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Chapter 5 - Inhalational Anesthetics

Published online by Cambridge University Press:  24 May 2023

By
Ricardo Diaz Milian
Edited by
Alan David Kaye  and
Richard D. Urman
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
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Summary

Inhalational anesthetics (IAs) are a group of medications utilized, almost exclusively, for the induction and maintenance of anesthesia during surgery. The demonstration of ether anesthesia in 1846 marked the beginning of the use of IAs in clinical practice. Today, modern IAs are used widely, mainly due to their reliability, minimal interindividual variation of the desired pharmacological effect, and the ease of continuous monitoring during anesthesia. Interestingly, the exact mechanism of action of modern IAs is not completely understood. However, recent developments in basic neuropharmacology have elucidated a probable mechanism of action. IAs display unique pharmacokinetics due to the fact that they are gases and are delivered directly to the lungs via the anesthesia machine. Consequently, the interactions of IAs with the body (pharmacokinetics) are very different in comparison to other anesthetics that are administered intravenously. IAs have proven to be instrumental in the modern practice of anesthesia. However, they are not deprived of unwanted adverse effects, some of which can be life-threatening. A deep understanding of these potent drugs and their effects on patients is indispensable for the practice of anesthesiology.

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Chapter
Information
Cambridge Handbook of Anesthesiology , pp. 75 - 85
Publisher: Cambridge University Press
Print publication year: 2023

