Which is most pungent: isoflurane, sevoflurane or desflurane?

TerRiet, Menno F.; DeSouza, Gerard; Jacobs, Jeffrey; Young, D. S.; Lewis, Michael C.; Herrington, Claire; Gold, Martin I.

doi:10.1093/bja/85.2.305

Cited by 100 publications

(80 citation statements)

References 7 publications

(2 reference statements)

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“…The order of the four anaesthetics in terms of their irritancy (sevoflurane < halothane < isoflurane < desflurane) confirms the results of previous studies [19][20][21]. The similarity of the irritancy of halothane and isoflurane was surprising, but a large fraction of the incidence of adverse airway events to halothane came from one volunteer (Tables 3 and 4).…”

supporting

confidence: 84%

Adverse airway events during brief nasal inhalations of volatile anaesthetics: the effect of humidity and repeated exposure on incidence in volunteers preselected by response to desflurane*

Wilkes¹,

Raj²,

Hall

2003

Anaesthesia

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SummaryTwelve volunteers known to have airways that responded adversely to 2.0 MAC desflurane were recruited. Each volunteer inhaled three single breaths of each of 0.5, 1.0 and 2.0 MAC of sevoflurane, halothane, isoflurane, desflurane and balance air, with breaths of air between, whilst breathing nasally through a face mask attached to one of three filters that provided three different levels of humidification. The incidence of any adverse airway events was recorded. The anaesthetic inhaled significantly affected the incidence of adverse airway events (p < 0.001), with the least to most irritant being sevoflurane, halothane, isoflurane and desflurane. Increasing the concentration of anaesthetic also significantly increased the incidence of adverse airway events (p < 0.001). The filter used, and hence the level of humidification, did not affect the incidence of adverse airway events (p ¼ 0.09), but repeated exposure caused a significant reduction in the incidence of adverse airway events (p < 0.001).

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supporting

confidence: 84%

Adverse airway events during brief nasal inhalations of volatile anaesthetics: the effect of humidity and repeated exposure on incidence in volunteers preselected by response to desflurane*

Wilkes¹,

Raj²,

Hall

2003

Anaesthesia

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“…Moreover, VGAs appear to activate exclusively capsaicin-sensitive or TRPV11 sensory neurons (Mutoh et al, 1998). Indeed, volatile anesthetics such as isoflurane and desflurane are perceived as pungent and cause airway irritation when inhaled, which has limited their use as induction agents (Eger, 1995;TerRiet et al, 2000). Following up on these findings showed that these VGAs directly activate TRPA1 and sensitize TRPV1 Matta et al, 2008;Eilers et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

The Pore Loop Domain of TRPV1 Is Required for Its Activation by the Volatile Anesthetics Chloroform and Isoflurane

Kimball

Luo

Yin

et al. 2015

Molecular Pharmacology

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The environmental irritant chloroform, a naturally occurring small volatile organohalogen, briefly became the world's most popular volatile general anesthetic (VGA) before being abandoned because of its low therapeutic index. When chloroform comes in contact with skin or is ingested, it causes a painful burning sensation. The molecular basis for the pain associated with chloroform remains unknown. In this study, we assessed the role of transient receptor potential (TRP) channel family members in mediating chloroform activation and the molecular determinants of VGA activation of TRPV1. We identified the subpopulation of dorsal root ganglion (DRG) neurons that are activated by chloroform. Additionally, we transiently expressed wild-type or specifically mutated TRP channels in human embryonic kidney cells and used calcium imaging or wholecell patch-clamp electrophysiology to assess the effects of chloroform or the VGA isoflurane on TRP channel activation. The results revealed that chloroform activates DRG neurons via TRPV1 activation. Furthermore, chloroform activates TRPV1, and it also activates TRPM8 and functions as a potent inhibitor of the noxious chemical receptor TRPA1. The results also indicate that residues in the outer pore region of TRPV1 previously thought to be required for either proton or heat activation of the channel are also required for activation by chloroform and isoflurane. In addition to identifying the molecular basis of DRG neuron activation by chloroform and the opposing effects chloroform has on different TRP channel family members, the findings of this study provide novel insights into the structural basis for the activation of TRPV1 by VGAs.

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“…In contrast to isoflurane, a high concentration of sevoflurane did not alter HR but caused MAP to decrease, probably because of its direct effect on vascular smooth muscle. Because sevoflurane is less pungent than isoflurane, 18 differences in the hemodynamic variables between isoflurane and sevoflurane might have resulted from their different potentials to elicit airway irritation. This finding corresponds to the results of Tanaka et al 8 showing that a stepwise increase in isoflurane concentration from 0.9 MAC to 2.7 MAC elicited tachycardia and hypertension but that sevoflurane did not induce hyperdynamic responses.…”

mentioning

confidence: 99%

Les valeurs de l’index bispectral ne correspondent pas a la réponse hémodynamique à la suite de l’augmentation rapide de la concentration d’isoflurane

Nakayama

Hayashi

Ichinose

et al. 2001

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To investigate the changes in hemodynamic variables and bispectral index (BIS) in response to a rapid increase in isoflurane or sevoflurane concentration.M Me et th ho od d: : Thirty adult patients were anesthetized with either isoflurane (isoflurane group) or sevoflurane (sevoflurane group). Two minutes after induction of anesthesia with thiamylal, the inspired concentrations of isoflurane and sevoflurane were rapidly increased from 0.5 minimum alveolar anaesthetic concentration (MAC) to 3 MAC and maintained for five minutes. Heart rate (HR), mean arterial pressure (MAP), and BIS were measured every minute.R Re es su ul lt ts s: : An increase in the anesthetic concentration caused increases in HR and MAP in the isoflurane group and a decrease in MAP in the sevoflurane group. Consequently, HR and MAP in the isoflurane group were significantly higher than those in the sevoflurane group. After inhalation of high concentrations, BIS significantly and progressively decreased in both groups.

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Which is most pungent: isoflurane, sevoflurane or desflurane?

Cited by 100 publications

References 7 publications

Adverse airway events during brief nasal inhalations of volatile anaesthetics: the effect of humidity and repeated exposure on incidence in volunteers preselected by response to desflurane*

Adverse airway events during brief nasal inhalations of volatile anaesthetics: the effect of humidity and repeated exposure on incidence in volunteers preselected by response to desflurane*

The Pore Loop Domain of TRPV1 Is Required for Its Activation by the Volatile Anesthetics Chloroform and Isoflurane

Les valeurs de l’index bispectral ne correspondent pas a la réponse hémodynamique à la suite de l’augmentation rapide de la concentration d’isoflurane

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