Diethyl ether (Aether diaethylicus)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Means for anesthesia

Included in the formulation
  • Ether for narcosis stabilized
    solution d / inhal. 
    MEDHIMPROM ПХФК, ОАО     Russia
  • Ether for narcosis stabilized
    solution d / inhal. 
       
    • АТХ:

    N.01.A.A.01   Diethyl ether

    Pharmacodynamics:
    Pharmacological action - anesthesia.
    Nonspecifically interacts with the membranes of neurons, mainly - with two-layer lipid membranes of the axons of the brain, oblong and spinal cord, reversibly modifies their ultrastructure and functions. Oppresses the central nervous system: blocks the synaptic transmission of excitation (mainly afferent impulses), functionally disintegrates the cortical-subcortical interactions while maintaining the activity of bulbar centers. Causes distinctly expressed "classical" stages of anesthesia - analgesia, excitation, surgical anesthesia with three levels (superficial, medium, deep) and characteristic signs: lack of consciousness and all kinds of sensitivity, inhibition of reflex reactions and relaxation of skeletal muscles.
    In the case of premedication and against the background of other inhaled or non-inhaling general anesthetics, the classical narcosis pattern changes significantly. At the stage of analgesia lowers the functional activity of cortical neurons, causes an amnestic effect.In the stage of excitation, it depresses the cerebral cortex, turns off subordinate mechanisms that control the state of the subcortical structures (mainly the midbrain). The increase in activity of subcortical formations is manifested by psychomotor excitation, variability of respiration, arterial pressure, pulse, etc. This stage is more pronounced in adults than in children, less (or absent) - against a background of premedication and basic anesthesia. It irritates the mucous membranes, including the oral cavity, increases the secretion of the salivary glands (hypersalivation). Through the receptor zones of the trigeminal, laryngeal and vagus nerves increases bronchial secretion; causes cough, laryngospasm, bronchial spasm (alternating with deep anesthesia by their expansion), respiratory disorders (reflex stimulation or depression, up to apnea) and heart activity (tachycardia or bradycardia, cardiac arrest), hypertension. When the saliva or mucus, saturated with ether, gets into the stomach, irritates its mucous membrane, reflexively stimulates the vomiting center, causes nausea and vomiting (at the beginning of anesthesia and on awakening).
    At the stage of surgical anesthesia, he significantly inhibits interneuronal transmission in the brain and spinal cord. Increases the activity of the hypothalamus, regulates the functions of the pituitary-adrenal cortex and the sympathetic nervous system, increases the secretion of glucocorticoids and catecholamines. Increases the release of adrenaline from the adrenal medulla, causes hyperglycemia, spasm of the vessels of internal organs, increases blood pressure, strength and heart rate (does not sensitize the myocardium to catecholamines). Activation of the sympathetic nervous system levels the depressing effect on the vascular tone, blood pressure and heart function. Increases the bleeding of the capillaries, inhibits peristalsis of the intestine (at the beginning of anesthesia). Relaxes the skeletal muscles, as it disrupts the central regulation of the muscle tone and blocks the spread of local potential on the postsynaptic membrane of the skeletal muscle.
    In high concentrations, directly depresses the respiratory and vasomotor center (violation of pulmonary ventilation, hypotension), has a direct cardiodepressant effect.Causes cooling of the lung tissue, which in combination with the accumulation of mucus in the bronchi (because of the irritating effect) contributes to the development of pneumonia, often in young children. Violates the metabolism (loss of glycogen stores, fatty infiltration) and liver function, including detoxification. It induces microsomal enzymes of the cytochrome P450 system. Oppresses kidney function and reduces diuresis due to the release of antidiuretic hormone and narrowing of the kidney vessels. Characterized by a small breadth of anesthesia (therapeutic index does not exceed 1.5), relatively low organ toxicity (heart, liver, kidneys).
    Ethereal anesthesia is characterized by good controllability and controllability. With the masking method, the effect develops slowly, the surgical anesthesia stage begins in 15-20 minutes (in younger children it is faster). Awakening is gradual - (20-40 minutes). And in the subsequent period, the CNS depression, drowsiness and analgesia persist for a long time (the brain functions are completely restored after a few hours). Against the backdrop of barbiturates and muscle relaxants, there is usually no stage of excitation (the introduction to anesthesia is not accompanied by suffocation, fear and other unpleasant sensations),Miorelaxation is potentiated and the severity of post-arthritis depression decreases.
    Pharmacokinetics:It passes well through the blood-brain barrier, diffuses easily to neurons through an interneuron liquid (low-molecular uncharged compound). It is distributed unevenly in the organs: the level in the brain exceeds the concentration in the blood and other organs (the content in the oblong and spinal cord is about 50% greater than in the brain, due to the higher content of lipids in nerve conductors). Concentrations in the blood are: 10-25 mg% (stage of analgesia), 25-70 mg% (stage of excitation) and 80-110 mg% (stage of surgical anesthesia). Passes through the placental barrier and creates high concentrations in the fetus. It is deposited in membranes of hepatocytes. Insignificantly (10-15%) is biotransformed. Quickly eliminated within the first few minutes, then the elimination gradually slows down: 85-90% is excreted unchanged by the lungs, the rest - by the kidneys. The medical ether with local application on the tooth tissue causes a "drying" effect (quickly evaporates at room temperature), exhibits weak antibacterial and local anesthetic activity (due to an irritating effect).The local irritant effect of the ester on the skin can be used for distraction therapy (rubbing).
    Indications:
    Ether anesthesia: inhalation anesthesia (mixed, combined, potentiated), including maintenance of anesthesia (usually in a mixture with oxygen and dinitrogen oxide, against muscle relaxants, induction of anesthesia barbiturate or dinitrogen oxide).
    Medical ether: for the treatment of carious cavities and root canals of the tooth (preparation for filling).
    ICD-10

