Anesthesia, gases used

In contrast to the barbiturates, benzodiazepines do not produce an anesthetized state. They may be used as a preanesthetic in order to lessen anxiety, to be followed by a barbiturate and then the general anesthesia gas such as halothane. 

SAFETY PROFILE A deadly human poison by skin contact and inhalation. (A small drop on the skin can kill a man.) A deadly experimental poison by ingestion, inhalation, skin contact, subcutaneous, intravenous, intramuscular, and intraperitoneal routes. Human systemic effects muscle weakness, bronchiolar constriction, nausea or vomiting, flaccid paralysis without anesthesia, miosis (pupOlar constriction), cholinesterase inhibition. A nerve gas used as a chemical warfare agent. To fight fire, use foam, CO2, drj chemical. When heated to decomposition or reacted with steam, it emits very toxic fumes of F and PO.. See also PARATHION. 

Patients with moderate to severe pulmonary disease requiring vascular access surgery will benefit most from a LRA technique. General anesthesia (GA) with intermittent positive pressure ventilation (IPPV) and use of muscle relaxants impairs respiration more than LRA with maintained spontaneous breathing. IPPV may cause dynamic overinflation or barotrauma to lungs, promote atelectasis and impair mucociliary clearance [7]. This may be associated with increased pulmonary morbidity, prolonged hospital stay, resource utilization and cost. 

The narcotic potency and solubiUty in oHve oil of several metabohcaHy inert gases are Hsted in Table 10. The narcotic potency, ED q, is expressed as the partial pressure of the gas in breathing mixtures requited to produce a certain degree of anesthesia in 50% of the test animals. The solubiUties are expressed as Bunsen coefficients, the volume of atmospheric pressure gas dissolved by an equal volume of Hquid. The Hpid solubiHty of xenon is about the same as that of nitrous oxide, a commonly used light anesthetic, and its narcotic potency is also about the same. As an anesthetic, xenon has the virtues of reasonable potency, nonflammability, chemical inertness, and easy elimination by the body, but its scarcity and great cost preclude its wide use for this purpose (see Anesthetics). 

Historical Inhalation Agents. Diethyl ether produces excellent surgical anesthesia, but it is flammable (see Ethers). Chloroform is a nonflammable, sweet smelling, colorless Hquid which provides analgesia at nonanesthetic doses and can provide potent anesthesia at 1% (see Chlorocarbons AND CHLOROHYDROCARBONs). However, a metabohte causes hepatic cell necrosis. Tdlene, a nonflammable colorless Hquid, has a slower onset and recovery and a higher toxicity and chemical reactivity than desirable. Cyclopropane is a colorless gas which has rapid induction (2 —3 min) and recovery characteristics and analgesia is obtained in the range of 3—5% with adequate skeletal muscle relaxation (see Hydrocarbons). The use of cyclopropane has ceased, however, because of its flammabiHty and marked predisposition to cause arrhythmias. 

Nitrous Oxide. Nitrous oxide, described by Priesdy in 1772, was first used to reHeve severe dental pain in the latter part of the 18th century. Sometime in the mid-1800s N2O was successfully used as an anesthetic, and its widespread usage coincided with the development of anesthesia machines. Nitrous oxide is a nonflammable, colorless, odorless, and tasteless gas that can exist as a Hquid under pressure at room temperature. It is normally stored in cylinders. However, it supports combustion. 

Sevoflurane. Sevoflurane, l,l,l,3,3,3-hexafluoro-2-propyl fluromethyl ether [28523-86-6] is nonpungent, suggesting use in induction of anesthesia. The blood/gas partition coefficient is less than other marketed products (Table 1) yet similar to nitrous oxide, suggesting fast onset and recovery. In animal studies, recovery was faster for sevoflurane than for isoflurane, enflurane, or halothane (76). Sevoflurane is stable to light, oxygen, and metals (28). However, the agent does degrade in soda lime (77). 

Narcosis Narcosis is a state of deep stupor or unconsciousness, produced by a chemical substance, such as a drug or anesthesia. Inhalation of certain chemicals can lead to narcosis. For example, diethyl ether and chloroform, two common organic solvents, were among the first examples of anesthesia known. Many other chemicals that you would not suspect can also cause narcosis. For example, even though nitrogen gas comprises 80% of the air we breathe and is considered chemically inert (unreactive) it can cause narcosis under certain conditions. Always work with adequate inhalation and avoid inhaling chemical fumes, mists, dusts etc. whenever possible. Use fume hoods and respirators as necessary. 

An anesthetic gas, cyclopropane has a rapid onset of action and may be used for induction and maintenance of anesthesia Skeletal muscle relaxation is produced with full anesthetic doses. Cyclopropane is supplied in orange cylinders. Disadvantages of cyclopropane are difficulty in detecting the planes of anesthesia, occasional laryngospasm, cardiac arrhythmias, and postanesthesia nausea, vomiting, and headache Cyclopropane and oxygen mixtures are explosive, which limits the use of this gas anesthetic. 

Which of the following drug s is the most commonly used gas for general anesthesia ... 

