1. Volatile anesthetics (not nitrous oxide) directly relax skeletal muscle (most prominent >1 MAC) and potentiate the action of neuromuscular blocking drugs. (The infusion rate of rocuronium required to maintain neuromuscular blockade is 30%–40% less with isoflurane, desflurane, and sevoflurane than with propofol.)
2. Although the mechanism of this potentiation is not entirely clear, it appears to be largely caused by a postsynaptic effect at the nicotinic acetylcholine receptors located at the neuromuscular junction. (Volatile anesthetics act synergistically with neuromuscular blocking drugs to enhance their action.)
3. All volatile anesthetics serve as triggers for malignant hyperthermia (halothane greatest and desflurane less), but nitrous oxide is only a weak trigger.

Inhaled Anesthetics

1. Pharmacokinetic Principles
2. Clinical Overview of Current Inhaled Anesthetics
3. Neuropharmacology of Inhaled Anesthetics
4. The Circulatory System
5. The Pulmonary System
6. Hepatic Effects
7. Neuromuscular System and Malignant Hyperthermia
8. Genetic Effects, Obstetric Use, and Effects on Fetal Development
9. Anesthetic Degradation by Carbon Dioxide Absorbers
10. Anesthetic Metabolism
11. Clinical Utility of Volatile Anesthetics
12. Pharmacoeconomics and Value-Based Decisions