Authors | Hendrickx, J. Peyton, P. Carette, R. De Wolf, A. |
---|---|
Type | Journal Article (Review) |
Journal | European Journal of Anaesthesiology |
PubMed ID | 27164016 |
Year of Publication | 2016 |
URL | http://www.ncbi.nlm.nih.gov/pubmed/27164016 |
DOI | http://dx.doi.org/10.1097/eja.0000000000000467 |
Download | 2016_EJA_Peyton.pdf (791.8 KB) |
Abstract | This review re-examines existing pharmacokinetic and pharmacodynamic concepts of inhaled anaesthetics. After showing where uptake is hidden in the classic FA/FI curve, it is argued that target-controlled delivery of inhaled agents warrants a different interpretation of the factors affecting this curve (cardiac output, ventilation and blood/gas partition coefficient). Blood/gas partition coefficients of modern agents may be less important clinically than generally assumed. The partial pressure cascade from delivered to inspired to end-expired is re-examined to better understand the effect of rebreathing during low-flow anaesthesia, including the possibility of developing a hypoxic inspired mixture despite existing machine standards. Inhaled agents are easy to administer because they are transferred according to partial pressure gradients. In addition, the narrow dose-response curves for the three end points of general anaesthesia (loss of response to verbal command, immobility and autonomic reflex control) allow the clinical use of MACawake, MAC and MACBAR to determine depth of anaesthesia. Opioids differentially affect these clinical effects of inhaled agents. The effect of ventilation-perfusion relationships on gas uptake is discussed, and it is shown how moving beyond Riley's useful but simplistic model allows us to better understand both the concept and the magnitude of the second gas effect of nitrous oxide. It is argued that nitrous oxide remains a clinically useful drug. We hope to bring old (but ignored) and new (but potentially overlooked) information into the educational and clinical arenas to stimulate discussion among clinicians and researchers. We should not let technology pass by our all too engrained older concepts. |
http://www.ibas.org.au/what-we-do/publications/3872861
SHIFT WORK AND BREASTFEEDING PROJECT
Researchers at Austin Health are looking for volunteers to participate in a study exploring the impact shift work has on breast milk composition. Participants will be compensated with a $100 gift voucher.
Interstitial lung disease (ILD) is a chronic lung condition that causes stiff lungs and restricts sufferers from taking a deep breath. Exercise in a gym, or swimming, walking or riding a bike, can help...
HEALTHY MALES AND FEMALES WANTED FOR SLEEP STUDY
Interested to participate in a study investigating the effect of fatigue on driving performance?
A/PROF MARK HOWARD AWARDED MAJOR COMPETITIVE MRFF GRANT
IBAS leads project to revolutionize Home Ventilation with $1.2 million grant for Assoc. Prof Mark Howard's research titled "Synchronise non-invasive ventilation at home".
PROF ANNE HOLLAND RECEIVES PRESTIGIOUS RESEARCH AWARD
Prof Anne Holland receives prestigious award for Excellent in Research Engagement and Impact from Monash University.
WORLD SLEEP DAY ON 17TH MARCH 2023
The benefits of quality sleep and to acknowledge the issue of sleep problems and their medical, educational, and social aspects as well as the prevention and management of sleep disorders, is promoted on World Sleep Day on the 17th March 2023.
A/PROF MARK HOWARD IS LISTED IN 'THE AUSTRALIAN'
The Australian's Research magazine names the top researcher and top research institution in each field of research, based on the number of citations for papers published in the top 20 journals in each field over the past five years.