ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

INHALATION ANESTHETICS

Evren Selma Evirgen

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Evirgen ES. Respiratory Phisiology. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.101-111.

ABSTRACT

  • Inhalational anesthetics are applied as a gas mixture component in order to reach sufficient anesthetic concentration in the central nervous system. After the lungs where absorption occurs, it requires the achievement of the agent-specific partial pressure in the target tissues, the brain and spinal cord.
  • After Meyer-Overton’s lipid theory, the prevailing view today is that they act via protein receptors. They increase inhibitory postsynaptic activity and inhibit excitatory synaptic activity. They increase GABAA and glycine receptor function, while N2O and Xenon in the gaseous state act by inhibiting N-methyl-D-Aspartate (NMDA) channels.
  • The most important factor in determining the rate of induction and recovery from anesthetic is the blood/gas partition coefficient. A high coefficient means that too much of the anesthetic is dissolved in the blood, and it will take a long time for the target tissue concentration to approach the alveolar concentration.
  • Pharmacokinetic effects may vary with the solubility of the anesthetic agent, cardiac output, respiratory frequencies, tissue perfusion and age.
  • All agents are cerebroprotective and cardioprotective. Anesthetic preconditioning is protective for myocardial and cerebral ischemia.
  • Their use has been discontinued after immune-based hepatitis in halothane applications and nephrotoxicity in methoxyflurane applications.
  • Compound A may occur in the interaction of sevoflurane with CO2 absorbant. Bone marrow depression and DNA damage have been observed with N2O. All except N2O and Xenon can cause malignant hyperthermia.
  • In addition to their immunosuppressive effects, concerns about neurotoxicity in developing brains require long-term studies.
  • Inhalational agents are potent greenhouse gases. Alternative anesthetic methods, effective ventilation and cleaning systems, and low fresh gas flow applications can reduce atmospheric emissions.

Keywords: Nitrous oxide; Desflurane; Sevoflurane; Isoflurane; Halothane; Environment; Climate change

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