吸入麻醉药的临床药理学(英文)
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• Halogenation reduces flammability • Fluorination reduces solubility • Trifluorcarbon groups add stability • Alkanes precipitate arrythmias
Department of Anesthesiology Civic Campus
Clinical Pharmacology of Inhaled Anesthetics
Department of Anesthesiology University of Ottawa
Core Program Lecture Series September 2003
Department of Anesthesiology Civic Campus
Department of Anesthesiology Civic Campus
Objectives II
• Definition of MAC • Factors which affect MAC • Cardiovascular effects • Pulmonary effects • CNS effects • Neuromuscular effects • Hepatic effects • Renal effects • Uterine effects • Marrow effects
blood
Department of Anesthesiology Civic Campus
Blood:gas partition coefficients
• Measured at equilibrium so partial pressures are equal, but...
• The amounts of gas dissolved in each substance (concentration) aren’t equal.
• We most commonly refer to blood:gas pc • The larger the number, the more soluble in
Department of Anesthesiology Civic Campus
Chemical structure I
Nitrous Oxide
Diethyl Ether
Halothane
Department of Anesthesiology Civic Campus
Fun with chemistry
Department of Anesthesiology Civic Campus
The reality
• There’s an awful lot of stuff here - none of it is “new” • All of it is in the textbooks • Barash 4th Edition
Greg’s goals for this lecture
• Inflict my view of what you should know • Put this in a clinical (read: useful) context • Explain that which needs explaining • Leave the memory work to you • Be back on my porch, beer in hand, by 1730
• Chapter 15. Inhalation Anesthesia. 377-417.
• Miller 5th Edition
• Chapter 3. Mechanisms of Action. 48-73 • Chapter 4. Uptake and Distribution. 74-95 • Chapter 5a. Cardiovascular Pharmacology. 96-124 • Chapter 5b. Pulmonary Pharmacology. 125-146 • Chapter 6. Metabolism and Toxicity. 147-173
actually be useful
Department of Anesthesiology Civic Campus
Partition coefficients
• Represent the relative affinity of a gas for 2 different substances (solubility)
• desflurane boils at 24 OC • halothane is preserved with thymol • vapor pressures are needed for some exam
questions • knowledge of blood:gas partition coefficients may
• Much of it requires rote memorization • Some of it useful - all of it “test-able” • I can’t cover all of it in 3 hours
Department of Anesthesiology Civic Campus
Chemical structure II
Isoflurane
Deepartment of Anesthesiology Civic Campus
Physical characteristics
• Please cram the contents of the appropriate table 15.1 from Barash 4th Ed the night before the exam. Take home points include:
Department of Anesthesiology Civic Campus
Clinical Pharmacology of Inhaled Anesthetics
Department of Anesthesiology University of Ottawa
Core Program Lecture Series September 2003
Department of Anesthesiology Civic Campus
Department of Anesthesiology Civic Campus
Objectives II
• Definition of MAC • Factors which affect MAC • Cardiovascular effects • Pulmonary effects • CNS effects • Neuromuscular effects • Hepatic effects • Renal effects • Uterine effects • Marrow effects
blood
Department of Anesthesiology Civic Campus
Blood:gas partition coefficients
• Measured at equilibrium so partial pressures are equal, but...
• The amounts of gas dissolved in each substance (concentration) aren’t equal.
• We most commonly refer to blood:gas pc • The larger the number, the more soluble in
Department of Anesthesiology Civic Campus
Chemical structure I
Nitrous Oxide
Diethyl Ether
Halothane
Department of Anesthesiology Civic Campus
Fun with chemistry
Department of Anesthesiology Civic Campus
The reality
• There’s an awful lot of stuff here - none of it is “new” • All of it is in the textbooks • Barash 4th Edition
Greg’s goals for this lecture
• Inflict my view of what you should know • Put this in a clinical (read: useful) context • Explain that which needs explaining • Leave the memory work to you • Be back on my porch, beer in hand, by 1730
• Chapter 15. Inhalation Anesthesia. 377-417.
• Miller 5th Edition
• Chapter 3. Mechanisms of Action. 48-73 • Chapter 4. Uptake and Distribution. 74-95 • Chapter 5a. Cardiovascular Pharmacology. 96-124 • Chapter 5b. Pulmonary Pharmacology. 125-146 • Chapter 6. Metabolism and Toxicity. 147-173
actually be useful
Department of Anesthesiology Civic Campus
Partition coefficients
• Represent the relative affinity of a gas for 2 different substances (solubility)
• desflurane boils at 24 OC • halothane is preserved with thymol • vapor pressures are needed for some exam
questions • knowledge of blood:gas partition coefficients may
• Much of it requires rote memorization • Some of it useful - all of it “test-able” • I can’t cover all of it in 3 hours
Department of Anesthesiology Civic Campus
Chemical structure II
Isoflurane
Deepartment of Anesthesiology Civic Campus
Physical characteristics
• Please cram the contents of the appropriate table 15.1 from Barash 4th Ed the night before the exam. Take home points include: