Dr.M.

Prakash Kumar

Department of Anesthesiology

Govt Karur Medical College & Hospital

General Anesthetics
 Objectives

Define anesthesia, balanced anesthesia, and pre-

anesthetic medications.

Be able to define MAC, potency, blood: gas partition

coefficient and oil: gas partition coefficient.

Distinguish between inhalation and intravenous

anesthetics.

Identify the pharmacokinetics, pharmacological actions,

and side effects of inhalation anesthetics.

Identify the pharmacokinetics, pharmacodynamics, and

side effects of intravenous anesthetics.

Know the difference between neuroleptanalgesia and

neuroleptanesthesia.
.
 overview:
General Anesthesia

Inhalation
Intravenou
al
s
Can be used for
induction
Ga
Volatile
s
liquids

Nitrous Faster
Methoxyflu Slower
r- ane
oxide inducin
Halothane
zenon acting g
Enflurane agents
Isoflurane
Desflurane
Sevofluran
e Ether Dissociati Opioid Benzodiazepines
ve analgesi
anesthesi a
a

Diazepa
Ketamine Fentan m
yl Lorazepa
m
Are Midazola
halogenated m
hydrocarbon Propofol
s Etomidat
e
Barbiturate
Droperid
Ultra short ol
Mnemonic: acting
The benzodiazepines family is
small, happy, and hyperactive.
They have 3 kids: Clara, Lora, and Thiopental
Dia. methohexital
Used as antidepressant bc
they’re happy. But also bc
they’re hyperactive they may
fall, forget things, and run out of
breath (respiratory effect)
2
 Introduction:
General Anesthetics: Drugs used to induce loss of pain
sensation, loss of consciousness, skeletal muscle relaxation,
analgesia, amnesia and inhibitions of undesirable autonomic
reflexes.

types of
anesthesia

General Local
anesthesia anesthesia

stages of anesthesia

Stage I Stage IV
Stage II Stage III
(analgesi (coma
(Excitemen (Surgical
a) and
t) anesthesia)
death)

-
Increase divided into 4
d planes:
respirator - Regular 1. Cortical centers
y rate. respiration 2. Basal ganglia
-Loss of pain -Increased, & 3. Spinal cord
sensation irregular relaxation
-The patient 4. Medulla
blood of Sk.
is conscious pressure. muscles.
and -Patient - Eye
conversation may reflexes
al experience decrease
. delirium & until the
violent pupil is
behavior. fixed.
-Eye dilated -the most
& reactive. desire stage.
-Hyperactivity +
irregularity of
most the
autonomic N.S
 -
Medullar
y
paralysis
.
-Severe
depress
ion of
vasomo
tor
-
Depres
sion of
respirat
ory
centers
.
- Death
may
occur.

3
 Introduction:

Characters of an ideal anesthetic drug

smooth & rapid induction

Rapid recovery Wide safety margin Minimal side effects

Ideal general anesthesia

Loss of pain Analgesi

sensation & Need for
muscle a
unconsciousness ‘Loss of sensory
‘Amnesia- relaxation
& autonomic
hypnosis’ reflexes’ Loss of
unwanted
autonomic
reflexes

Balanced Anesthesia

- Balanced anesthesia is achieved by a combination of I.V and

inhaled anesthesia , Pre-anaesthetic medications and also sk.
muscle relaxants .

- Thus it will increase the beneficial effects & decrease the adverse
effects
of general anesthetics which will fulfill the patient needs.
 Pre-Anesthetic Medications

★ Calm the patient & relieve pain.

★ Protect against undesirable effects of the subsequently
administered anesthetics or the surgical procedure.
★ Facilitate smooth induction of anaesthesia.
★ Lowered the dose of anaesthetic required.

