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Answer

Would you choose an inhalational or an intravenous technique for maintenance of anesthesia?

Answer:

For maintenance of anesthesia, inhalation agents such as sevoflurane and isoflurane can be used. These agents are thought to be superior to desflurane because of its pungent odor that may cause airway irritation and trigger bronchospasm. At lower doses (<1.0 minimum alveolar concentration), the inhaled anesthetics inhibit chemically induced tracheal contractions in the order: enflurane≥ isoflurane> sevoflurane. More recent clinical observations in humans indicate that sevoflurane at 1.1 minimum alveolar concentration may be the most effective agent, particularly in the presence of airway instrumentation. In addition, sevoflurane may have a more rapid onset of bronchodilation than isoflurane.

Desflurane has been shown to cause elevations in airway resistance and tissue mechanical parameters, with markedly enhanced airway narrowing in children with asthma or a recent URI. Therefore, desflurane should be avoided in children with susceptible airways.

Nitrous oxide can also be used, provided that the patient does not have pulmonary hypertension, a condition commonly present in patients with COPD.

For scenarios that require avoidance of inhaled anesthetics, such as patients with history of malignant hyperthermia or cases that require monitoring of motor and somatosensory evoked potentials, intravenous anesthetics can be used for maintenance. Bronchodilating properties of propofol make it a choice intravenous anesthetic for patients with obstructive lung disease. Opioids without histamine-releasing effects and ketamine can be used as adjuncts to the intravenous technique.

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