MindMap Gallery anaesthetization
Pharmacological effects and clinical applications of sevoflurane, desflurane, and isoflurane.
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inhalation anesthetic
Desflurane
Physical and chemical properties
It has a pungent odor and is very stable chemically, surpassing isoflurane.
Very low toxicity to liver and kidneys
The blood/gas distribution coefficient is 0.42, which is the lowest among existing inhalation anesthetics, and its induction and awakening effects are very rapid; Excitation is common during induction and can more effectively suppress laryngoscope-induced tachycardia and blood pressure increase during induction.
Pharmacological effects
Large doses cause dilation of cerebral blood vessels, increased cerebral blood flow, increased intracranial pressure, and decreased cerebral oxygen consumption.
It has a stronger neuromuscular blocking effect than other fluoride-containing anesthetics and can produce satisfactory muscle relaxation during anesthesia.
It inhibits circulatory function in a dose-dependent manner and can reduce myocardial contractility, cardiac output, peripheral vascular resistance and blood pressure to a lesser extent than halothane, and has less impact on cardiovascular function.
Dose-dependent inhibition of respiration, lowering minute ventilation, increasing PaCO2 and enhancing the body's ventilatory response to increased PaCO2
Clinical application
Anesthesia induction, anesthesia maintenance, used in various general anesthesia situations, suitable for outpatient clinics and other minor surgeries
Adverse reactions
It reacts with the CO2 absorbent to produce CO. The order of the amount of CO produced at the same MAC is desflurane, enflurane, and isoflurane. Sevoflurane and halothane do not produce CO
Respiratory irritation, enhanced sympathetic activity, temporary increase in blood pressure, accelerated heart rate, and arrhythmia
Sevoflurane
Physical and chemical properties
Colorless and transparent liquid, no odor
The chemical properties are not stable enough, soda lime can be absorbed and decomposed
Non-irritating to respiratory tract
MAC 1.85, high general anesthesia efficiency; low blood/gas distribution coefficient, 1.69, induction and recovery are very fast and the process is smooth
Pharmacological effects
During anesthesia, the EEG shows high-amplitude slow waves and sometimes spike wave groups.
Increases cerebral blood flow, increases intracranial pressure, and reduces cerebral oxygen consumption. It is similar to isoflurane and weaker than halothane.
Muscle relaxant, enhances and prolongs the effects of non-depolarizing muscle relaxants
It has a dose-dependent inhibitory effect on the circulatory system, lowers blood pressure, and usually has no significant change in heart rate.
Does not increase myocardial sensitivity to catecholamines and can be used in pheochromocytoma surgery and combined with epinephrine
Dilate coronary blood vessels and reduce coronary artery resistance
Relaxes bronchial smooth muscle; inhibits bronchoconstriction caused by acetylcholine and histamine, and can be used for asthma patients
Inhibits the body's ventilatory response to hypoxia and increased PaCO2, and has a weaker inhibitory effect on hypoxic pulmonary vasoconstriction than halothane
Clinical application
Suitable for major and minor surgeries of all ages and parts
Suitable for pediatric and outpatient surgery
Use with caution: Those who develop unexplained jaundice and fever after using halogenated anesthetics; patients and their family members who have a history of allergies to halogenated anesthetics or a history of malignant hyperthermia; those who suffer from liver, gallbladder, and kidney diseases.
Adverse reactions
Nausea, vomiting, cardiac arrhythmia, hypotension
Isoflurane
Physical and chemical properties
Pungent smell, stable chemical properties
The blood/gas distribution coefficient is low, 1.41
There is very little biological transformation in the body, and almost all of it is exhaled from the lungs in its original form.
No reductive metabolism occurs, so no free radicals are produced
Pharmacological effects
The general anesthesia potency is high, 1.15%, between halothane and enflurane; It does not cause convulsive brain electrical activity and limb twitching like enflurane, and can be used for patients with epilepsy
Inhibits breathing, increases PaCO2, causes cerebral vasodilation, increases cerebral blood flow, and increases intracranial pressure, to a lesser degree than halothane and enflurane
Has a certain analgesic effect
Enhances the nerve-blocking effect of non-depolarizing muscle relaxants; like enflurane, indicated in patients with myasthenia gravis
When the patient has liver and kidney dysfunction and the muscle relaxant is slowly eliminated, isoflurane can be used, with less or no muscle relaxant.
Inhibits circulatory function, weaker than halothane and enflurane; Much less myocardial depression than halothane and enflurane
The stroke volume is reduced, but the heart rate is accelerated, and the cardiac output is not significantly reduced; Lowered blood pressure, mainly due to peripheral vascular resistance
Does not slow down His-Purpur fiber conduction, does not induce arrhythmias, and does not increase myocardial sensitivity to catecholamines; Adrenaline can be used in anesthesia fashion
Dilates contracted bronchi, which is beneficial for the management of COPD and bronchial asthma
No obvious damage to the liver and kidneys, lower toxicity than halothane, methoxyflurane, and enflurane
Reduces or does not change intraocular pressure in children and can reduce intraocular pressure in adults to a slightly weaker extent than enflurane
Does not raise blood sugar and can be used by diabetic patients
Clinical application
Maintenance of anesthesia, various surgeries; Epilepsy, increased intracranial pressure, myasthenia gravis, pheochromocytoma, diabetes, bronchial asthma
controlled blood pressure reduction
Adverse reactions
It is irritating to the respiratory tract and should not be used for anesthesia induction.