INHALATION

AGENT
INTRODUCTION
Inhalation agents are substances that are
brought into the body via the lungs and are
distributed with the blood into the different
tissues

Requires conversion from liquid phase to

vapor phase by vaporizer

The main target of inhalation : the brain

A combination on inhalation anesthetics +

intravenous drug is called = balanced
HISTORY
Last century : Chloroform, ether,
Nitrous Oxide , Ethyl Chloride
1930 – 1940’s : Ethylene,
Cyclopropane, Trichloroethylene,
Isopropenyl Vinyl ether

1956 : Halothane

1960’s : Methoxyflurane (pull

from the market = nephrotoxic
potential)

1970’s : Enflurane, Isoflurane

1990 : Sevoflurane

1992 : Desflurane
HOW IT IS DELIVERED TO
PATIENT
Pipeline/ tank 02, o2/N2o, or O2/air

- Flowmeter (o2, N2o, air : L/mmin)

- Vaporizer (dialled %)
- Breathing circuit
- Airway (ETT / LMA)
- Lungs (trachea > Bronchioles > alveoli)
- Pulmonary veins
- L Atrium, L Ventricle, Aorta
- Brain, Other Organs
HOW DOES IT ACT ON THE
BRAIN TO CAUSE SLEEP
MULTIPLE THEORIES

- Action on cell membrane :

- inhibition of ligand gated channels
- NMDA receptor blockade
- GABA receptor potentiated
- Voltage gated Na, Ca, P channels effect
- Axonal transmission depressed
- Synaptic transmission altered

= Final effect suppression of the brain activity

MECHANISM OF ACTION
Theories suggest that they work by altering
the lipids in cell membranes since the
potency of anesthetics correlates extremely
closely with the solubility of the drug in oil.
CURRENTLY USED INHALED
ANESTHETICS
Halothane
Isoflurane
Enflurane
Desflurane
Sevoflurane
Nitrous Oxide
HALOTHANE
HALOTHANE
Colorless, pleasant smell liquid
Non flammable halogenated alkene
Vapor pressure of 244mmHg at 20 degree
Celsius and boils at 50.2 degree Celsius
Is susceptible to decomposition = stored in
amber-colored bottles + thymol is added as
preservative
Not recommended for obstetric anesthesia
except uterine relaxation is required. It crosses
placenta barrier = fetal depression =resulting
hypotension, hypoxemia and acidosis
Excellent hypnotic but no analgesic properties
Advantage :

- Rapid, smooth induction

- Minimal stimulation of salivary and bronchial
secretions
- Bronchodilatation
- Muscle relaxation
- Relatively rapid recovery
Disadvantage :

- Relatively slower induction compared to

isoflurane and sevoflurane
- Myocardial depression
- Bradycardia
- Arrhythmias
- Uterine relaxation
- Post- operative shivering
- Liver toxicity
ISOFLURANE
ISOFLURANE
Nonflammable halogenated
Vapor pressure of 239mm Mercury at 20 degree
Celsius and boils at 48.5 degree Celsius
Colorless liquid, pungent odor, stable in liquid
Does not react with metal or other substances

Advantage :
- Rapid induction and recovery
- Little risk of liver and renal toxicity
- Cardiovascular stability
- Muscle relaxation
Disadvantage :

- Expensive
- Pungent odor, makes inhalation induction
unpleasant
- Causes coronary vasodilatation and may
aggravate coronary ischemia
ENFLURANE
ENFLURANE
Nonflammable, clear and colorless liquid
Pleasant ethereal smell
Stable in soda lime and metal
Vapor pressure of 172 mm Mercury at 20
degree Celsius and boils at 56.5 degree Celsius
Advantage :

- Rapid induction and recovery

- Little risk of liver toxicity
- Muscle relaxation
- Low incidence of arrhythmias

Disadvantage :

- Expensive
- Seizure activity on EEG
DESFLURANE
DESFLURANE
Nonflammable
Vapor pressure of 673mm Mercury at 20
degree Celsius and boils at 23.5 degree Celsius
Requires the use of electrically heated
vaporizers
Little effect on cardio-respiratory system
Pungent and may cause airway irritation
manifested by salivation, coughing and
laryngospasm
Might as well increase heart rate - not to be
used in patients with aortic valve stenosis
SEVOFLURANE
SEVOFLURANE
Nonflammable, clear, colorless liquid
Pleasant ethereal smell
Stable in soda lime and metal
Vapor pressure of 39000mm Mercury at 20
degree Celsius and boils at minus 88 degree
Celsius

