静脉麻醉的革命课件.ppt

IV vs VOLATILE POPULARITY OF INHALATIONAL ANAESTHETICS ease of administration with highly developed, calibrated vaporisers ease of control to achieve end-tidal and therefore blood concentrations few suitable intravenous alternatives anaesthetists are familiar with the technique and it is established TOXICITY OF INHALATIONAL ANAESTHETICS pollution of the operating environment inhalation agents included under the Regulations for Control of Substances Hazardous to Health CONTROL OF SUBSTANCESHAZARDOUS TO HEALTH 8-hour time weighted average 100 ppm nitrous oxide 50 ppm enflurane 50 ppm isoflurane 10 ppm halothane CONTROL OF SUBSTANCESHAZARDOUS TO HEALTH 8-hour time weighted average 100 ppm nitrous oxide 50 ppm enflurane 50 ppm isoflurane 10 ppm halothane TOXICITY OF INHALATIONAL ANAESTHETICS 27 non-smokers working in operating theatre and 27 non-smoking controls exposed to 8-hr time-weighted average of N2O 11.8 ppm and isoflurane 0.5 ppm (100 50 ppm were limits for COSHH) sister chromatid exchange frequency increased significantly Hoerauf KH et al. BJA 1999; 82: 764-6 TOXICITY OF INHALATIONAL ANAESTHETICS exposure to N2O 11.8 ppm and isoflurane 0.5 ppm caused equivalent genetic damage to 11-20 cigarettes per day TOXICITY OF VOLATILE AGENTS prolonged halothane anaesthesia increased glutathione S-transferase activity and reduced clearance of ICG Murray JM et al. Br J Anaesth 1992; 68: 168-171 similar changes with isoflurane and desflurane anaesthesia Suttner et al BJA 1999 A439 hepatitis has been reported with sevoflurane Masui 1993 Jun 42:6 902-5 Masui 1991 Oct 40:10 1542-5 TOXICITY OF VOLATILE AGENTS increased production of fluoride ions: after administration of sevoflurane Smith I, Ding Y, White PF. Anesth Analg 1992; 74: 253-259 after prolonged anaesthesia with isoflurane Murray JM, Trinick TR. Anesth Analg 1992; 74: 236-240 Sevoflurane anaesthetic causes a transient decrease in aquaporin-2 and impairment of urine concentration Morita K.