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Intravenous
Anesthetics
Regimen for balanced anesthesia
(Luellmann Color Atlas of Pharmacology 3rd ed, 2005)
Facilitate smooth induction of anesthesia and lower
required anesthetic doses
H2 blockers
Benzodiazepines
Nonopioids or opioids
Antihistamines
Antiemetics
Anticholinergics
Nonflammable, nonexplosive, and volatile
agents
Primarily for maintenance
Depth of anesthesia depend on
concentration of anesthetic in the CNS
The principal objective of inhalation
anesthesia is a constant and optimal brain
partial pressure (Pbr) of inhaled anesthetic
(partial pressure equilibrium between
alveoli [Palv] and brain [Pbr])
Concentration of anesthetic in the brain is
reached depends on:
Solubility properties of the anesthetic
Concentration in the inspired air
Pulmonary ventilation rate
Pulmonary blood flow
Partial pressure gradient of the
anesthetic between arterial and mixed
venous blood
Why induction of anesthesia is slower with more soluble anesthetic gases
(Katzung Basic & Clinical Pharmacology 9th ed)
Properties of Inhaled Anesthetics
(Katzung Basic & Clinical Pharmacology 9th ed)
Ventilation rate and arterial anesthetic tensions. Increased ventilation (8 versus 2
L/min) has a much greater effect on equilibration of halothane than nitrous
oxide (Katzung Basic & Clinical Pharmacology 9th ed)
The minimal alveolar concentration
(MAC) at which 50% of patients remain
immobile following a defined painful
stimulus (skin incision)
MAC is small for potent anesthetics such
as sevoflurane and large for less potent
agents such as nitrous oxide
Inhaled anesthetics that are relatively
insoluble are eliminated at faster rates
than more soluble anesthetics
The duration of exposure to the
anesthetic can also have a marked
effect on the time of recovery
Clearance of inhaled anesthetics by the
lungs into the expired air is the major
route of their elimination from the body
Elimination routes of different volatile anesthetics
(Luellmann Color Atlas of Pharmacology 3rd ed, 2005)
Dexmedetomidine
IV sedative/hypnotic used for induction
and/or maintenance of anesthesia
Widely used and has replaced thiopental
as the first choice for induction of general
anesthesia and sedation
PKs distribution half-life is 28 minutes; the
elimination half-life is approximately 3060
minutes, rapidly met in the liver, excr in the
urine as glucuronide and sulfate conjugates
Induction is smooth and occurs 30-40 s
after adm, rapid equilibration between
the plasma and brain, plasma levels
decline rapidly as a result of redistribution
CNS, BP without myocardium
Does not provide analgesia
The incidence of postoperative nausea
and vomiting is very low
Characteristics of Some Intravenous Anesthetics
PKs AEs