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Volatile Anesthetics
Desflurane, Xenon
Mahmood Hasan Taha
HD/ Anesthesia
Zakho General H.
Aug/ 2022
Desflurane (Suprane) 1992
General Description:
• Very similar structure to that of Isoflurane.
(Substitution of a fluorine atom for Isoflurane's
chlorine atom).
• Vapor pressure at 20 ℃ = 681 mmHg at sea level.
• At high altitudes (e.g. Denver, Colorado 1.6 km) it
boils at room temperature.
• 1.4km? 565m ? 440m ?
• These features (high v.p & low boiling point)
necessitate using a special vaporizer.
• Low solubility in blood → very rapid induction
& emergence.
Tec6 plus® Datex Ohmeda
Desflurane vaporizer
with illustration of mechanism of action
• Wakeup time are approximately 5% less than
those observed following Isoflurane.
• The alveolar concentration approaches the
inspired concentration much more rapidly
than other volatile agents.
• Blood/Gas: 0.42
(Blood/Gas: 0.69 for Sevoflurane).
• ¼ as potent as the other volatile agents.
• 17 times more potent than N2O.
• MAC = 6
Effects on organ systems
Cardiovascular:
( similar to those of Isoflurane).
• ↓ SVR, ↓ B.P
• COP maintained or slightly depressed at 1 -2
MAC.
• HR ↑ moderately.
• CVP ↑ moderately.
• Rapid ↑ in Desflurane concentration →
transient or sometimes worrisome elevation
in HR, B.P & catecholamine level more than
that with Isoflurane. These events can be
attenuated by fentanyl, esmolol, clonidine.
Respiratory:
• ↓ Vt, ↑ RR
• ↑ in resting PaCO2
• Depresses the ventilatory response to ↑PaCO2 .
• Pungency & airway irritation during induction can
be manifested by salivation, breath holding,
coughing & laryngospasm.
• ↑ airway resistance may ↑ in children with
reactive airway susceptibility.
• These problems make Desflurane a poor choice
for inhalation induction.
Cerebral:
• ↑ CBF, ↑ CBV, ↑ICP
• ↓↓ CMRO2 → cerebral vasoconstriction.
• ↑ ICP can be ↓ by hyperventilation.
• EEG , like Isoflurane: 2 MAC → silent EEG.
Neuromuscular:
• Dose dependent reduction in the response to
train of four & tetanic peripheral nerve
stimulation.
Renal:
• Safe.
• ↓ RBF, ↓GFR, ↓ UOP.
• Inhalation of choice for chronic renal failure
like Isoflurane.
Hepatic:
• Nearly safe.
• Minimum metabolism.
• Hepatitis is minimum.
• Hepatic O2 delivery is generally maintained by
maintaining the hepatic blood flow unlike
halothane.
Contraindications:
• Sever hypovolemia.
• History of Malignant hyperthermia.
• I.C. hypertension.
Drug interaction:
• Non depolarizing NMBA effect is increased.
• Epinephrine safe up to 4.5 mcg/kg (similar to
Isoflurane).
• Delirium in some pediatric patients.
• Desflurane, much more than any other volatile
anesthetics, has been associated with the
production of CO.
• The strongly alkaline and desiccated CO2
absorbent: CO forming when the absorbent is
dry, regenerate the original anesthetic when
wet.
• The first case of the day, when machines have
not been used for some time, or when fresh
gas flow has been left on for a protracted
period of time, Monday morning ; So, the
absorbent should be changed routinely
despite lack of apparent color change.
• The CO2 absorbents CO production from
greatest to least:
KOH- containing absorbents are(Baralyme®)(4.6%) >
classic soda lime (2.6%) > new soda lime (0%) >
calcium hydroxide lime (AMSORB®) (0%).
AMSORB® SODASORB®
• Choice of volatile anesthetic also determine the
amount of CO produced, and at equi MAC
concentrations: Desflurane > Enflurane >
Isoflurane.
• Sevoflurane when exposed to dry absorbent
(especially KOH-containing), this leads to CO
production and a rapid increase in absorbent
temperature, that exceed 300°C and it can lead to
fires , generation of forming acid leading to sever
airway irritation, and a lower circuit concentration
of delivered Sevoflurane compared to that of
vaporizer dial concentration.
Xenon (Xe)
• Xenon is a "noble" gas that has long been
known to have anesthetic properties.
• Inert element that does not form chemical
bonds.
• Scavenged from the atmosphere through a
costly distillation process.
• Odorless, non explosive. Inert (probably
nontoxic with no metabolism).
• Naturally occurring gas with low potency
( MAC=70%).
• Blood/Gas = 0.115, giving it very fast onset
and emergence.
• Anesthetic effects seem to be mediated by
NMDA (N-methyl-D-aspartate) receptor
inhibition by competing with glycine at the
glycine binding site.
• Little effect on cardiovascular, hepatic, or
renal systems and has been found to be
protective against neuronal ischemia.
• Does not trigger malignant hyperthermia
• As a natural element, it has no effect upon the
ozone layer compared with another NMDA
antagonist, nitrous oxide.
• High cost and little availability have prevented
its widespread use.