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References

Whalen, FX, Bacon, DR, Smith, HM. Inhaled anesthetics: an historical overview. Best Pract Res Clin Anaesthesiol. 2005;19(3):323–30. DOI: 10.1016/j.bpa.2005.02.001.CrossRefGoogle ScholarPubMed
Chaturvedi, R, Gogna, RL. Ether day: an intriguing history. Med J Armed Forces India. 2011;67(4):306–8. DOI: 10.1016/S0377-1237(11)60098-1.Google Scholar
Lew, V, McKay, E, Maze, M. Past, present, and future of nitrous oxide. Br Med Bull. 2018;125(1):103–19. DOI: 10.1093/bmb/ldx050.CrossRefGoogle ScholarPubMed
Holmes, CMK. The Manhattan legacy. Anaesth Intensive Care. 2007;35(Suppl. 1):17–20. DOI: 10.1177/0310057x0703501s03.CrossRefGoogle ScholarPubMed
Terrell, RC. The invention and development of enflurane, isoflurane, sevoflurane, and desflurane. Anesthesiology. 2008;108(3):531–3. DOI: 10.1097/aln.0b013e31816499cc.CrossRefGoogle ScholarPubMed
Lynch, C. Meyer and Overton revisited. Anesth Analg. 2008;107(3):864–7. DOI: 10.1213/ane.0b013e3181706c7e.CrossRefGoogle Scholar
Eger, EI. New inhaled anesthetics. Anesthesiology. 1994;80(4):906–22.CrossRefGoogle ScholarPubMed
Chang, CY, Goldstein, E, Agarwal, N, Swan, KG. Ether in the developing world: rethinking an abandoned agent. BMC Anesthesiol. 2015;15(1):1–5. DOI: 10.1186/s12871-015-0128-3.Google Scholar
Brown, EN, Pavone, KJ, Naranjo, M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246–58. DOI: 10.1213/ANE.0000000000003668.CrossRefGoogle ScholarPubMed
Kelz, MB, Mashour, GA. The biology of general anesthesia from paramecium to primate. Curr Biol. 2019;29(22):R1199–210. DOI: 10.1016/j.cub.2019.09.071.Google Scholar
Krasowski, M. Contradicting a unitary theory of general anesthetic action: a history of three compounds from 1901 to 2001. Bull Anesth Hist. 2003;21(3):1–7.CrossRefGoogle Scholar
Sezgin, E, Levental, I, Mayor, S, Eggeling, C. The mystery of membrane organization: composition, regulation and roles of lipid rafts. Nat Rev Mol Cell Biol. 2017;18(6):361–74. DOI: 10.1038/nrm.2017.16.Google Scholar
Pavel, MA, Petersen, EN, Wang, H, Lerner, RA, Hansen, SB. Studies on the mechanism of general anesthesia. Proc Natl Acad Sci U S A. 2020;117(24):13757–66. DOI: 10.1073/pnas.2004259117.CrossRefGoogle ScholarPubMed
Esper, T, Wehner, M, Meinecke, CD, Rueffert, H. Blood/gas partition coefficients for isoflurane, sevoflurane, and desflurane in a clinically relevant patient population. Anesth Analg. 2015;120(1):45–50. DOI: 10.1213/ANE.0000000000000516.Google Scholar
Vallejo, MC, Zakowski, MI. Pro–con debate: nitrous oxide for labor analgesia. Biomed Res Int. 2019;2019:4618798. DOI: 10.1155/2019/4618798.Google Scholar
Kharasch, ED. Biotransformation of sevoflurane. Anesth Analg. 1995;81:27S–38S. DOI: 10.1097/00000539-199512001-00005.Google Scholar
Stevanovic, A, Rossaint, R, Fritz, HG, et al. Airway reactions and emergence times in general laryngeal mask airway anaesthesia: a meta-analysis. Eur J Anaesthesiol. 2015;32(2):106–16. DOI: 10.1097/EJA.0000000000000183.CrossRefGoogle ScholarPubMed
Carpenter, RL, Eger, RI, Johnson, BH, Unadkat, JD, Sheiner, LB. Does the duration of anesthetic administration affect the pharmacokinetics or metabolism of inhaled anesthetics in humans? Anesth Analg. 1987;66(1):1–8. DOI: 10.1213/00000539-198701000-00001.Google Scholar
Peyton, PJ, Chao, I, Weinberg, L, Robinson, GJB, Thompson, BR. Nitrous oxide diffusion and the second gas effect on emergence from anesthesia. Anesthesiology. 2011;114(3):596–602. DOI: 10.1097/ALN.0b013e318209367b.CrossRefGoogle ScholarPubMed
Zafirova, Z, Sheehan, C, Hosseinian, L. Update on nitrous oxide and its use in anesthesia practice. Best Pract Res Clin Anaesthesiol. 2018;32(2):113–23. DOI: 10.1016/j.bpa.2018.06.003.Google Scholar
Young, J, Apfelbaum, JL. Inhalational anesthetics: desflurane and sevoflurane. Rev Lit Arts Am. 1995;8180(95):564–77.Google Scholar
Sondekoppam, RV, Narsingani, KH, Schimmel, TA, McConnell, BM, Buro, K, Özelsel, TJP. The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials. Can J Anesth. 2020;67(11):1595–623. DOI: 10.1007/s12630-020-01791-5.Google Scholar
Eger, EI. Characteristics of anesthetic agents used for induction and maintenance of general anesthesia. Am J Heal Pharm. 2004;61(Suppl. 4):S3–10. DOI: 10.1093/ajhp/61.suppl_4.s3.CrossRefGoogle ScholarPubMed
Sakai, EM, Connolly, LA, Klauck, JA. Inhalation anesthesiology and volatile liquid anesthetics: focus on isoflurane, desflurane, and sevoflurane. Pharmacotherapy. 2005;25(12I):1773–88. DOI: 10.1592/phco.2005.25.12.1773.Google Scholar
Zhang, C, Xu, L, Ma, YQ, et al. Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J (Engl). 2011;124(22):3664–9. DOI: 10.3760/cma.j.issn.0366-6999.2011.22.012.Google ScholarPubMed
Horn, C, Wallisch, W, Homanics, G, Williams, J. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014;5(722):55–66. DOI: 10.1016/j.ejphar.2013.10.037.Pathophysiological.Google Scholar
Eger, EI, Saidman, LJ. Hazards of nitrous oxide anesthesia in bowel abstruction and pneumothorax. Anesthesiology. 1965;26(1):61–6.Google Scholar
Rosenberg, H, Pollock, N, Schiemann, A, Bulger, T, Stowell, K. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015;10(1):1–19. DOI: 10.1186/s13023-015-0310-1.CrossRefGoogle ScholarPubMed
Landoni, G, Lomivorotov, VV, Nigro Neto, C, et al. Volatile anesthetics versus total intravenous anesthesia for cardiac surgery. N Engl J Med. 2019;380(13):1214–25. DOI: 10.1056/nejmoa1816476.CrossRefGoogle ScholarPubMed
American Society of Anesthesiologists Task Force on Intraoperative Awareness.Practice advisory for intraoperative awareness and brain function monitoring: a report by the American Society of Anesthesiologists Task Force on Intraoperative Awareness. Anesthesiology. 2006;104(4):847–64. DOI: 10.1097/00000542-200604000-00031.Google Scholar
Aranake, A, Mashour, GA, Avidan, MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia. 2013;68(5):512–22. DOI: 10.1111/anae.12168.Google Scholar
Myles, PS, Leslie, K, McNeil, J, Forbes, A, Chan, MTV. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363(9423):1757–63. DOI: 10.1016/S0140-6736(04)16300-9.CrossRefGoogle ScholarPubMed
Avidan, M, Zhang, L, Burnside, B, Finkel, K, Searlman, A. Anesthesia awareness and the bispectral index. N Engl J Med. 2008;358(11):1097–108.CrossRefGoogle ScholarPubMed
Avidan, M, Jacobsohn, E, Glick, D, Burnskide, B. Prevention of intraoperative awareness in a high risk surgical population. N Engl J Med. 2011;365(7):591–600.Google Scholar

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