New Inhalational Anesthetics in Infants and Children

  • J. Lerman
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 30)


The methyl ethyl ethers have proven to be a successful series of anesthetics because of several characteristics: molecular stability, non-flammability, lack of arrhythmogenicity, lack of neuronal excitation, cardiovascular stability, large lethal-to-anesthetic concentration ratio, and minimal end-organ effects (1, 2). In this lecture, I shall review the pharmacology of the two new anesthetics, desflurane and sevoflurane, with a particular view to their future roles in pediatric anesthesia.


Soda Lime Inhalational Anesthetic Sevoflurane Anesthesia Inorganic Fluoride Inhalational Induction 
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  1. 1.
    Terrell RC: Physical and chemical properties of anesthetic agents. Br J Anaesth 56:3S–7S, 1984PubMedCrossRefGoogle Scholar
  2. 2.
    Yasuda N, Targ AG, Eger EI II: Solubility of 1–653, sevoflurane, isoflurane and halothane in human tissues. Anesth Analg 69:370–373, 1989PubMedCrossRefGoogle Scholar
  3. 3.
    Yasuda N, Lockhart S, Eger EI II et al: Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg 72:316–324, 1991PubMedCrossRefGoogle Scholar
  4. 4.
    Koblin DD, Eger I. II, Johnson BH et al: 1–653 resists degradation in rats. Anesth Analg 67:534–538, 1988PubMedCrossRefGoogle Scholar
  5. 5.
    Wallin RF, Regan BM, Napoli MD et al: Sevoflurane: A new inhalational anesthetic agent. Anesth Analg 54:758–766, 1975PubMedCrossRefGoogle Scholar
  6. 6.
    Halsey MJ: Investigations on isoflurane, sevoflurane and other experimental anesthetics. Br J Anaesth 53:435–475, 1981CrossRefGoogle Scholar
  7. 7.
    Malviya S, Lerman J: The blood/gas solubilities of sevoflurane, isoflurane, and halothane and serum constituent concentrations in neonates and adults. Anesthesiology 72:793–796, 1990PubMedCrossRefGoogle Scholar
  8. 8.
    Holaday PA, Smith FR: Clinical characteristics and biotransformation of sevoflurane in healthy human volunteers. Anesthesiology 54:100–106, 1981PubMedCrossRefGoogle Scholar
  9. 9.
    Naito Y, Tamai S, Shingu K et al: Comparison between sevoflurane and halothane for pediatric ambulatory anesthesia. Br J Anaesth 67:387–389, 1991PubMedCrossRefGoogle Scholar
  10. 10.
    Lerman J, Sikich N, Kleinman S et al: The pharmacology of sevoflurane in infants and children. Anesthesiology 80:814–824, 1994PubMedCrossRefGoogle Scholar
  11. 11.
    Shiraishi Y, Ikeda K: Uptake and biotransformation of sevoflurane in humans: A comparative study of sevoflurane with halothane, enflurane, and isoflurane. J Clin Anesth 2:381–386, 1990PubMedCrossRefGoogle Scholar
  12. 12.
    Frink Jr. EJ, Malan TP, Isner RJ et al: Renal concentrating function with prolonged sevoflurane or enflurane anesthesia in volunteers. Anesthesiology 80:1019–1025, 1994PubMedCrossRefGoogle Scholar
  13. 13.
    Hanaki C, Fujii K, Morio M et al: Decomposition of sevoflurane by soda lime. Hiroshima J Med Sci 36:61–67, 1987PubMedGoogle Scholar
  14. 14.
    Lerman J: Pharmacology of inhalational anesthetics in infants and children. Pediatr Anesth 2:191–203, 1992CrossRefGoogle Scholar
  15. 15.
    Taylor RH, Lerman J: Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants and children. Anesthesiology 75:975–979, 1991PubMedCrossRefGoogle Scholar
  16. 16.
    Fisher DM, Zwass MS: MAC of desflurane in 60% nitrous oxide in infants and children. Anesthesiology 76:354–356, 1992PubMedCrossRefGoogle Scholar
  17. 17.
    Murray DJ, Mehta MP, Forbes RB et al: Additive contribution of nitrous oxide to halothane MAC in infants and children. Anesth Analg 71:120–124, 1990PubMedCrossRefGoogle Scholar
  18. 18.
    Murray DJ, Mehta MP, Forbes RB: The additive contribution of nitrous oxide to isoflurane MAC in infants and children. Anesthesiology 75:186–190, 1991PubMedCrossRefGoogle Scholar
  19. 19.
    Zwass MS, Fisher DM, Welborn LG et al: Induction and maintenance characteristics of anesthesia with desflurane and nitrous oxide in infants and children. Anesthesiology 76:373–378, 1992PubMedCrossRefGoogle Scholar
  20. 20.