Russia remains secretive about this operation. Reporters learned that they drilled holes in the floor and used vents high on the wall to pump gas into the theater. Regrettably, however, they were unable to learn the precise nature of the gas, beyond the admission by a Russian scientist that it was a derivative of Fentanyl. Several highly potent drugs fit that definition, including carfentanil, sufentanil, alfentanil, remifentanil and etorphine. Any of these can produce anesthesia, lasting from minutes to hours. A Russian medical authority later added that they used 5x the effective dose in order to guarantee a rapid effect on the terrorists. It is not clear exactly what this means. 

A continuous flow gas anesthesia system is used to deliver isofiurane to the mice. The mice are placed in an induction chamber for initial anesthetization and then supplied the gas... 

Nitrous oxide is the only inhalation anesthetic that is a gas. It is chemically inert. Nitrous oxide has little effect on overall cardiovascular function. Disadvantages are that it has no muscle relaxing effect and that it cannot be used on its own because of high Minimal Alveolar Concentration values needed for adequate anesthesia. During recovery there is a risk for hypoxia and anesthesia should be slowly tapered off to prevent this event. 

The use of inhalational anesthetics is generally reserved for maintenance of anesthesia. The development of an anesthetic concentration in the brain occurs more slowly with inhalational anesthetics than with IV drugs. Once an anesthetic level has been achieved, however, it is easily adjusted by controlling the rate or concentration of gas delivery from the anesthesia machine. The rate of recovery from a lengthy procedure in which inhalational agents are used is reasonably rapid, since inhalational anesthetics are eliminated by the lungs and do not depend on a slow rate of metabolism for their tissue clearance. Thus, inhalational drugs meet the requirement for a relatively prompt return of the patient s psychomotor competence. 

Four highly fluorinated ethers with low boiling points are currently used in anesthesia enflurane, isoflurane, sevoflumne, and desflurane (Figure 8.89). Des-flurane and sevoflurane are now the most used (sevoflurane is especially used in pediatrics). They exhibit the lowest blood-gas partition coefficients, the lowest ratio of toxic metabolites, and the lowest solubilities in lipids. These features limit the retention and, consequently, the metabolism is delayed (Table 8.2). 

The newer volatile anesthetics, desflurane and sevoflurane, have physicochemical characteristics (ie, low blood gas partition coefficients) that are favorable to a more rapid onset and shorter duration of anesthetic actions compared with isoflurane and halothane. However, both of these newer agents also have certain limitations. The low volatility of desflurane necessitates the use of a specialized heated vaporizer, and the pungency of the drug leads to a high incidence of coughing and sympathomimetic side effects that make it less than ideally suited for induction of anesthesia. 

MAC values of the inhaled anesthetics are additive. For example, nitrous oxide (60-70%) can be used as a carrier gas producing 40% of a MAC, thereby decreasing the anesthetic requirement of both volatile and intravenous anesthetics. The addition of nitrous oxide (60% tension, 40% MAC) to 70% of a volatile agent s MAC would yield a total of 110% of a MAC, a value sufficient for surgical anesthesia in most patients. 

The concentration of an individual gas in a mixture of gases is proportionate to its partial pressure or tension. These terms are often used interchangeably in discussing the various transfer processes of anesthetic gases in the body. Achievement of a brain concentration of an inhaled anesthetic adequate to cause anesthesia requires transfer of that anesthetic from the alveolar air to blood and then to brain. The rate at which a given concentration of anesthetic in the brain is reached depends on the solubility properties of the anesthetic, its concentration in the inspired air, pulmonary ventilation rate, pulmonary blood flow, and the partial pressure gradient of the anesthetic between arterial and mixed venous blood. 

In the case of the newest agent, sevoflurane, induction of anesthesia is achieved rapidly and smoothly, and recovery is more rapid than most other inhaled anesthetics including isoflurane. However, sevoflurane is chemically unstable when exposed to carbon dioxide absorbents, degrading to an olefinic compound (fluoromethyl-2,2-difluoro-l-[trifluoromethyl]vinyl ether, compound A) that is potentially nephrotoxic. In addition, sevoflurane is metabolized by the liver to release fluoride ions, raising concerns about possible renal damage similar to that caused by methoxyflurane. Sevoflurane comes close to having the characteristics of an ideal gas anesthetic, but a relatively insoluble compound that has greater chemical stability could be a useful alternative in the future. 

Five reporter mice are anesthetized using a subcutaneous (s.c.) injection of 50 piL ketamine-xylazine solution or by gas anesthesia exposing mice for 2 min to isofluorane. They are then injected intraperitoneal (i.p.) with 80 mg/kg D-luciferin. 

Animals are anesthetized with s.c. injection of ketamine-xylazine solution or gas anesthesia using isofluorane. 

When using an anesthesia machine, such as V-10 Mobile Cart System described here, ensure all carrier gas lines are securely attached and all chambers, breathing circuits, and nose cones are firmly in place (see Note 3). 

Acetylene (Figure 13.1) is widely used as a chemical raw material and fuel for oxyacetylene torches. It was once the principal raw material for the manufacture of vinyl chloride (see reaction 13.2.4), but other synthetic routes are now used. Acetylene is a colorless gas with an odor resembling garlic. Though not notably toxic, it acts as an asphyxiant and narcotic and has been used for anesthesia. Exposure can cause headache, dizziness, and gastric disturbances. Some adverse effects from exposure to acetylene may be due to the presence of impurities in the commercial product. 

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