US EPA

4022906 

Journal Article 

A comparative review of the newer inhalational anaesthetics 

Young, CJ; Apfelbaum, JL 

1998 

1 

CNS Drugs
ISSN: 1172-7047
EISSN: 1179-1934 

10 

4 

287-310 

10.2165/00023210-199810040-00006 

WOS:000076873300006 

The physical and physiological characteristics and efficacy and adverse effects of sevoflurane and desflurane are reviewed. A lower blood-gas solubility of both drugs affords a greater degree of control of anaesthetic levels and a more rapid immediate recovery from anaesthesia than is achieved with older inhaled agents. However, this rapid recovery may result in emergence agitation for both agents, probably related to rapid awakening to postoperative pain. The cost efficacy of both agents will depend upon their ability to reduce the personnel and time costs of surgery through this rapid emergence, and this aspect needs to be studied further.



Sevoflurane is currently in widespread clinical use in Japan and parts of Europe and the Americas. Compared with desflurane, it has the additional advantage of being nonirritating to the airway; inhalational induction of anaesthesia with sevoflurane is achieved rapidly and easily. The instability of sevoflurane with carbon dioxide absorbents and its in vivo biotransformation produce potentially toxic by-products. These by-products, including Compound A [pentafluoro isopropenyl fluoromethyl ether (PIFE)] and fluoride, have been extensively studied, and although there is a possibility of iatrogenic sequelae from sevoflurane, the likelihood of long term toxicity appears to be quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane: ii) to renally impaired patients, and (ii) to any patient when fresh gas flows of <2 L/min are used. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anaesthesia, with excellent haemodynamic characteristics.



Desflurane is currently in widespread use in the US and does not possess the in vitro and in vivo stability concerns of sevoflurane. with the exception of carbon monoxide production from dry carbon dioxide absorbents, Because of its significant pungency, desflurane is not approved for use in inhalational inductions. In addition, its transient activation of the sympathetic nervous system produces hypertension and tachycardia, probably from stimulation of airway receptors. Desflurane is also otherwise well tolerated and provides very rapid emergence from general anaesthesia.