ISOFLURANE ، SEVOFLURANE ، DESFLURANE

ISOFLURANE
Properties
 isomer of enflurane.
 Carcinogenic (not approved)
 colorless, volatile, liquid, pungent odor.
 stable.
 No preservative.
 Non-flammable.

Advantages and Disadvantages

Advantages Disadvantages
1.Rapid induction and recovery. 1.Pungent odor.

2.Little risk of hepatic or renal toxicity. 2.Coronary vasodilatation.

3.Cardiovascular stability.

4.Muscle relaxation.

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 Effects on Organ Systems
 A. Cardiovascular
1. Isoflurane causes minimal left ventricular depression in
vivo.

2. Cardiac output is maintained by a rise in heart rate due to

partial preservation of carotid baroreflxes.

3. decreases systemic vascular resistance, and lowers arterial

blood pressure.

4. Rapid increases in isoflurane concentration lead to

transient increases in heart rate, arterial blood pressure

 RESPIRATORY SYSTEM
Initially, until deeper levels of anesthesia are reached,
isoflurane stimulates airway reflexes with:

1.increases in secretions

2.coughing

3.laryngospasm

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 CNS

low concentration Vs High concentration

 Low: no change on the flow.

 High : increase blood flow by vasodilatation of the cerebral

arteries.

 Generalized CNS depression; Rapid emergence

 Increased ICP reversed by Hyperventilation

 Agent of choice for neuro-anaesthesia

 Neuromuscular
Isoflurane relaxes skeletal muscle.

 Renal

Isoflurane decreases renal blood flow, glomerular filtration

rate, and urinary output

 Uterus

Isoflurane has an effect on the pregnant uterus similar to that

of halothane

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 Hepatic

Total hepatic blood flow (hepatic artery and

portal vein flow) may be reduced during isofl
urane anesthesia. Hepatic oxygen supply is
better maintained with isoflurane than with
halothane, however, because hepatic artery
perfusion is preserved. Liver function tests are
usually not affected.

 Coronary steal phenomenon

Isoflurane induced coronary artery

vasodilatation can lead to redistribution of
coronary blood flow away from diseased areas
where arterioles are maximally dilated to areas
with normal responsive coronary arteries. This
phenomenon is called the coronary steal
syndrome

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 SEVOFLURANE
Properties
 New drug.

 Non flammable.

 Pleasant smell.

 MAC 2%.

 Stable.

 Low blood/gas partition coefficient => faster equilibrium.

 non irritant => so the fastest for induction.

Effects on Organ Systems

 Cardiovascular
1.It decreases arterial pressure mainly by reducing
peripheral vascular resistance but cardiac output is well
maintained over the normal anaesthetic maintenance
doses

2.There is mild myocardial depression resulting from its

effect on calcium channels

3.It is a less potent coronary arteriolar dilator and does

not appear to cause coronary steal

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 Respiratory System
1.The drug is non-irritant to the upper respiratory tract.
It produces dose-dependent ventilatory depression,
reduces respiratory drive in response to hypoxaemia
and increases carbon dioxide partial pressure to a
similar degree to other volatile agents

2.It relaxes bronchial smooth muscle but not as

effectively as halothane

 Cerebral
 Similar to isoflurane and desflrane, sevoflurane causes
slight increases in CBF and intracranial pressure at
normocarbia

 Cerebral metabolic oxygen requirements decrease, and

seizure activity has not been reported.

 Neuromuscular

Sevoflurane produces adequate muscle relaxation for

intubation of children following an inhalation induction.

 Renal

Sevoflurane slightly decreases renal blood flow

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 Hepatic

Sevoflurane decreases portal vein blood flow, but

increases hepatic artery blood flow, there by
maintaining total hepatic blood flow and oxygen
delivery. It is generally not associated with
immune-mediated anesthetic hepatotoxicity

 Musculoskeletal System

Sevoflurane potentiates non-depolarizing muscle

relaxants to a similar extent to isoflurane.
Sevoflurane may trigger malignant hyperthermia
in susceptible patients.

 Compound A in sevoflurane

 (fluoromethyl-2,2-difluoro-1-[trifluoromethyl] vinyl ether)

is a breakdown product of sevoflurane produced by its
interaction with carbon dioxide absorbents in the
anaesthesia machine

 Compound A produces evidence of transient renal injury in

rats.

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 DESFLURANE
Physical Properties
1.vapor pressure of desflurane at
20°C is 681 mm Hg, at high altitudes
it boils at room temperature. This
problem necessitated the development
of a special desflurane vaporizer

2.a blood/gas partition coeffi cient

(0.42) that is even lower than that of
nitrous oxide (0.47)

3.low solubility of desflurane in blood and body

tissues causes a very rapid induction and
emergence of anesthesia

Pungent odor --desflurane less likely to be used for

inhalation induction compared to halothane or
sevoflurane.
Airway irritation, breath-holding, coughing,
laryngospasm, significant salivation, when >6%
desflurane administered to an awake patient.
Produces the highest carbon monoxide
concentrations, followed by enflurane and isoflurane

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 Effects on Organ Systems
 Cardiovascular
1.Increasing the dose is associated with a decline in
systemic vascular resistance that leads to a fall in
arterial blood pressure. Cardiac output remains
relatively unchanged
2.Addition of nitrous oxide maintains heart rate
unchanged. Cardiac output tends to be maintained as
with isoflurane

 Respiratory System
1.Desflurane causes respiratory depression to a degree
similar to that of isoflurane up to a MAC of 1.5.
2.It increases PaCO2 and decreases the ventilatory
response to imposed increases in PaCO2.
3.It is irritant to the upper respiratory tract,
particularly at concentrations greater than 6%.
4.Pungency and airway irritation during desfl urane
induction can be manifested by salivation, breath-
holding, coughing, and laryngospasm. Airway resistance
may increase in children with reactive airway
susceptibility. These problems make desflurane a poor
choice for inhalation induction

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 Cerebral
Like the other volatile anesthetics, desfl urane directly
vasodilates the cerebral vasculature, increasing CBF,
cerebral blood volume, and intracranial pressure at
normotension and normocapnia

 Neuromuscular
Desflurane is associated with a dose-dependent decrease
in the response to train-of-four and tetanic peripheral
nerve stimulation.

 Renal
There is no evidence of any signifi cant nephrotoxic
effects caused by exposure to desflurane.

 Hepatic
Hepatic function tests are generally unaffected by
desflurane

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