Used to Example

Opiates Induce analgesia morphine

Prevent secretion
Anticholinergics of fluids into the hyoscine
respiratory tract
Protect the heart
against vagal
stimulation
(bradycardia)

Sedatives & Relieve anxiety diazepam

anxiolytics
Antihistamines Allergic reactions diphenhydrami
ne
Antiemetics metoclopramide
Post surgical N&V. &
prochlorperazin
e
H2-receptor Reduce gastric ranitidine
blockers acidity

Thiopental Smooth induction

succinylcholine,
Facilitate vecuronium &
Neuromuscular intubation & atracurium
blockers suppress skeletal
muscle tone.
 MOA of General Anaesthetics
MOA:
-Disruption of the function of ionic channels
-Disruption of lipids associated with ionic channels

Enhanced GABA A
Inhibitory glycine
*NB: General
anesthetics do
Recept

Enhance the action of GABA A and glycine receptorsNOT leading to

combine
greater entrance of chloride ion nAch hyperpolarization
with GABA
thus decrease neuronal
n= Nicotinic receptors (they
Excitatory just enhance
excitability.
Inhibited
-CNS depressant most NMDAor inhibit of their
of them act to stimulate exist
action)
neurotransmitter . N-methyl-D-aspartate

Inhalation anesthetics
The faster
induction : time elapsed between onset of the better
administration of anesthetics(drug) and development
of effective surgical anesthesia (stage no.3).

Maintenance : Time during which the patient is

surgically
anesthetized(keeping the patient stage 3).

Recovery: The time from discontinuation(stopping)of anesthetic

drug until consciousness is The faster
regained the better
 Inhalation anesthetics

Pharmacokinetics of Inhalation anesthetics:

- Rate of induction
- Depth of anesthesia and Recovery

Factors controlling induction & recovery :

1-The anesthetic concentration in the inspired airDirect

2- Blood solubility : Blood gas partition coefficient
Inverse relation (means it need more time to reach
CNS to produce an effect.)
3-Rate and depth of ventilation Direct

Drugs Solubilit Induction & Recovery

y
“Blood : gas partition coefficient”

methoxyflura 12 Slow
ne
halothane 2.3 Slow

Enflurane 1.8 Medium

Isoflurane 1.4 Medium

Sevoflurane 0.69 Rapid

Desflurane 0.42 Poor &

Rapid
Nitrious oxide 0.47 Rapid
7

Nitrous oxide has lowest

the solubility,the induction
fastest highest
and recovery, potent
 Minimum alveolar concentration
(MAC)
It is the concentration of inhalation anesthetic that
produce immobility (affect) in 50 % patients in
response to surgical incision.
● Potency of anesthetic agents.
● Oil: gas partition coefficient =lipid
solubility = (Direct with potency).
● The lower the MAC value the more potent the drug.
● Decreased by CNS depressants, old people.
● Increased by CNS stimulants.
● Potency is inversely proportional to MAC
value of anesthetic agents.

Drug MAC Induction & Potency

value recovery

Methoxyflura low MAC slow The most

ne value 0.16 induction & potent
recovery
Halothane 0.75 Slow Potent
(Pleasant
odor)
Enflurane 1.4 Medium Less potent
(Pungent
odor)
Isoflurane 1.7 Medium Less potent

Sevofluran 2 Rapid Less potent

e (Better
smell)
Desflurane 6-7 Rapid Less potent
(Pungent
odor)
Nitrous oxide >100 Rapid Least
potent
8
Pharmacological actions of inhalation a

System Pharmacological action

- ↓ metabolic rate.
- ↑ ICP (due to cerebral vasodilatation) #
Central nervous
in head injuries.
- Dose -dependent EEG changes (Enflurane). - -
Enflurane contraindicated in epilepsy

- Hypotension
- Bradycardia Except (Isoflurane
Cardiovascular
,Desflurane & Sevoflurane ).
- Myocardial depression (Halothane –
Enflurane).
-Sensitize heart to catecholamines (Halothane)
Halothane contraindicated in
pheochromochytoma

- All respiratory depressants

Respiratory
-Airway irritation (Desflurane-Enflurane due to
pungent odor).

