Inhalational anesthetics: desflurane and sevoflurane.
ABSTRACT This article reviews the physico-chemical properties and performance characteristics of the two new potent inhaled anesthetics, desflurane and sevoflurane. Both drugs provide a greater degree of control of anesthetic depth and a more rapid immediate recovery from anesthesia than is currently available with other inhaled agents because of their decreased solubility. Desflurane is currently in widespread clinical use in the United States and parts of Europe. Compared with sevoflurane, it has the additional advantage of being extremely resistant to degradation and biotransformation. However, its pungent odor and tendency to irritate the respiratory tract make it unsuitable for inhalational inductions, and it has been linked to CO production in CO2 absorbents. The sympathetic nervous system activation that occurs with desflurane limits its use in patients with cardiac disease. Otherwise, its hemodynamic and physiologic effects are similar to those seen with isoflurane. Studies of the economics of using desflurane are mixed, although it may offer the advantage of shorter postoperative recovery time. Sevoflurane is currently in widespread clinical use in Japan and parts of South America. The FDA Advisory Panel has recently recommended approval of sevoflurane in the United States, and we can expect the drug to be clinically available in the United States in the second quarter of 1995. Compared with desflurane, sevoflurane has the additional advantage of being nonirritating to the airway; inhalational induction of anesthesia with sevoflurane is achieved rapidly and easily. The instability of sevoflurane with CO2 absorbents and its in vivo biotransformation produce potentially toxic byproducts. These byproducts, including Compound A and fluoride, have been extensively studied, and although the possibility for iatrogenic sequelae from sevoflurane exists, the likelihood of long-term toxicity appears quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane (1) to renally impaired patients and (2) to any patient with fresh gas flows less than 2 L/min. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anesthesia.
SourceAvailable from: Hiroaki Miyajima[Show abstract] [Hide abstract]
ABSTRACT: Trinitrobenzenesulfonic acid (TNBS)-induced colitis is one of the most widely used experimental colitis models. However, there is no standard procedure for inducing colitis by TNBS because it is difficult to achieve a uniform distribution of colitis. We have developed a modified method of murine TNBS-induced colitis that involves inhalation anesthesia with sevoflurane combined with both single and repeated TNBS administrations. To compare the usefulness of our newly developed method for inducing murine TNBS-induced colitis with that of conventional intraperitoneal anesthesia. TNBS in ethanol was administered to C57BL/6J mice held in an inverted vertical position either under continuous inhalation anesthesia with sevoflurane, in accordance with our newly developed method, or by intraperitoneal injection with 2.5 % avertin, in accordance with the conventional procedure. Body weight change, cytokine profile, and histological findings were examined during the course of colitis. The dispersion of anesthesia time, TNBS retention time, and nadir weight during the course of colitis was decreased using the newly developed method compared with the conventional procedure. Optimization of the modified TNBS-induced colitis, as evidenced by the predominant expression of Th1 and Th17 cytokines on day 7, was attained by the injection of 2.25 mg TNBS in 55 % ethanol. Regulation of the TNBS retention time using inhalation anesthesia with sevoflurane allowed strict control of the disease severity of TNBS-induced colitis. Using the modified method we were also able to develop a chronic TNBS-induced colitis model by repeated TNBS administration without excessive mortality of the mice. Our modified method for murine TNBS-induced colitis using continuous inhalation anesthesia with sevoflurane provides a better experimental colitis model following both single and repeated TNBS administrations.Digestive Diseases and Sciences 01/2014; 59(7). DOI:10.1007/s10620-013-3023-0 · 2.55 Impact Factor
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ABSTRACT: Purpose Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia. Materials and Methods From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR). Results The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR. Conclusion Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.Yonsei medical journal 09/2013; 54(5):1266-72. DOI:10.3349/ymj.2013.54.5.1266 · 1.26 Impact Factor
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ABSTRACT: A theoretical study on the mechanism and kinetics of the gas phase reactions of a volatile anaesthetic compound (CF3)2CHOCH2F (Sevoflurane) with the OH radicals has been carried out using the hybrid HF–density functional M06-2X/6-31+G(d,p) method. Three conformations are predicted for the Sevoflurane molecule. Among the three conformers, the most stable one is considered for a detailed study. Reaction profiles are modeled including the formation of pre-reactive and post-reactive complexes at entrance and exit channels. Single point energy calculations have been performed by using the 6-311++G(d,p) basis set. The hydrogen abstraction from the –CH2F group is found to be the dominant reaction channel for hydrogen abstraction by OH radicals. Theoretically the calculated rate constant is found to be in good agreement with the experimentally measured ones. Using groupbalanced isodesmic reactions, the standard enthalpies of formation for (CF3)2CHOCH2F, (CF3)2COCH2F and (CF3)2CHOCHF radicals are also reported for the first time. The atmospheric fate of the alkoxy radical, (CF3)2CHOCHFO, is also investigated for the first time using the same level of theory. Out of four prominent plausible decomposition channels including oxidation, our results clearly point out that reaction with O2 is the dominant path for the decomposition of (CF3)2CHOCHFO in the atmosphere involving the lowest energy barrier which is in accord with recent experimental findings.New Journal of Chemistry 03/2014; 38(7). DOI:10.1039/c3nj01408h · 3.16 Impact Factor