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Anesthesiologists have several tools for diminishing pain, awareness, movement, and the hemodynamic derangements of stress in the surgical patient. Gaseous anesthetics used most commonly today are a single gas nitrous oxide and volatile fluorinated liquids (isoflurane, desflurane, sevoflurane) administered via specific vaporizers that transform the liquids into gases that diminish and, at higher doses, eradicate patient awareness. This activity reviews the history, proposed function, clinical significance, and pertinent issues concerning of gaseous anesthetics. Objectives: Review the use, advantages, and disadvantages of sevoflurane, isoflurane, desflurane, and nitrous oxide. Explain the risk and treatment of malignant hyperthermia. Outline the physiologic effects of sevoflurane, isoflurane, desflurane, and nitrous oxide. Summarize the types, advantages, and disadvantages of gaseous anesthetic agents and outline the role of the interprofessional team in providing pain relief using these medications. Access free multiple choice questions on this topic.

The history of anesthesia is relatively recent, often traced to the dentist Horace Wells, who demonstrated the use of nitrous oxide during a dental extraction in the early 1800s. The first public showing of anesthesia occurred in October 1846, when ether was used to prevent pain during surgery at Massachusetts General Hospital. The following year, in 1847, Scottish obstetrician James Y. Simpson began using chloroform to treat childbirth pain. In 1956, halothane came into clinical practice, but it caused fulminant hepatic necrosis, which promoted the development of new inhaled agents. Methoxyflurane came into clinical use in 1960 but was found to metabolize to nephrotoxic inorganic fluoride. In 1972, enflurane was an improvement because it was not hepatotoxic and did not cause myocardial sensitivity to catecholamines, unlike halothane. However, enflurane is also metabolized to inorganic fluoride, linked to increased seizure activity.[1] Today, anesthesiologists have several tools for diminishing pain, awareness, movement, and the hemodynamic derangements of stress in the surgical patient. Gaseous anesthetics, used most commonly today, are a single gas (nitrous oxide) and volatile fluorinated liquids (isoflurane, desflurane, sevoflurane), which are administered via specific vaporizers that transform the liquids into gases that diminish and, at higher doses, eradicate patient awareness.

When gaseous anesthetics are in use, it is of paramount importance that everyone in the operating room and/or procedural site communicates well in preparation for their use and potential adverse effects. During all inductions of general anesthesia, the operating room nurse, anesthesiologist/nurse anesthetist, and surgeon should all be attentive and ready to assist in securing the patient's airway. Ideally, the operating room nurse is at the patient's side to assist the anesthesiologist and/or anesthetist, and in cases of an anticipated difficult airway, the surgeon should be in the room ready to establish an invasive airway. Studies overall have been inconsistent in showing other adverse effects to healthcare workers occupationally exposed to modern gaseous anesthetics. None have been shown to be teratogenic; however, nitrous oxide in large amounts can cause megaloblastic anemia due to a functional vitamin B12 deficiency. Since the 1970s, studies have investigated the effects of waste anesthetic gases on healthcare workers regularly exposed to them. There is a suspected association with an increased relative risk for spontaneous abortions in women who are occupationally exposed to waste gaseous anesthetics. However, there are no official standards from the Occupational Safety and Health Administration (OSHA) regarding acceptable exposure limits.[13][14] The safety and health of everyone in the operating room are aided when anesthesiologists, anesthetists, and anesthesia technicians ensure that scavenging systems are in place and working. Operating room nurses can confirm that operating room ventilation is active, and anesthesia providers can use low-gas-flow approaches to deliver general anesthesia, thereby minimizing gaseous anesthetic waste.[15] In light of this, an interprofessional team approach is the most prudent course when gaseous anesthetics are in use; this applies to both the patient and those in the operating theater who are performing and assisting with the procedure. The surgeon, other physicians, anesthesiologist/nurse anesthetist, and medical/surgical nursing professionals working together as a team can ensure the optimal outcome for the patient and all OR personnel involved.