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Inhalational Anesthetics; Nitrous Oxide and Halothane.pptx

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Inhalational Anesthetics; Nitrous Oxide and Halothane.pptx

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All details about N2O and Halothane volatile anesthetic, their physical properties , their anesthetic effect on human body systems, also the indications and the history, the complications and contraindications, the metabolism.
How supplied ? Types of vaporizers, old and modern.

All details about N2O and Halothane volatile anesthetic, their physical properties , their anesthetic effect on human body systems, also the indications and the history, the complications and contraindications, the metabolism.
How supplied ? Types of vaporizers, old and modern.

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Inhalational Anesthetics; Nitrous Oxide and Halothane.pptx

  1. 1. Inhalational Anesthetics Nitrous Oxide , Halothane Mahmood Hasan Taha H.D Anesthesia Zakho General H. Aug 2022
  2. 2. Nitrous Oxide (N2O), Laugh Gas • Clear, colorless, non explosive , non flammable. • Supplied by pipeline or pressurized cylinders. • Boiling point -89ċ. • Gas at room temperature. • ≈ 5 times more rapid diffusion than N2. • Inexpensive.!!
  3. 3. • Safe ?, weak anesthetic but good analgesic. • No toxicity to Heart, Liver, Kidneys. • Prolong exposure to N2O → bone marrow depression (megaloblastic anemia) & peripheral neuropathies. • Teratogenic after long term uses. • MAC = 105
  4. 4. Effects on organ systems
  5. 5. Cardiovascular: • Minimal tendency to sympathetic stimulation. • Myocardial depression: caution in IHD & sever hypovolemia. • B.P, COP & HR unchanged or slightly increased.
  6. 6. Respiratory: • RR ↑ • Vt ↓ • Vm (-) • Diffusional hypoxia during recovery d.t elimination of N2O via alveolus is so rapid, this hypoxia can be prevented by administration of 100% O2 for 5-10 minute after discontinuing N2O.
  7. 7. Cerebral: • CBF ↑,CBV↑,ICP↑(mild), CMRO2 ↑. Renal: • GFR ↓ ,UOP ↓. Liver: • HBF ↓ < other volatile Anesthetics. Gastrointestinal: • PONV ↑ Neuromuscular: • ↑ potency of non depolarizing NMBA.
  8. 8. Contraindications: • Space occupying gas Brain? , Lung? , GIT? , ETT ? Pneumothorax, bullae, small bowel obstruction, middle ear surgery.
  9. 9. • Metabolism: 0.004%. • 70% nitrous oxide for >2hours have been shown to have more postoperative complications: atelectasis, fever, pneumonia, and wound infections. _______________
  10. 10. Halothane (Fluothane) 1956
  11. 11. General Description: • Non flammable. • Non explosive. • Potent anesthetic. • Induction is pleasant. • Recovery delayed. • Shivering is common.
  12. 12. • Malignant hyperthermia & hepatitis ? • Rarely used nowadays. • MAC = 0.75 • Blood/ Gas: 2.3, Oil/ Gas: 224 • Boiling point 50.2℃, SVP 32.5 mmHg. • Color code: red. • Clear, colorless liquid in brown glass bottle.
  13. 13. • 0.1% Thymol as preservative to protect against decomposition by light. • The Thymol preservative does not readily evaporate, and therefore builds up in the vaporizer, which requires drainage and cleaning at regular intervals.
  14. 14. • Slightly water soluble. • Soda lime: compatible. • Halothane may corrode or tarnish most metals: with the exception of chromium , nickel and titanium; Halothane attacks aluminum, tin, lead, magnesium, brass and solder alloys in the presence of water; this contact causes rubber and some plastic materials to deteriorate rapidly.
  15. 15. • Suitable vaporizer: Old design: Goldman vaporizers. • Designed by an English physician Dr. Victor Goldman (1903b. – 1994d). tow models: 1956 - 1962. Modern and New design: a specifically calibrated plenum vaporizers e.g: (TEC3,4,5&7, Dräger Vapor, Penlon, Blease). The term plenum= pressurized chamber in which the FGF is above atmospheric pressure.
  16. 16. Goldman vaporizer (made in England)
  17. 17. TEC2 Cyprane Fluotec Vaporizer
  18. 18. TEC3 Cyprane Fluotec Vaporizer (out of circuit)
  19. 19. Accoma / Halothane Vaporizer made in Japan 1980s
  20. 20. Datex - Ohmeda TEC3(within the circuit) Halothane Vaporizer
  21. 21. Ohmeda Fluotec4/ Halothane Vaporizer
  22. 22. Datex Ohmeda Fluotec5/ Halothane Vaporizer
  23. 23. Dräger Vapor 19.1 / Halothane Vaporizer
  24. 24. Dräger Vapor 2000 – Halothane Vaporizer
  25. 25. Dräger Vapor 3000 – Halothane Vaporizer
  26. 26. Penlon, Sigma Delta – Halothane Vaporizer
  27. 27. Blease- Datum- Halothane Vaporizer
  28. 28. Datex - Omeda Tec7/ Halothane Vaporizer
  29. 29. Effects on organ systems
  30. 30. Cardiovascular: • Myocardial depression, COP ↓. • B.P ↓↓ → HR ↓. • At 2 MAC of Halothane without surgery, 50% reduction in COP & B.P.
  31. 31. • Coronary vasodilatation but coronary Blood flow reduced d.t. ↓ in MAP. • Adequate myocardial perfusion is usually maintained d.t ↓ in O2 consumption (↓ demand).
  32. 32. • Halothane sensitizes the heart to arrhythmogenic effect of epinephrine (epinephrine > 1.5 mcg/kg should be avoided).
  33. 33. Lidocaine HCl 2% with Epinephrine 20mg/10mcg per mL
  34. 34. Carpules cartridge syringe
  35. 35. Respiratory: •Non irritant. •Rapid, shallow breathing ( Vt ↓ , RR ↑). •Vm ↓ → ↑ PaCO2. •Apneic threshold ↑. •Good bronchodilator → safe in asthma. •Mucociliary function ↓ → post operative atelectasis & hypoxia.
  36. 36. Neuromuscular: • Adequate M.R for intubation of a child. • potentiate the non depolarizing (NMBA) action. • Malignant hyperthermia triggering.
  37. 37. Renal: RBF ↓, GFR↓ , UOP↓.
  38. 38. Liver: • HBF↓↓. • Halothane hepatitis: Extremely rare (1 : 35000). Multiple exposure at short interval. Middle age obese females. Family history. Personal history. Avoidance??
  39. 39. Uterus: Uterine relaxation. Others: Postoperative shivering is common.
  40. 40. Contraindications: • History of unexplained liver dysfunction, jaundice following prior administration. • Risk of triggering malignant hyperthermia. • With caution in neurosurgical procedure d.t ↑ ICP or ↑ CBF. • Hypovolemic patient or sever left ventricular failure. • With exogenous epinephrine or with pheochrom- ocytoma.
  41. 41. Drug Interaction: • Myocardial depression ↑↑ with B-blockers & Ca++ blockers. • Tricyclic antidep. & MAOI → ↑↓ (fluctuation) B.P & arrhythmias. • Halothane + aminophylline → serious ventricular arrhythmias.
  42. 42. Metabolism and elimination: • 60 -80 % unchanged via lungs. • 20% metabolized in liver (metabolites excreted in urine for several weeks).

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