Skip to main content
Log in

A novel intravenous general anesthetic — emulsified isoflurane: from bench to bedside

  • Review
  • Published:
Frontiers of Medicine Aims and scope Submit manuscript

Abstract

Application of volatile anesthetics greatly alters modern medicine. There are obvious advantages of volatile anesthetics such as strong anesthetic potency, rapid onset and elimination through respiration system. Isoflurane is one of the most widely used volatile anesthetics in clinic. Emulsified isoflurane, the emulsion of isoflurane, is a novel intravenous general anesthetic. With the development of emulsified isoflurane in the past fifteen years, its utility has spread from intravenous general anesthesia to various fields including regional anesthesia, organ protection, as well as anesthetic pharmacological study. In this review, we will summarize literatures of emulsified isoflurane about its history, clinical application and future potential utility in the above mentioned fields.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mazze RI. Methoxyflurane revisited: tale of an anesthetic from cradle to grave. Anesthesiology 2006; 105(4): 843–846

    Article  PubMed  CAS  Google Scholar 

  2. Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM. Halothane-induced hepatitis: a forgotten issue in developing countries. Hepat Mon 2011; 11(1): 3–6

    PubMed  Google Scholar 

  3. Brasil LJ, San-Miguel B, Kretzmann NA, Amaral JL, Zettler CG, Marroni N, González-Gallego J, Tuñón MJ. Halothane induces oxidative stress and NF-kappaB activation in rat liver: protective effect of propofol. Toxicology 2006; 227(1–2): 53–61

    Article  PubMed  CAS  Google Scholar 

  4. Lucchinetti E, Schaub MC, Zaugg M. Emulsified intravenous versus evaporated inhaled isoflurane for heart protection: old wine in a new bottle or true innovation? Anesth Analg 2008; 106(5): 1346–1349

    Article  PubMed  Google Scholar 

  5. Spencer JA, Green NM. Suicide by ingestion of halothane. JAMA 1968; 205(10): 702–703

    Article  PubMed  CAS  Google Scholar 

  6. Sutton J, Harrison GA, Hickie JB. Intravenous halothane. Lancet 1971; 297(7694): 345–346

    Article  Google Scholar 

  7. Sandison JW, Sivapragasam S, Hayes JA, Woo-Ming MO. An experimental study of pulmonary damage associated with intravenous injection of halothane in dogs. Br J Anaesth 1970; 42(5): 419–424

    Article  PubMed  CAS  Google Scholar 

  8. Sutton J, Harrison GA, Hickie JB. Accidental intravenous injection of halothane. Case report. Br J Anaesth 1971; 43(5): 513–520

    Article  PubMed  CAS  Google Scholar 

  9. Krantz JC Jr, Cascorbi HF, Rudo FG. Anesthesia. 64. The intravenous administration of methoxyflurane (Penthrane) emulsions in animals and man. Anesth Analg 1962; 41: 257–262

    Article  PubMed  CAS  Google Scholar 

  10. Cascorbi HF, Helrich M, Krantz JC Jr, Baker LR, Rozman RS, Rudo FG. Hazards of methoxyflurane emulsions in man. Anesth Analg 1968; 47(5): 557–559

    Article  PubMed  CAS  Google Scholar 

  11. Eger RP, MacLeod BA. Anaesthesia by intravenous emulsified isoflurane in mice. Can J Anaesth 1995; 42(2): 173–176

    Article  PubMed  CAS  Google Scholar 

  12. Ma HX, Li J, Yang ZB, Yang XL, Liu AJ, Yang JW, Rao Y, Luo NF, Zhang WS, Liu J. Comparison of emulsified isoflurane and propofol with intravenous injection in Beagle dogs. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi) 2006; 26(9): 862–863 (in Chinese)

    Google Scholar 

  13. Johannesson G, Alm P, Biber B, Lennander O, Werner O. Halothane dissolved in fat as an intravenous anaesthetic to rats. Acta Anaesthesiol Scand 1984; 28(4): 381–384

    Article  PubMed  CAS  Google Scholar 

  14. Fast JP, Perkins MG, Pearce RA, Mecozzi S. Fluoropolymer-based emulsions for the intravenous delivery of sevoflurane. Anesthesiology 2008; 109(4): 651–656

    Article  PubMed  CAS  Google Scholar 

  15. Jee JP, Parlato MC, Perkins MG, Mecozzi S, Pearce RA. Exceptionally stable fluorous emulsions for the intravenous delivery of volatile general anesthetics. Anesthesiology 2012; 116(3): 580–585

