Pharmacology

Halogenated Volatiles

Isoflurane, sevoflurane, and desflurane

Halogenated volatile anesthetics (“anesthesia gases”) serve as the backbone for maintaining most of the general anesthetics I perform. Although their mechanism is not completely understood, studies suggest that they alter membrane proteins in the lipid bilayer while potentiating the effects of GABA – an inhibitory neurotransmitter – in the brain in spinal cord. The result is amnesia and immobility. During my anesthesiology residency and fellowship, I’ve used three major volatile agents.

Due to its relatively fast onset and minimal pungency, sevoflurane (Ultane) is often used as a potent bronchodilator and for mask inductions in pediatrics. Its metabolism generates fluoride and “compound A”, both of which have NOT been shown to translate to renal injury in humans.

Isoflurane (Forane) is the cheapest and most potent but has a relatively slow onset and recovery. This is the most common agent I use in cardiac surgery since it dilates the coronary vessels and tends to preserve cardiac output.

Desflurane (Suprane) is my favorite agent for non-cardiothoracic cases since its low blood:gas solubility leads to a rapid emergence. However, rushing desflurane in rapidly (ie, right after the induction of anesthesia) can lead to a sympathetic surge causing tachycardia and hypertension.

I try to utilize the unique properties of the aforementioned gases in the clinical context (type of surgery, patient’s comorbidities, etc.) to justify my selection.

Drop me a comment below with questions! 🙂

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