Enflurane |

Enflurane

Sun, 11/04/2007 - 12:11 — oxygen

Enflurane Listen to Audio physical properties effects on organ system biotransformation and toxicity contraindications drug interactions physical properties -MAC value: 1.7 % -vapor pressure: 175 mmHg at 20 degrees celcius -halogenated ether -mild, sweet odor -nonflammable at clinical concentrations Effects on organ systems Central Nervous System -decreased CMR02 (unless seizure activity is induced) -increased CBF -increased ICP -increased CSF secretion and increased resistance to CSF outflow -association with tonic clonic seizure activity followed by high voltage high frequency EEG patterns -high concentrations of enflurane in the setting of hypocapnia may exacerbate epileptiform activity Cardiovascular System -enflurane decreases both myocardial contractility and systemic vascular resistance -lowered mean arterial pressure -lowered cardiac output -lowered myocardial oxygen consumption -increase in heart rate due to decreased arterial pressure -sensitizes myocardium to epinephrine induced dysrhythmias usually at a dose > 4.5 ug/kg Respiratory System -increases respiratory rate -decreases tidal volume -resultant decrease in alveolar ventilation -increased resting PaC02 -decreased response to an elevated PaC02 -decreased/abolished hypoxic drive -bronchodilation -depressed mucociliary function Hepatic System -decreases hepatic blood flow Renal System -decreases renal blood flow -decreases GFR -decreases urinary output -enflurane metabolites are nephrotoxic (discussed more in biotransformation and toxicity) Neuromuscular System -relaxes skeletal muscles -prolongs duration of nondepolarizing muscle relaxants (NDMR) biotransformation and toxicity -flouride ions are the metabolite of enflurane -flouride ions concentrations are far less than metabolism of methoxyflurane -renal dysfunction with the use and metabolism of enflurane is unlikely -nearly after 10 MAC-hours of enflurane, flouride ion concentrations were less than 40 umol/L in healthy patients -flouride ion concentrations may lead to mild reduction concentrating abilities of the renal tubules in values of 40 umol/L contraindications -may best be avoided in patients with pre-existing renal disease -may best be avoided in patients with history of seizure disorders -may best be avoided in patients with history of increased ICP or decreased intracranial compliance drug interactions -isoniazid induces deflourination of enflurane possibly from stimulating the cytochrome P450 2EI -prolongs duration of nondepolarizing muscle relaxants (NDMR)

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