Isoflurane |

Isoflurane

Sun, 11/04/2007 - 12:54 — oxygen

Isoflurane Listen to Audio Physical Properties Effects on organ system Biotransformation and toxicity Contraindications Drug Interactions Physical properties -MAC value: 1.2 % -vapor pressure: 240mmHg at 20 degrees celcius -pungent odor -nonflammable -chemical isomer of enflurane Effects on organ systems Central Nervous System -decreases CMR02 (at 2MAC produces electrically silent EEG which may provide come cerebral protection against ischemia) -increases CBF -increases ICP (increased ICP may be reversed with hyperventilation) Cardiovascular System -in vivo: mild cardiac depressant -decreased systemic vascular resistance -resultant decrease in mean arterial blood pressure -decreased arterial blood pressure stimulated the preserved carotid baroreceptor which increases heart rate -decreased arterial pressure and increased heart rate generally leads to a maintained cardiac output -rapid increase in concentration may transiently increase heart rate, arterial pressure and norepinephrine levels -coronary artery vasodilation (less than nitroglycerin effects) -coronary steal phenomena possibilities Coronary steal phenomena: -coronary arteries that have atherosclerotic plaque lesions generally are unable to further vasodilate -therefore intense coronary artery vasodilation from normal vessels may divert blood from fixed stenotic (maximally dilated) vessels -would lead to decreased coronary blood flow to already ischemia stenotic vessels and increased blood flow to normal vessels Respiratory System -increased respiratory rate (tachypnea less pronounced with isoflurane compared to other volatile anesthetics) -decreased tidal volume -resultant decreased alveolar ventilation (more pronounced fall in minute ventilation due to less increased respiratory rate) -blunted response to elevating levels of PaC02 or hypoxia -good bronchodilator Hepatic System -reduces hepatic blood flow -possibly better oxygen supply to liver with isoflurane in comparison with halothane and enflurane -minimal effect on liver function tests Renal System -decreases renal blood flow -decreases GFR -decreases urinary output Neuromuscular System -relaxes skeletal muscles biotransformation and toxicity -isoflurane is metabolized in the liver to end products of trifluoracetic acid -flouride ions rise but extremely unlikely to cause nephrotoxicity even in combination with enyzme inducers -upto 20 MAC-hours of isoflurane may lead to flouride ion concentration greater than 50 umol/L without detectable renal dysfunction -isoflurane has limited metabolism which reduces the possible risk of significant hepatic dysfunction contraindications -no major contraindications -controvery regarding coronary steal phenomena drug interactions -epinephrine may be safely administered upto 4.5 ug/kg -prolonged duration of action of nondepolarizing muscle relaxants (NDMR)

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