Advantage :

- Rapid induction and recovery

- Little risk of liver and renal toxicity
- Muscle relaxation
- Low incidence of arrhythmias
Disadvantage :

- Expensive
- Seizure activity on EEG
Nitrous Oxide
Nitrous Oxide
INTRODUCTION
Nitrous oxide, is a chemical compound with
chemical formula N20
Nitrous Oxide
Is an organic nonflammable gas that support
combustion
Also known as laughing gas
Vapor pressure 0f 39 000 mm Mercury at 20
Degree Celsius and boils at minus 88 degree
Celsius
Colourless, sweet smelling, non-irritating
A gas at room temperature and ambient
pressure
Inexpensive
A week analgesic but good analgesic agent
Entonox is preparation of 50% nitrous in
oxygen = produce good analgesic effects

Side effect :
- Myocardial depression
- Effect on closed gas spaces; causes increase in
pressure in middle ear, bowel lumen, pleural,
pericardial cavities
- Prolonged exposure of more than 8 hours affect
vitamin B12 synthesis and may result in
megaloblastic anemia
- Teratogenic changes, should be avoided in
early pregnancy
MINIMUM ALVEOLAR
CONCENTARTION
(MAC)
The measure of potency is the minimum alveolar
concentration (MAC).

DEFINITION ?

MAC is the concentration of anesthetic that causes

immobility in 50% of subjects exposed to the agent at
one atmosphere.
The lower the MAC the more potent the general anesthetic agent
 10
0 N2

concentration)
concentration
(percent of
Alveolar
Isoflur

inspired
ane
5 Enflur Inducti
0 ane
Haloth
ane
0
2 4
Minut
0 0
10 es
0
Percent of initial
concentration
Alveolar

Haloth
ane
5
0
Enflur Recov
ane
Isoflur
ane
N 2
0

Rate of induction and rate of recovery from anesthesia

Rate Of Induction & Rate Of
Recovery
1. The more soluble the agent is in blood, the more
drug it takes to saturate the blood and
the more time it takes to raise the partial
pressure and the depth of anesthesia.

2. The less soluble the agent is in blood, the less drug

it takes to saturate the blood and the less time it
takes to raise the partial pressure and depth of
anesthesia.
OXYGEN
INTRODUCTION
Oxygen must be present in every breathing
gas. This is because it is essential to the
human body’s metabolic process, which
sustains life.

If the body is deprived of oxygen for more

than a few minutes, unconsciousness and
death result.
OXYGEN
At standard temperature and pressure, oxygen
is a colorless, odorless and tasteless gas
With the molecular formula O2, n which the
two oxygen atoms are chemically bonded to
each other with spin triplet electron
configuration
Has poor solubility in water. Specific gravity of
1.105 makes it slightly heavier than air.
When cooled to its boiling point of -297o F
(-183o C), oxygen becomes a transparent, pale
blue liquid that is slightly heavier than water.
OXYGEN
Piped O2 is supplied from a liquid O2 reserve,
where it’s stored under pressure (10-12 bar,
1200 Kpa) at approximately -180ºC in a
vacuum-insulated evaporator (VIE), effectively
a thermos flusk

O2, are delivered to the anaesthetic room

at a pressure of 400 kilopascal (Kpa) (4 bar,
60 pounds per square inch (psiJ) )
 OXYGEN
The gas reach the anesthetic
machine via flexible reinforced
hoses, color coded throughout
the length

These attached to the wall

outlet via a specific probe to
the anesthetic machine via a
specific nut and union.
 OXYGEN
A smaller cylinder is
attached directly to the o
anesthetic machine as an
emergency
2

The pressure in a full

cylinder is 12000 Kpaand
this falls in direct proportion
to the cylinder content.
TUBING COLOR CODES
BRITISH AMERICAN
STANDARD STANDARD

OXYGEN

NITROU
S
OXIDE