    Article  PubMed  Google Scholar 

  16. Jia MX, Luo NF, Zhang WS, Zhou JX, Liu J. Partition coefficients of volatile anesthetics in lipid emulsion and its components. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi) 2004; 19(6): 422–425 (in Chinese)

    Google Scholar 

  17. Zhou JX, Liu J. The effect of temperature on solubility of volatile anesthetics in human tissues. Anesth Analg 2001; 93(1): 234–238

    Article  PubMed  CAS  Google Scholar 

  18. Zhou JX, Liu YQ, Liu J. Combined effect of hypothermia and crystalloid hemodilution on the solubility of volatile anesthetics in human blood. Chin Med J (Engl) 2002; 115(7): 1014–1019

    CAS  Google Scholar 

  19. Zhou JX, Luo NF, Liu J. Saturated concentration of emulsified isoflurane at 20°C and its anesthetic potency for intravenous injection in rats. J Beijing Med (Bei Jing Yi Xue) 2004; 26(6): 376–378 (in Chinese)

    Google Scholar 

  20. Zhou JX, Luo NF, Liang XM, Liu J. The efficacy and safety of intravenous emulsified isoflurane in rats. Anesth Analg 2006; 102(1): 129–134

    Article  PubMed  CAS  Google Scholar 

  21. Ma HX, Yang ZB, Yang XL, Liu AJ, Yang JW, Rao Y, Luo NF, Zhang WS, Liu J. Determination of intravenous emulsified isoflurane MAC and its circulatory effects in Beagle dogs. J Clin Anesthesiol (Lin Chuang Ma Zui Xue) 2007; 23(10): 836–838 (in Chinese)

    CAS  Google Scholar 

  22. Yang XL, Ma HX, Yang ZB, Liu AJ, Luo NF, Zhang WS, Wang L, Jiang XH, Li J, Liu J. Comparison of minimum alveolar concentration between intravenous isoflurane lipid emulsion and inhaled isoflurane in dogs. Anesthesiology 2006; 104(3): 482–487

    Article  PubMed  CAS  Google Scholar 

  23. Rao Y, Wang YL, Zhang WS, Yang XL, Ma HX, Yang JW, Liu AJ, Yang ZB, Liu J. The hemolytic effect of emulsified isoflurane after single bolus in Beagle dogs. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi) 2006; 7(26): 666–667 (in Chinese)

    Google Scholar 

  24. Yang ZB, Yang XL, Zhang WS, Ma HX, Liu AJ, Rao Y, Yang JW, Liu J. Toxicity study on long-term intravenous administration of emulsified isoflurane in rats. J Clin Anesthesiol (Lin Chuang Ma Zui Xue) 2008; 24(9): 112–115 (in Chinese)

    Google Scholar 

  25. Sun HF, Wang QY, Liang XM, Zhang ZX, Liu J. The efficacy and safety of emulsified isoflurane after intraperitoneal injection in rats. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi) 2004; 24(1): 51–53 (in Chinese)

    Google Scholar 

  26. Lin HX, Luo NF, Liu J, Yang J, Li Q. The sedative and hypnotic effects and safety of oral emulsified isoflurane in rats. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban) 2010; 41(5): 862–864, 887 (in Chinese)

    CAS  Google Scholar 

  27. Yang JW, Yi ML, Chai YF, Zhang WS, Liu J. Fentanyl hypnotic interaction with emulsified isoflurane. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban) 2007; 38(6): 973–976 (in Chinese)

    CAS  Google Scholar 

  28. Yang JW, Chen Y, Gao AL, Zhang WS, Liu J. Interaction between fentanyl with emulsified isoflurane.West China J Pharm Sci (Hua Xi Yao Xue Za Zhi) 2007; 22(5): 529–532 (in Chinese)

    CAS  Google Scholar 

  29. Haynes DH, Kirkpatrick AF. Long duration local anesthesia with lecithin-coated microdroplets of methoxyflurane: studies with human skin. Reg Anesth 1991; 16(3): 173–180

    PubMed  CAS  Google Scholar 

  30. Kirkpatrick AF, Lavallee-Grey M, Haynes DH. Long duration local anesthesia with lecithin-coated microdroplets of methoxyflurane: studies with rat skin. Reg Anesth 1991; 16(3): 164–172