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Inhalational Anesthetics; Desflurane and Zenon.pptx

  • 1. Volatile Anesthetics Desflurane, Xenon Mahmood Hasan Taha HD/ Anesthesia Zakho General H. Aug/ 2022
  • 3. General Description: • Very similar structure to that of Isoflurane. (Substitution of a fluorine atom for Isoflurane's chlorine atom). • Vapor pressure at 20 ℃ = 681 mmHg at sea level. • At high altitudes (e.g. Denver, Colorado 1.6 km) it boils at room temperature. • 1.4km? 565m ? 440m ?
  • 4. • These features (high v.p & low boiling point) necessitate using a special vaporizer. • Low solubility in blood → very rapid induction & emergence.
  • 5. Tec6 plus® Datex Ohmeda Desflurane vaporizer with illustration of mechanism of action
  • 6.
  • 7. • Wakeup time are approximately 5% less than those observed following Isoflurane. • The alveolar concentration approaches the inspired concentration much more rapidly than other volatile agents.
  • 8. • Blood/Gas: 0.42 (Blood/Gas: 0.69 for Sevoflurane). • ¼ as potent as the other volatile agents. • 17 times more potent than N2O. • MAC = 6
  • 10. Cardiovascular: ( similar to those of Isoflurane). • ↓ SVR, ↓ B.P • COP maintained or slightly depressed at 1 -2 MAC. • HR ↑ moderately. • CVP ↑ moderately.
  • 11. • Rapid ↑ in Desflurane concentration → transient or sometimes worrisome elevation in HR, B.P & catecholamine level more than that with Isoflurane. These events can be attenuated by fentanyl, esmolol, clonidine.
  • 12. Respiratory: • ↓ Vt, ↑ RR • ↑ in resting PaCO2 • Depresses the ventilatory response to ↑PaCO2 . • Pungency & airway irritation during induction can be manifested by salivation, breath holding, coughing & laryngospasm. • ↑ airway resistance may ↑ in children with reactive airway susceptibility. • These problems make Desflurane a poor choice for inhalation induction.
  • 13. Cerebral: • ↑ CBF, ↑ CBV, ↑ICP • ↓↓ CMRO2 → cerebral vasoconstriction. • ↑ ICP can be ↓ by hyperventilation. • EEG , like Isoflurane: 2 MAC → silent EEG.
  • 14. Neuromuscular: • Dose dependent reduction in the response to train of four & tetanic peripheral nerve stimulation.
  • 15. Renal: • Safe. • ↓ RBF, ↓GFR, ↓ UOP. • Inhalation of choice for chronic renal failure like Isoflurane.
  • 16. Hepatic: • Nearly safe. • Minimum metabolism. • Hepatitis is minimum. • Hepatic O2 delivery is generally maintained by maintaining the hepatic blood flow unlike halothane.
  • 17. Contraindications: • Sever hypovolemia. • History of Malignant hyperthermia. • I.C. hypertension.
  • 18. Drug interaction: • Non depolarizing NMBA effect is increased. • Epinephrine safe up to 4.5 mcg/kg (similar to Isoflurane). • Delirium in some pediatric patients.
  • 19. • Desflurane, much more than any other volatile anesthetics, has been associated with the production of CO. • The strongly alkaline and desiccated CO2 absorbent: CO forming when the absorbent is dry, regenerate the original anesthetic when wet.
  • 20. • The first case of the day, when machines have not been used for some time, or when fresh gas flow has been left on for a protracted period of time, Monday morning ; So, the absorbent should be changed routinely despite lack of apparent color change.
  • 21. • The CO2 absorbents CO production from greatest to least: KOH- containing absorbents are(Baralyme®)(4.6%) > classic soda lime (2.6%) > new soda lime (0%) > calcium hydroxide lime (AMSORB®) (0%).
  • 23. • Choice of volatile anesthetic also determine the amount of CO produced, and at equi MAC concentrations: Desflurane > Enflurane > Isoflurane. • Sevoflurane when exposed to dry absorbent (especially KOH-containing), this leads to CO production and a rapid increase in absorbent temperature, that exceed 300°C and it can lead to fires , generation of forming acid leading to sever
  • 24. airway irritation, and a lower circuit concentration of delivered Sevoflurane compared to that of vaporizer dial concentration.
  • 26. • Xenon is a "noble" gas that has long been known to have anesthetic properties. • Inert element that does not form chemical bonds. • Scavenged from the atmosphere through a costly distillation process. • Odorless, non explosive. Inert (probably nontoxic with no metabolism).
  • 27. • Naturally occurring gas with low potency ( MAC=70%). • Blood/Gas = 0.115, giving it very fast onset and emergence. • Anesthetic effects seem to be mediated by NMDA (N-methyl-D-aspartate) receptor inhibition by competing with glycine at the glycine binding site.
  • 28. • Little effect on cardiovascular, hepatic, or renal systems and has been found to be protective against neuronal ischemia. • Does not trigger malignant hyperthermia • As a natural element, it has no effect upon the ozone layer compared with another NMDA antagonist, nitrous oxide. • High cost and little availability have prevented its widespread use.