Medical Pharmacology Chapter 14:  General Anesthesia

 

 

Comparative Pharmacology and Physiology

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Inhalational agents and the Cardiovascular System

Seizure activity and inhalational anesthetics:

Some Important Antiepileptic Drugs

Grand mal

Petit mal

Carbamazepine (Tegretol)

Acetazolamide (Diamox)

Clonazepam (Klonopin)

Ethosuximide (Zarontin)

Diazepam (Valium) (status epilepticus)

Trimethadione

Phenobarbital (Luminal)

Valproic acid (Depakene, Depakote)

Phenytoin (Dilantin)

 

Primidone (Mysoline)

 

Valproic acid (Depakene, Depakote)

 

 

Partial Seizures

Carbamazepine (Tegretol)

Phenytoin (Dilantin)

Vigabratrin

 

 

 

Cerebral Blood Flow (CBF)

Anesthetics and Cerebral Blood Flow (CBF)*

Anesthetic

Cerebral blood flow (CBF)

Direct Cerebral Vasodilation

Halothane (Fluothane)

+++

yes

Enflurane (Ethrane)

++

yes

Isoflurane (Forane)

+

yes

Desflurane (Suprane)

+

yes

Sevoflurane (Sevorane, Ultane)

+

yes

Thiopental (Pentothal)

---

no

Etomidate (Amidate)

---

no

Propofol (Diprivan)

--

no

Midazolam (Versed)

--

no

Ketamine (Ketalar)

++

yes

Fentanyl (Sublimaze)

-/0

no

Nitrous oxide alone

+

no change

Nitrous oxide + Volatile anesthetics

+

no change

Nitrous oxide + Intravenous anesthetics

0

no change

* adapted from Table 28-5--Bendo, A.A., Kass, I.S., Hartung, J and Cottrell, J. E., "Anesthesia for Neurosurgery", in Clincial Anesthesia, 3rd Edition, ( Barash, P.G, Cullen, B. F. and Stoelting, R. K., eds) Lippincott-Raven Publishers, 1997, p705.

 

 

Cerebral Metabolic Requirements (CMR)

Intracranial pressure

 

Clinical Correlations-- Anesthesia and Brain Physiology-- Neuroanesthesia considerations

 

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

Dierdorf, S. F., "Anesthesia for Patients with Rare and Coexisting Disease", in Clincial Anesthesia, 3rd Edition,  (Barash, P.G, Cullen, B. F. and Stoelting, R. K., eds) Lippincott-Raven Publishers, 1997, pp 461-487.

Bendo, A.A., Kass, I.S., Hartung, J and Cottrell, J. E., "Anesthesia for Neurosurgery", in Clincial Anesthesia, 3rd Edition, ( Barash, P.G, Cullen, B. F. and Stoelting, R. K., eds) Lippincott-Raven Publishers, 1997, pp 704-706.