    PubMed  CAS  Google Scholar 

  31. Haynes DH, Kirkpatrick AF. Ultra-long-duration local anesthesia produced by injection of lecithin-coated methoxyflurane microdroplets. Anesthesiology 1985; 63(5): 490–499

    Article  PubMed  CAS  Google Scholar 

  32. Chai YF, Yang J, Liu J, Song HB, Yang JW, Liu SL, Zhang WS, Wang QW. Epidural anaesthetic effect of the 8% emulsified isoflurane: a study in rabbits. Br J Anaesth 2008; 100(1): 109–115

    Article  PubMed  CAS  Google Scholar 

  33. Zhou C, Wu W, Liu J, Liao DQ, Kang Y, Chen XD. Inhibition of voltage-gated sodium channels by emulsified isoflurane may contribute to its subarachnoid anesthetic effect in beagle dogs. Reg Anesth Pain Med 2011; 36(6): 553–559

    PubMed  CAS  Google Scholar 

  34. Zhou C, Gan J, Liu J, Luo WJ, Zhang WS, Chai YF. The interaction between emulsified isoflurane and lidocaine is synergism in intravenous regional anesthesia in rats. Anesth Analg 2011; 113(2): 245–250

    Article  PubMed  CAS  Google Scholar 

  35. Li Z, Yang J, Liu J, Gong CY, Gan J, Zhang X, Luo WJ, Li GH. Reversible conduction block in isolated toad sciatic nerve by emulsified isoflurane. Anesth Analg 2010; 110(4): 1024–1029

    Article  PubMed  CAS  Google Scholar 

  36. Chiari PC, Pagel PS, Tanaka K, Krolikowski JG, Ludwig LM, Trillo RA Jr, Puri N, Kersten JR, Warltier DC. Intravenous emulsified halogenated anesthetics produce acute and delayed preconditioning against myocardial infarction in rabbits. Anesthesiology 2004; 101(5): 1160–1166

    Article  PubMed  CAS  Google Scholar 

  37. Liu XL, Liu J. Effects of emulsified isoflurane and intralipid on ischemia-reperfusion injury in isolated rat heart. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi) 2007; 22(5): 525–527 (in Chinese)

    CAS  Google Scholar 

  38. Hu Q, Wang J, Chang X, Long C. Cardioprotective effects of emulsified isoflurane strengthened cardioplegia on ischemia-reperfusion injury in isolated rat hearts. J Clin Med Pract (Shi Yong Lin Chuang Yi Yao Za Zhi) 2009; 13(1): 5–8 (in Chinese)

    Google Scholar 

  39. Huang H, Zhang W, Liu S, Yanfang C, Li T, Liu J. Cardioprotection afforded by St Thomas solution is enhanced by emulsified isoflurane in an isolated heart ischemia reperfusion injury model in rats. J Cardiothorac Vasc Anesth 2010; 24(1): 99–103

    Article  PubMed  Google Scholar 

  40. Liu SL, Liu J. Apoptosis mechanism of intralipid postconditioning to reduce ischemia reperfusion injury of isolated rat hearts. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban) 2007; 38(4): 663–666 (in Chinese)

    CAS  Google Scholar 

  41. Chen YQ, Jin XJ, Dai ZP, Zhang WS, Liu J. Effects of emulsified isoflurane induced preconditioning on cardiac hemodynamic during myocardiac ischemia-reperfusion injury in rabbits. J Anesthesiol Resusc (Guo Ji Ma Zui Xue Yu Fu Su Za Zhi) 2006; 27(4): 224–226 (in Chinese)

    CAS  Google Scholar 

  42. Rao Y, Wang YL, Zhang WS, Liu J. Emulsified isoflurane produces cardiac protection after ischemia-reperfusion injury in rabbits. Anesth Analg 2008; 106(5): 1353–1359

    Article  PubMed  CAS  Google Scholar 

  43. Rao Y, Wang YL, Chen YQ, Zhang WS, Liu J. Protective effects of emulsified isoflurane after myocardial ischemia-reperfusion injury and its mechanism in rabbits. Chin J Traumatol 2009; 12(1): 18–21

    PubMed  CAS  Google Scholar 

  44. Yang MC, Chen YP, Cao DJ, Qian X, Li P. The optimal concentration for the protective effect of emulsified isoflurane on the neonatal rat cardiac myocytes hypoxia/reoxygenation injury of primary culture. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban) 2009; 40(6): 1075–1077, 1090 (in Chinese)

