Saraiva Renato Angelo
Hospitais do Aparelho Locomotor, Rede Sarah.
Rev Bras Anestesiol. 2003 Apr;53(2):214-26.
Following the development of nuclear chemistry with halogenate synthesis in the 50s of past century, several anesthetics were clinically studied and some of them had wide practical application. The search for the ideal agent continues. Currently, halothane, isoflurane, enflurane, sevoflurane and desflurane are in clinical use. All have advantages and disadvantages. Desflurane is the newest agent. This study aimed at describing physicochemical and pharmacological properties of desflurane and reporting clinical experiences with this agent.
Physicochemical properties and pharmacokinetic and pharmacodynamic properties of desflurane determine its clinical use. With a low boiling point, it volatizes easily in normal operating room temperatures and its high MAC requires it to be administered in high concentrations. So, the use of low fresh gas flow and special vaporizer is recommended for it to be economically feasible. In addition, the use of coadjuvant anesthetics, such as nitrous oxide, decreases its MAC and allows it to be used in lower concentrations. Its pharmacokinetics provides fast induction and recovery being also worth mentioning that it has a highly stable molecule and is minimally metabolized, thus being well tolerated by the human body. Its pharmacodynamic repercussions are dose-dependent and similar to other potent inhalation anesthetics.
Desflurane is an additional step in the evolution toward the ideal anesthetic agent. Its physicochemical properties give it highly desirable pharmacokinetic characteristics which provide fast induction (progression) and recovery and also minimal metabolic degradation with the lowest organic toxicity among halogenate anesthetics, in addition to strong molecular stability, even in the presence of carbon dioxide absorbents. With special attention regarding vaporization, storage, and consumption, desflurane may be used even in large scale, being economically feasible.
自上世纪50年代卤代合成核化学发展以来，多种麻醉剂进入临床研究，部分已广泛应用。对理想麻醉剂的探索仍在继续。目前，氟烷、异氟烷、恩氟烷、七氟烷和地氟烷均应用于临床。各有优缺点。地氟烷是最新的麻醉剂。本研究旨在描述地氟烷的物理化学和药理学特性，并报告其临床应用经验。
地氟烷的物理化学性质以及药代动力学和药效学性质决定了其临床应用。因其沸点低，在正常手术室温度下易挥发，且其最低肺泡有效浓度（MAC）高，需要高浓度给药。因此，建议使用低新鲜气体流量和特殊蒸发器以使其在经济上可行。此外，使用氧化亚氮等辅助麻醉剂可降低其MAC，使其能以较低浓度使用。其药代动力学特点是诱导和恢复迅速，还值得一提的是它分子高度稳定，代谢极少，因此人体耐受性良好。其药效学反应呈剂量依赖性，与其他强效吸入麻醉剂相似。
地氟烷是向理想麻醉剂发展进程中的又一步。其物理化学性质赋予它非常理想的药代动力学特性，能实现快速诱导（起效）和恢复，代谢降解极少，在卤代麻醉剂中具有最低的有机毒性，分子稳定性强，即使在有二氧化碳吸收剂的情况下也是如此。在汽化、储存和消耗方面加以特别关注，地氟烷甚至可大规模使用，在经济上可行。