- Decrease hepatic flow

Live
r - Hepatotoxicity (Only halothane) only in
adults

-Uterine relaxation BUT Nitrous oxide has

Uterus & skeletal minimal relaxant effect (labor)
muscle - All are skeletal muscle relaxants. (of variable
degrees)

9
Drug
Inhalation Anesthetics
Halothane Enfluran Isoflurane (Forane)
e
Potent Less potent than Potent, stable
Potenc

Halothane compound
(2%)
y
Recovery

Slow induction More rapid induction Rapid induction

Smell Induction

and recovery and recovery than and recovery

halothane
&

Pleasant odor used in Pungent Pungent

children

Metabolized to Metabolized to Low

Metaboli

toxic metabolites fluoride (8%), biotransformation

ation

(trifluoroethanol) excreted in the (Less fluoride)

z

hepatotoxic kidney (lead to

nephrotoxicity)
Potent anesthetic, Better muscle Potent
Uses

Weak analgesic, relaxation, Better anesthetic, Good

Weak skeletal analgesic properties analgesic action
muscle relaxant
- No nephrotoxicity
Profs. Notes on - No hepatotoxicity
Advantages

Halothane: 1- Slow
- No sensitization of
induction
--- the heart
2- Very potent
3- Hepatotoxicity in - No
adults 4- Arrhythmias cardiac
(sensitizes heart to arrhythmia
catecholamines) s
 - CVS depression: Pungent (Less Pungent (Not for
Hypotension, induction in comparison pediatrics)
bradycardia to other inhalation it’s
(vagomimetic action) slow Not for pediatrics)
↓Myocardial -CNS stimulation
contractility, (Epilepsy-like
ADRs / Disadvantages

↓Cardiac output seizure - abnormal

EEG)
- Hepatotoxicity
(repeated use). (only in
adults, not in children)
- Malignant
hyperthermia.
(can’t be predicted)
- Cardiac arrhythmias.
- Sensitizes heart to
action of
catecholamines
→arrhythmias.
- Pheochromocytoma -Patients with
seizure disorders --- 10
CI.

(epilepsy)
-Not for renal failures
Drug
Inhalation Anesthetics
Desflurane Sevoflurane Nitrous Oxide (N2O)
Metaboli Smel Induction & Potenc

Less potent than Less potent than the Lowest potency

Halothane Halothane
Recovery y

Rapid induction and Rapid onset and Rapid induction and

fast recovery (Low recovery (Low recovery (Low
solubility) solubility) solubility)

Pungent (worst odor) Better smell ---

l

Less metabolized Less metabolized (3-

(0.05%) Low boiling 5% fluoride) ---
z

point (special
equipment)
No airway Weak anesthetic
irritation (Low potency,
(preferable for combined) Potent
children) analgesic
---
Uses

- Outpatient
anesthesia (Dental
procedures).
- Balanced anesthesia.
- Neuroleptanalgesia
- Delivery.
Advantage

Little effect on HR No muscle relaxation,

No respiratory
--- depression Not
hepatotoxic, minimal
CVS adverse effects
s

Pungent odor - Diffusion Hypoxia:

(irritation - cough) (respiratory
diseases).
- Nausea and vomiting.
ADRs / Disadvantages

- Inactivation of B12
--- →megaloblastic anemia.
- Bone marrow
depression-
Leukopenia (chronic
use).
- Abortion -
Congenital
anomalies with
repeated exposure eg.
Nurses
 - Pregnancy(uterine
All of the inhalation anesthetic relaxant)
CI.

drugs are contraindicated in - Pernicious anemia.

- Immunosuppression. 11
head injury.

Opiate drugs

Neuroleptanalgesia :

( Opiate drugs)

● A state of analgesia, sedation and muscle relaxation

without loss of consciousness.
● used for diagnostic procedures that require
cooperation of the patient.
● Innovar (Fentanyl + Droperidol ). Blocks dopamine release
● Contraindicated in parkinsonism.

Neuroleptanesthesia :
Thank You!