    Taylor R, Lerman J: Induction and recovery characteristics of desflurane in infants and children. Can J Anaesth 39:6–13, 1992PubMedCrossRefGoogle Scholar
  21. 21.
    Doi M, Ikeda K: Airway irritation produced by volatile anesthetics during brief inhalation: Comparison of halothane, enflurane, isoflurane and sevoflurane. Can J Anaesth 40:122–126, 1993PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher DM, Robinson S, Brett CM et al: Comparison of enflurane, halothane, and isoflurane for diagnostic and therapeutic procedures in children with malignancies. Anesthesiology 63:647–650, 1981CrossRefGoogle Scholar
  23. 23.
    Davis PJ, Cohen IT, McGowan FX et al: Recovery characteristics of desflurane versus halothane for maintenance of anesthesia in pediatric ambulatory patients. Anesthesiology 80:298–302, 1994PubMedCrossRefGoogle Scholar
  24. 24.
    Piat V, Dubois MC, Murat I: Comparison of induction and recovery characteristics of sevoflurane and halothane in children (abstract). Br J Anaesth 72 (suppl 1) A178, 1994Google Scholar
  25. 25.
    Taivainen T, Meretoja OA, Tiainen P et al: Sevoflurane versus halothane in pediatric anesthesia (abstract). Br J Anaesth 72 (suppl 1) A177, 1994Google Scholar
  26. 26.
    Eger EI II, Johnson BH: Rates of awakening from anesthesia with I653, halothane, isoflurane, and sevoflurane: A test of the effect of anesthetic concentration and duration in rats. Anesth Analg 66:977–982, 1987PubMedGoogle Scholar
  27. 27.
    Levine M, Sarner J, Lerman J et al: Emergence characteristics after sevoflurane anesthesia in children: A comparison with halothane. Anesth Analg 76:S221, 1993Google Scholar
  28. 28.
    Koblin DD: Characteristics and implications of desflurane metabolism and toxicity. Anesth Analg 75:S10–16, 1992PubMedGoogle Scholar
  29. 29.
    Kharasch ED, Thummel KE: Identification of cytochrome P450 2E1 as the predominant enzyme catalyzing human liver microsomal defluorination of sevoflurane, isoflurane, and methoxyflurane. Anesthesiology 79:795–807, 1993PubMedCrossRefGoogle Scholar
  30. 30.
    Levine M, Sarner J, Lerman J et al: Plasma inorganic fluoride ion concentration in children after prolonged sevoflurane anesthesia. Can J Anaesth 40:A66, 1993Google Scholar
  31. 31.
    Frink EJ, Malan TP, Isner RJ et al: Renal concentrating function with prolonged sevoflurane or enflurane anesthesia in volunteers. Anesthesiology 80:1019–1025, 1994PubMedCrossRefGoogle Scholar
  32. 32.
    Stoelting RK, Peterson C: Methoxyflurane anesthesia in pediatric patients: Evaluation of anesthetic metabolism and renal function. Anesthesiology 42:26–29, 1975PubMedCrossRefGoogle Scholar
  33. 33.
    Wong DT, Lerman J, Volgyesi GA: Factors affecting the disappearance of sevoflurane in baralyme. Can J Anaesth 39:366–369, 1992PubMedCrossRefGoogle Scholar
  34. 34.
    Frink EJ, Malan TP, Morgan SE et al: Quantification of the degradation products of sevoflurane in two CO2 absorbants during low-flow anesthesia in surgical patients. Anesthesiology 77:1064–1069, 1992PubMedCrossRefGoogle Scholar
  35. 35.
    Bito H, Ikeda K: Closed circuit anesthesia with sevoflurane in humans: Effects on renal and hepatic function and concentrations of breakdown products with soda lime in the circuit. Anesthesiology 80:71–76, 1994PubMedCrossRefGoogle Scholar
  36. 36.
    Mazze RI. The safety of sevoflurane in humans (editorial). Anesthesiology 77:1062–1063, 1992PubMedCrossRefGoogle Scholar
  37. 37.
    Gonsowski CT, Laster MJ, Eger EI II et al: Toxicity of compound A in rats: Effect of a 3-hour administration. Anesethesiology 80:556–565, 1994CrossRefGoogle Scholar
  38. 38.
    Gonsowski CT, Laster MJ, Eger II EI et al: Toxicity of compound A in rats: Effect of increasing duration of administration. Anesthesiology 80:566–575, 1994PubMedCrossRefGoogle Scholar
  39. 39.
    Weiskopf RB, Sampson D, Moore MA: The desflurane (TEC 6) vaporizer: Design, design considerations, and performance evaluation. Br J Anaesth 72:474–479, 1994PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media Dordrecht 1995

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  • J. Lerman

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