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. 2021 Apr;70(4):343-355.
doi: 10.1007/s00101-020-00908-1.

[Inhalational anesthetics]

[Article in German]
Jan Jedlicka  1 , Philipp Groene  2 , Julia Linhart  2 , Elisabeth Raith  2 , Da Vy Mu Stapha  2 , Peter Conzen  2
Affiliations

[Inhalational anesthetics]

[Article in German]
Jan Jedlicka et al. Anaesthesist. 2021 Apr.

Abstract
in English, German

Inhalational anesthetics have been used for induction and maintenance of general anesthesia for more than 150 years. All of the currently used inhalational anesthetics are chlorinated and fluorinated derivatives of ether. Dosing is carried out using the minimal alveolar concentration (MAC) concept. The pharmacokinetic properties of the various inhalational anesthetics are governed by the specific distribution coefficients. Mechanisms of action include specific modulations of various receptors of the central nervous system as well as an unspecific interaction with the cell membrane. Organ toxicity of modern inhalational anesthetics is considered to be minimal. The role of inhalational anesthetics in the context of postoperative nausea and vomiting (PONV) has been reassessed in recent years. The superiority of inhalational anesthetics over intravenous hypnotics with respect to intraoperative awareness is undisputed. The organ protective mechanism of preconditioning is an exclusive property of inhalational anesthetics among all the currently available hypnotics.

Inhalationsanästhetika werden seit mehr als 150 Jahren zur Durchführung von Allgemeinanästhesien verwendet. Alle heute verwendeten Substanzen sind chlorierte und fluorierte Ätherderivate. Ihre Dosierung erfolgt nach dem Konzept der „minimal alveolar concentration“ (MAC). Die pharmakokinetischen Eigenschaften der einzelnen Inhalationsanästhetika werden durch spezifische Verteilungskoeffizienten beschrieben. Die Wirkmechanismen umfassen spezifische Modulationen verschiedener Rezeptoren des Zentralnervensystems (ZNS) und eine unspezifische Interaktion an der Zellmembran. Die Organtoxizität heutiger Inhalationsanästhetika wird als minimal erachtet. Die Rolle von Inhalationsanästhetika im Zusammenhang mit „postoperative nausea and vomiting“ (PONV) ist in den letzten Jahren neu bewertet worden. Unbestritten ist die Überlegenheit von Inhalationsanästhetika gegenüber i.v.-Hypnotika bezüglich intraoperativer Awareness. Den organprotektiven Mechanismus der Präkonditionierung bieten unter den heute verfügbaren Narkosemitteln einzig die Inhalationsanästhetika.

Keywords: Anesthetic gases; Desflurane; Intraoperative awareness; Sevoflurane; Volatile anesthetics.

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References

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