Medical Pharmacology:  General Anesthesia

 
 

Medical Pharmacology Chapter 14:  General Anesthesia

 

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Fulminant halothane Hepatitis

 

  • The liver is flabby, soft, friable similar to any acute viral hepatitis. It was called in the past 'acute yellow atrophy'.

  • Dr. Emilio Orfei, Loyola University Chicago, Stritch School of Medicine

 

  • Massive centrolobular necrosis. Notice the central vein and necrosis of liver cells in all three zones of the lobule. A few cloisters of hepatocytes in form of cords and pseudo-ductules remain in the periphery of the lobule.Notice absence of inflammatory reaction and no endophlebites of the vein as it would be seen in viral hepatitis."

  • Dr. Emilio Orfei,  Loyola University Chicago, Stritch School of Medicine

 

Kennedy, S.K. and Longnecker, D.E., History and Principles of Anesthesiology In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics,(Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, p 313.

White, P. F. "Anesthesia Drug Manual", W.B. Saunders Company, 1996, p. 249.

 

 

Nitrous oxide

  • Nitrous oxide should not be used if pockets of trapped air are suspected in the patient (e.g. following a pneuomoencephalogram or in an occluded middle ear, because of exchange of NO with nitrogen with attendant gas expansion.

    • This observation should not be interpreted to suggest that nitrous oxide does not play a significant role in otolaryngologic surgical procedures.  For example, in tonsillectomy and adenoidectomy, induction is typically with a volatile agent + nitrous oxide.  Furthermore, with myringotomy and tube insertion a volatile agent and nitrous oxide can be used.

    • For tympanoplasty,  however, nitrous oxide should be discontinued during the placement of the tympanic membrane graft

  •   Nitrous oxide has minimal effects on the circulation compared to the other inhalational agents with which it is co-administered.

  • May inactivate vitamin B12.

  • Nitrous oxide by itself has minimal effects on respiratory drive.

  •  Minimal skeletal muscle relaxation.

  •  No significant effects on the liver, kidney, or GI tract.

 

Kennedy, S.K. and Longnecker, D.E., History and Principles of Anesthesiology In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics,(Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) The McGraw-Hill Companies, Inc.,1996, p 319 - 321.

Stoelting, R.K., "Inhaled Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 36-76

 

  

 

 

Stoelting, R.K., "Inhaled Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 36-76

White, P. F. "Anesthesia Drug Manual", W.B. Saunders Company, 1996. p.248

 

Kennedy, S.K. and Longnecker, D.E., History and Principles of Anesthesiology In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics,(Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, p 315 - 317.

White, P. F. "Anesthesia Drug Manual", W.B. Saunders Company, 1996, p. 250.

Stoelting, R.K., "Inhaled Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 36-76

White, P. F. "Anesthesia Drug Manual", W.B. Saunders Company, 1996, p. 248.

 

 

Stoelting, R.K., "Inhaled Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 36-76 White, P. F. "Anesthesia Drug Manual", W.B. Saunders Company, 1996.

 

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