesia is produced by a single agent or by
combination of several agents. This ensures optimal
anaesthetic result while reducing the side effects.
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 Base of Inhalation Anaesthesia

Combined Anaesthesia :

Analgsique Hypnotique Systme Muscle

vgtatif Relaxant

Anesthsie - N20 - Barbiturique - Atropine - Curare

par - Morphine - Halothane
Inhalation - Enflurane
- Isoflurane
- Sevofluran
- Desfluran
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Morphine: Fentanyl, Rapifen, Sufenta et Ultiva

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 Base of Inhalation Anaesthesia

Physical Properties of Inhalation Anaesthesia :

Halothane Enflurane Isoflurane Sevofluran Desfluran

State of matter at Liquide Liquide Liquide Liquide Liquide

20C

Boiling point in 50.2 56.5 48.5 58.5 22.8

C
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Therapeutic
Concentration 0.2 - 1.5 0.2 - 3.0 0.2 - 2.5 0.2 - 3.0 1 - 10
Range in vol%

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 Base of Inhalation Anaesthesia

Minimum Alveolar Concentration (MAC 50)

MAC50, is the point at which 50% of patients between 31 and 55 years

cease to move in response to a stimulus.

MAC value is a measure for the narcotic effect (potency) of an

anaesthetic agent:
The lower the MAC the higher the narcotic potency.
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 Base of Inhalation Anaesthesia

MAC Values of all the anaesthetic agent:

Halothane Enflurane Isoflurane Sevofluran Desfluran

MAC 1.15 1.7 0.75 2.05 6.0

100% O2 vol. % vol. % vol. % vol. % vol. %

MAC
70% N2O 0.50 0.57 0.29 0.66 2.83
30% O2 vol. % vol. % vol. % vol. % vol. %
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 Base of Inhalation Anaesthesia

Nitrous Oxide (N2O)

Basic drug used in general anaesthesia together with oxygen.

Properties:

- Excellent ANALGETIC agent

- Minor Hypnotic effect

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 Base of Inhalation Anaesthesia

Nitrous Oxide (N2O)

Side effects:

- In air-filled rooms nitrogen (N2) is displaced by nitrous oxide

(N2O). Nitrous oxide occupies a volume 38 times greater than that
of Nitrogen:

Volume increases Pressure increases

(Risk of perforation)
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- In case of long-term use, risk of anaemia.

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 Base of Inhalation Anaesthesia

Volatile Anaesthetics:

Enflurane - Isoflurane - Halothane - Sevofluran - Desfluran

Properties:

- Good HYPNOTIC effect.

- Minor ANALGETIC effect.

Side effects:

- Reduced heart function

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- Bio transformation
(a portion of the gas is not eliminated by the lungs)

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 Base of Inhalation Anaesthesia

Metabolism of anaesthetic gases:

Halothane Enflurane Isoflurane Sevofluran Desfluran

Metabolism 20.0% 2.0% 0.2% 3.0% 0.02%

(vol. %)

The anaesthetic agents are stored in the fatty tissue and metabolised in
the liver.
Anesthsie Et Ranimation, Jean Atto 2003

- Liver damage by metabolites with Halothane

- Renal insufficiency with enflurane.

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 Base of Inhalation Anaesthesia

How it works:

inhalated gas

Alveolar

Diffusion in the blud

Brain
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Loss of Consciousness

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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

-SB (Spontaneous Breathing)
Pression The patient is breathing ambient air without machine help.

0
Temps
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Inspiration Expiration

Respiration spontane

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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

- Manuel Ventilation (MAN)

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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

- Volume Controlled Ventilation(IPPV)

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 Base of Inhalation Anaesthesia

Volum Cntrolled Ventilation(IPPV)

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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

Synchronized intermitent Mandatory Ventilation (SIMV):

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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

- Pressure Controlled Ventilation(PCV):

P
t

V
t
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 Base of Inhalation Anaesthesia

Ventilation Modes for the inhalation Anaesthesia:

- Pressure Limited Ventilation(PLV)

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 Base of Inhalation Anaesthesia

Inhalation Anaesthesia: Application System

Open

Semi-Open

Semi-Close

Close
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