General anesthetics allosterically modulate the activity of neuronal ␥-aminobutyric acid, type A (GABA A ), receptors. Previous mutational studies from our laboratory and others have shown that the regions in transmembrane domain 1 (M1) and pre-M1 of ␣ and  subunits in GABA receptors are essential for positive modulation of GABA binding and function by the intravenous (IV) general anesthetics. Mutation of 2Gly-219 to Phe corresponded in nearly eliminated the modulatory effect of IV anesthetics in ␣1/2/␥2S combination. However, the general anesthetics retained the ability to directly open the channel of mutant G219F, and the apparent affinity for GABA was increased, and desensitization rate was reduced. In this study, we made additional single mutations such as 219 Ser, Cys, Ile, Asp, Arg, Tyr, and Trp. The larger side chains of the replacement residues produced the greatest reduction in enhancement of GABA currents by IV anesthetics at clinical concentrations (Trp > Tyr ؍ Phe > Arg > Asp > Ile > Cys > Ser ؍ wild type). Compared with a 2-3-fold response in wild type, pentobarbital and propofol enhanced less than 0.5-fold; etomidate and alphaxalone modulation was reduced from more than 4-to 1-fold in G219F, G219Y, and G219W. A linear correlation was observed between the volume of the residue at position 219 and the loss of modulation. An identical correlation was found for the effect of modulation on left-shift in the GABA EC 50 value; furthermore, the same rank order of residues, related to size, was found for reduction in the maximal direct channel-gating by pentobarbital (1 mM) and etomidate (100 M) and for increased apparent affinity for direct gating by the IV anesthetics.Considerable evidence supports the hypothesis that general anesthesia can be produced, at least in part, by enhancing neuronal inhibition mediated by GABA A receptors (GABAR). 1 GABA and most volatile and general intravenous (IV) anesthetics bind to GABAR. These are ligand-gated channels that enhance the flow of chloride ions (Cl Ϫ ) into the postsynaptic neuron, thus increasing its resting potential and making it less likely to fire, i.e. the inhibitory effect in GABA synapses. GABAR are modulated positively by a wide variety of structurally diverse general anesthetics (1). In particular, volatile anesthetics (2, 3) and IV anesthetic agents such as the barbiturates (4, 5), propofol (6), etomidate (7), and neuroactive steroid anesthetics, like alphaxalone (8 -10), all enhance the function of GABAR at clinically relevant concentrations. In addition, IV and volatile anesthetics can activate GABAR directly in the absence of GABA (11). Anesthetics appear to allosterically modulate ligand-gated ion channel (LGIC) receptor function by binding to the receptor itself, but not at the agonist-binding site, and to affect the conformation of the membrane protein in a functional manner. Exactly how such modulatory sites affect agonist-regulated channel opening is a major contemporary question in pharmacology and neurobiology. Obviously, the struct...