    CAS  Google Scholar 

  45. Hu ZY, Luo NF, Liu J. The protective effects of emulsified isoflurane on myocardial ischemia and reperfusion injury in rats. Can J Anaesth 2009; 56(2): 115–125

    Article  PubMed  Google Scholar 

  46. Tan XQ, Chen YP, Zhang WS, Liu J. Effect of emulsified isoflurane on myocardial apoptosis and expressions of bcl-2 and bax induced by hypoxia-reoxygenation. J Third Mil Med Univ (Di San Jun Yi Da Xue Xue Bao) 2008; 30(17): 1611–1614 (in Chinese)

    CAS  Google Scholar 

  47. Tan XQ, Chen YP. Emulsified isoflurane protects hypoxia/ reoxgenation injury in cultured neonatal rat myocardial cells by suppressing caspase-3 expression. J Third Mil Medical Univ (Di San Jun Yi Da Xue Xue Bao) 2009; 31(14): 1341–1344 (in Chinese)

    CAS  Google Scholar 

  48. Lv H, Yang LQ, Yu WF, Li Q, Ren HM, Zhu M, Xu LY. Protection of liver against ischemia/reperfusion injury by Kupffer cell mediated emulsified isoflurane preconditioning: experiment with rats. Natl Med J China (Zhonghua Yi Xue Za Zhi) 2007; 35(87): 2468–2471 (in Chinese)

    Google Scholar 

  49. Zhang L, Luo N, Liu J, Duan Z, Du G, Cheng J, Lin H, Li Z. Emulsified isoflurane preconditioning protects against liver and lung injury in rat model of hemorrhagic shock. J Surg Res 2011; 171(2): 783–790

    Article  PubMed  CAS  Google Scholar 

  50. Lv X, Wang ZM, Huang SD, Song SH, Wu FX, Yu WF. Emulsified isoflurane preconditioning reduces lung injury induced by hepatic ischemia/reperfusion in rats. Int J Med Sci 2011; 8(5): 353–361

    Article  PubMed  CAS  Google Scholar 

  51. Wang Y, Zhang WS, Deng L, Liu J. Protective effect of 8% emulsified isoflurane against focal cerebral ischemia-reperfusion injury in rats. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi) 2008; 23(2): 140–142 (in Chinese)

    CAS  Google Scholar 

  52. Wang YL, Wang ZP, Zhu W. Effect of preconditioning with different doses of emulsified isoflurane on focal cerebral ischemiareperfusion injury in rats. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi) 2010; 30(10): 1243–1246 (in Chinese)

    CAS  Google Scholar 

  53. Yang J, Chai YF, Gong CY, Li GH, Luo N, Luo NF, Liu J. Further proof that the spinal cord, and not the brain, mediates the immobility produced by inhaled anesthetics. Anesthesiology 2009; 110(3): 591–595

    Article  PubMed  CAS  Google Scholar 

  54. Yang J, Li Z, Gong CY, Chai YF, Li T, Li GH, Luo N, Luo NF, Zhu L, Liu J. A model for the preferential delivery of isoflurane to the spinal cord of the goat. Vet J 2011; 187(2): 239–244

    Article  PubMed  CAS  Google Scholar 

  55. Hang LH, Shao DH, Yang YH, Dai TJ, Zeng YM. Spinal alphaamino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors may mediate the analgesic effects of emulsified halogenated anaesthetics. Clin Exp Pharmacol Physiol 2007; 34(11): 1121–1125

    PubMed  CAS  Google Scholar 

  56. Hang LH, Dai TJ, Zeng YM. Spinal N-methyl-D-aspartate receptors may mediate the analgesic effects of emulsified halogenated anesthetics. Pharmacology 2006; 76(3): 105–109

    Article  PubMed  CAS  Google Scholar 

  57. Chen Y, Dai TJ, Zeng YM. Strychnine-sensitive glycine receptors mediate the analgesic but not hypnotic effects of emulsified volatile anesthetics. Pharmacology 2007; 80(2–3): 151–157

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jin Liu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, C., Liu, J. A novel intravenous general anesthetic — emulsified isoflurane: from bench to bedside. Front. Med. 6, 381–387 (2012). https://doi.org/10.1007/s11684-012-0229-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-012-0229-z

Keywords

Navigation