Anesthesia

Nitrous Oxide

Your Ad Here Nitrous Oxide Listen to Audio physical properties effects on organ system biotransformation and toxicity contraindications drug interactions Physical Properties -MAC value: 105 % -only inorganic gas used in the clincal practice of anesthesia -colorless and nearly odorless -nonexplosive, nonflammable (although may support combustion) -gas at room temperature -gas at ambient pressure -critical temperature is above room temperature therefore can be kept liquid while under pressure -relatively inexpensive anesthetic agent Effects on organ systems Central Nervous System -increases CMR02 -increases CBF -increases ICP (mild) Cardiovascular System -in vivo: direct myocardial contractility depressant -in vitro: stimulates sympathetic nervous system therefore increases cardiac function -overall: minimal or slight change in cardiac function due to the two opposing forces explained above patients with CAD or severe hypovolemia: -may have unmasked myocardial depression -resultant drop in arterial blood pressure may lead to myocardial ischemia and further compromise on a already failing heart patients with preexisting pulmonary HTN or Right sided CHF: -should avoid nitrous oxide due to increased pulmonary vascular resistance via vasoconstriction of pulmonary artery Respiratory System -increases respiratory rate -decreases tidal volume -minimal change on minute ventilation -minimal change on resting PaC02 levels -hypoxic drive depressed by even low concentrations of nitrous oxide Hepatic System -decreases hepatic blood flow but to a lesser extent than volatile anesthetics Renal System -decreases renal blood flow secondary to increased renal vascular resistance -decreased GFR and therefore decreased urinary output Gastrointestinal System -may cause postoperative nausea and vomitting -may stimulate the chemoreceptor trigger zone (CTZ) and vomitting center in medulla Biotransformation and toxicity -biotransformation limited < 0.01 % which undergoes reductive metabolism within the GI anaerobic metabolism -nearly all the nitrous oxide is eliminated through exhalation during the emergence of anesthesia -toxicity may occur by irreversibly oxidizing the cobalt atom of vitamin B12 -therefore nitrous oxide inhibits enzymes which are vitamin B12 dependant (ex. methionine synthetase, thymidylate synthetase) methionine synthetase: involved in myelin formation thymidylate synthetase: involved in DNA synthesis -prolonged exposure of nitrous oxide may lead to bone marrow suppresion and neurological deficiencies bone marrow suppresion: megaloblastic anemia neurologic deficiencies: peripheral neuropathies, pernicious anemia -possible teratogenic effects: therefore avoid in pregnant women contraindications -nitrous oxide tends to diffuse into air-containing cavaties more rapidly than nitrogen absorbed into the blood stream therefore has an expanding capacity in air-containing cavaties such as: -air embolism -pneumothorax -acute intestinal obstruction -intracranial air -pulmonary air cysts -intraocular air bubbles -tempanic membrane grafting Drug Interactions -prolongs muscle relaxation from nondepolarzing muscle relaxants (NDMR) -attenuates the circulatory and respiratory effects caused by volatile anesthetics

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