Toxicity of inhaled agents after prolonged administration

J Clin Monit Comput. 2018 Aug;32(4):651-666. doi: 10.1007/s10877-017-0077-0. Epub 2017 Nov 2.


Inhaled anesthetics have been utilized mostly for general anesthesia in the operating room and oftentimes for sedation and for treatment of refractory status epilepticus and status asthmaticus in the intensive care unit. These contexts in the ICU setting are related to potential for prolonged administration wherein potential organ toxicity is a concern. Over the last decade, several clinical and animal studies of neurotoxicity attributable to inhaled anesthetics have been emerging, particularly in extremes of age. This review overviews potential for and potential mechanisms of neurotoxicity and systemic toxicity of prolonged inhaled anesthesia and clinical scenarios where inhaled anesthesia has been used in order to assess safety of possible prolonged use for sedation. High dose inhaled agents are associated with postoperative cognitive dysfunction (POCD) and other situations. However, thus far no strong indication of problematic neuro or organ toxicity has been demonstrated after prolonged use of low dose volatile anesthesia.

Keywords: Critical care; ICU; Inhaled agents; Neurotoxicity; Sedation; Volatile anesthetics.

Publication types

  • Review

MeSH terms

  • Anesthesia, Inhalation / adverse effects*
  • Anesthetics, Inhalation / administration & dosage*
  • Anesthetics, Inhalation / toxicity*
  • Animals
  • Central Nervous System / drug effects
  • Cognitive Dysfunction / chemically induced
  • Critical Care
  • Deep Sedation / adverse effects
  • Humans
  • Inflammation / chemically induced
  • Intensive Care Units
  • Neurotoxicity Syndromes / etiology
  • Postoperative Complications / chemically induced
  • Status Asthmaticus / therapy
  • Status Epilepticus / therapy


  • Anesthetics, Inhalation