    XXI.Z40-Z54.Z48.9   Subsequent surgical care, unspecified

    XX.Y83-Y84.Y83.9   Surgical operation, unspecified

    XX.Y83-Y84.Y83.8   Other Surgery

    Contraindications:Tuberculosis of the lungs, acute respiratory disease, increased intracranial pressure, cardiovascular disease with a significant increase in blood pressure, including essential hypertension, cardiac decompensation, severe liver and kidney disease, cachexia, thyrotoxicosis, diabetes mellitus, a condition of excitation expressed acidosis, operations using electrosurgical instruments, including electrocoagulation.
    Carefully:For premedication use narcotic analgesics (trimeridine), neuroleptics (chlorpromazine), antihistamines (diphenhydramine, promethazine), in order to prevent vomiting and other reflex reactions, including hypersecretion, m-cholinolytics are used (atropine, metocinium iodide). Avoid contact with skin and eyes with open application.
    Pregnancy and lactation:With caution in pregnancy (adequate clinical studies have not been performed) and during breastfeeding (data on excretion in female milk are absent).
    Dosing and Administration:Inhalation: open (drip, fractionally, device), semi-open, semi-closed and closed systems. The concentration depends on the method of anesthesia and the sensitivity of the patient; usually - first after getting used to the smell of 15-20% of the volume (if necessary, to use up to 25% of the volume), then after turning off the consciousness - up to 10% of the volume, to maintain anesthesia from 2-12% volume; with a semi-open system for the maintenance of anesthesia: 2-4% of volume for analgesia, 4-8% of volume at surface and 4-12% of volume for deep anesthesia.
    Side effects:
    On the part of the respiratory system: hypersecretion of bronchial glands, cough, laryngo- and bronchospasm, pulmonary ventilation disorders, acceleration or respiratory depression, up to apnea, pneumonia and bronchopneumonia (in the postoperative period), diffusion hypoxia (against pulmonary and cardiac function or long-term use in high concentrations ).
    From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): tachycardia or bradycardia, until the heart is stopped; arrhythmia; hyper- or hypotension; collapse; bleeding.
    On the part of the digestive system: hypersalivation, nausea, vomiting, a decrease in the tone and motility of the gastrointestinal tract, paralytic ileus (with prolonged anesthesia), transient jaundice, changes in hepatic samples.
    From the nervous system and sensory organs: excitation, motor activity, rarely - convulsions in children, drowsiness, depression (after surgery).
    Other: metabolic acidosis, hypoalbuminemia, hypogammaglobulinemia, decreased urine output, albuminuria.
    Overdose:
    Symptoms: oppression of the respiratory and vasomotor center, apnea, asphyxia, hypotension, collapse, heart failure, cardiac arrest, coma.
    Treatment: stopping anesthesia, providing airway patency, artificial ventilation of the lungs with hyperventilation, transfusion therapy, the administration of hydrocortisone, dopamine (0.2 g in 500 ml isotonic sodium chloride solution at a rate of 2.5 μg / kg / min), caffeine (1 ml 10 -20% solution subcutaneously), bemegrida (5-10 ml of 0.5% solution intravenously slowly); conducting activities to prevent pneumonia, including warming the patient.
    Interaction:Potentiates the effect of agents that depress the central nervous system (mutually), the effect of nondepolarizing muscle relaxants, such as tubocurarine, the hypotensive effect of beta-blockers. Reduces the hypoglycemic effect of insulin and derivatives of sulfonylurea, oxytocin and other hormonal stimulants of the uterus. Incompatible with analeptics and psychostimulants. Inhibitors monoamine oxidase inhibit metabolism (intensify anesthesia); epinephrine and eufillin increase the risk of arrhythmia, m-cholinoblockers and antihistamines neutralize the side effects, muscle relaxants halve the consumption of ether.
    Special instructions:It is necessary to comply with the measures of explosion safety and take into account that in the operating room a flammable layer can accumulate near the floor surface (since the ether is heavier than air).Every 6 months check for impurities is required.
    Instructions
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