Purpose: Product and patient-specific factors that may influence the selection of an inhaled anesthetic agent are discussed in four case studies.
Summary: The cardiovascular, respiratory, hepatic, and renal effects of various inhaled anesthetic agents vary and may be important in selecting an agent for patients with impairment of these systems. The extent to which anesthetics are metabolized and the risk of hepatotoxicity also vary. Halothane is associated with a relatively high risk for arrhythmias and hepatotoxicity. It also has a high solubility in tissues and is associated with a slow onset and termination of effect and recovery. Pharmacokinetic and pharmacodynamic differences among anesthetics may be important considerations, depending on the surgical setting, anticipated duration of surgery, whether endotracheal intubation is used, and other patient-specific factors such as body weight and age. The duration of surgery is an important consideration for most patients because differences between inhaled anesthetics in offset of effect vary with the duration of the procedure. Desflurane or sevoflurane may be preferred for obese patients because of a faster recovery and greater respiratory safety compared with isoflurane. Sevoflurane is preferred for pediatric patients undergoing induction by inhalation because of its low propensity to cause respiratory irritation.
Conclusion: There are many product- and patient-specific factors that pharmacists must take into account when selecting an inhaled anesthetic agent. It is important to consider all of these factors when developing the pre- and post-anesthesia plan.