Article Data

  • Views 1009
  • Dowloads 134


Open Access

Do Inhalational Anesthetic Agents Still Hold Their Place in Modern Anesthesia Practice?


1Department of Anesthesiology and Intensive Care, Institute of Oncology Ljubljana

2 Clinical Department of Anesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia

3 Medical Faculty, University of Ljubljana, Slovenia

DOI: 10.22514/SV152.092019.1 Vol.15,Issue 2,September 2019 pp.14-17

Published: 20 September 2019

*Corresponding Author(s): IZTOK POTOČNIK E-mail:


Inhalational anesthetic agents are chemi-cal substances that are administered into the body via lungs and distributed to or-gans and tissues by blood circulation.The main site of their action is the brain, but they also affect other parts of central nervous system. Volatile and intravenous anesthetics alike have nearly reached the characteristics of an ideal anesthetic, but at a first glance, the increase in use of in-travenous anesthetics could likely push out their volatile counterparts. Looking at the situation more thoroughly, positive side effects of volatile anesthetics that are not found in their intravenous counterparts, still give them a place in modern anesthe-sia practice. It is also possible to combine both techniques to reduce negative adverse effects, while making use of the positive ones.opioids, nitrogenous oxide, muscle relax-ants). Most often, we use them in so called “balanced anesthesia”. This way, safety is increased, while negative adverse effects are decreased.

Recently, TCI (target-controlled anesthe-sia) with intravenous anesthetics is being used more and more. It would appear that intravenous anesthetics are going to com-pletely push out the volatile anesthetics that had been used a lot in the past. But is this really going to happen?

Cite and Share

IZTOK POTOČNIK,ANDREJ HOSTNIK,JASMINA MARKOVIČ BOŽIČ. Do Inhalational Anesthetic Agents Still Hold Their Place in Modern Anesthesia Practice?. Signa Vitae. 2019. 15(2);14-17.


1. Antkowiak B, Grasshoff C. Volatile Anästhetika: Modellsubstanzen für Medikamente von morgen? V: Antkowiak B, Grasshoff Ch. Allgemeinanästhetika 5.Band. Ludwigshafen 2013: 41-51.

2. Kaiser MJ, Setola V, Irwinn JJ, Laggner C, Abbas AI, Hufeisen SJ, et al. Predicting new molecular targets for known drugs. Nature 2009 (462): 175-81.

3. Paul SM, Mytelka DS, Dunwiddie CT, Persinger CC, Munos BH, Lindborg SR, et al. How to improve R&D productivity: the pharma-ceutical industry's grand challenge. Nat Rev Drug Discov 2010 (9): 203-14.

4. Pujol A, Mosca R, Farres J, Aloy P. Unveiling the role of network and systems biology in drug discovery. Trends Pharmacol Sci 2010 (31): 115-23.

5. Hopkins AL. Network pharmacology: the next paradigm in drug discovery. Nat Chem Biol 2008 (4): 682-90.

6. Tylman M, Sarbinowski R, Bengtson JP, Kvarnström A, Bengtson A. Inflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anaestetic techniques. Minerva Anestesiol. 2011;77:275-82.

7. Orosz JE, Braz MG, Golim MA, Barreira MA, Fecchio D, Braz LG, et al. Cytokine profile in patients undergoing minimally invasive surgery with balanced anesthesia. Inflammation 2012;35(6):1807-13.

8. Jakobsen CJ, Berg H, Hindsholm KB, Faddy N, Sloth E. The influence of propofol versus sevoflurane anesthesia on outcome in 10 535 cardiac surgical procedures. J Cardiothorac Vasc Anesth 2007;21:664-71.

9. Jerin A, Požar-Lukanovič N, Sojar V, Stanisavljevic D, Paver-Erzen V, Osredkar J. Balance of pro- and anti-inflammatory cytokines in liver surgery. Clin Chem Lab Med 2003;41:899-903.

10. Lahat N, Zlotnick AY, Shtiller R, Bar I, Merin G. Serum levels of IL-1, IL-6 and TNF in patients undergoing coronary artery bypass grafts on cholecystectomy. Clin Exp Immunol 1992;89:255-60.

11. McBride WT, Armstrong MA, Crockard AD, et al. Selective reduction in leukocyte antigen expression following high dose fentanyl administration at cardiac surgery. B Jr Anaesth 1994;73:717-8.

12. Rosanno F, Tufano R, Cipollaro de L'Ero G, Servillo G, Baroni A, Tufano MA.. Anaesthetic agents induce human mononuclear leu-kocytes to release cytokines. Immunopharmacol Immunotoxicol 1992;14:439-50.

13. Straub RH, Herrmann M, Berkmiller G, Frauenholz T, Lang B, Schölmerich J, et al. Neuronal regulation of interleukin-6 secretion in murine spleen: adrenergic and opioidergic control. J Neurochem 1997; 68: 1633-9.

14. Morgan EL. Regulation of human B-lymphocyte activation by opioids peptide hormones. Inhibition of IgG production by opioids receptor class (mu, kappa, and delta) selective agonists. J Neuroimmunol 1996; 65: 21-30.

15. Blum FE, Zuo Z. Volatile anesthetics-induced neuroinflammatory and anti-inflammatory responses. Med Gas Res 2013;3:16.

16. Head BP, Patel P. Anesthetics and brain protection. Curr Opin Anaesthesiol 2007; 20: 395-9.

17. Colucci DG, Puig NR, Hernandez-Pand R. Influence of anaesthetic drugs on immune response: from inflammation to immunosup-pression. OA Anaesthetics 2013;30(3):21.

18. Marik PE. Propofol: an immunomodulating agent. Pharmacotherapy 2005; 25(5 Pt 2):28 -33S.

19. Vasile B, Rasulo F, Candiani A, Latronico N.. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 2003;29(9):1417-25.

20. Diprivan. US food and drug administration 1989. cfm?fuseaction=Search.DrugDetails

21. Ricou B, Bandschap O. Propofol and perioperative inflammation. 2010. accessable on:

22. Xu X, Feng J, Zuo Z. Isoflurane preconditioning reduces the rat NR8383 macrophage injury induced by lipopolysaccharide and in-terferon gamma. Anesthesiology 2008;108(4):643-50.

23. Fuentes JM1, Talamini MA, Fulton WB, Hanly EJ, Aurora AR, De Maio A.. General anesthesia delays the inflammatory response and increases survival for mice with endotoxic shock. Clin Vaccine Immunol 2006;13(2):281-8.

24. Chiang N1, Schwab JM, Fredman G, Kasuga K, Gelman S, Serhan CN.. Anesthetics impact the resolution of inflammation. PLoS One 2008;(3/4):1879.

25. Kosmač N, Kneževič I, Osredkar J, Vidmar G, Paver Eržen V:. Primerjava delovanja sevoflurana in propofola na srčno mišico in ledvica pri operacijah premostitve zožitev venčnih arterij brez uporabe zunajtelesnega krvnega obtoka. In: Novak-Jankovič V ed. 5. slovenski kongres anesteziologov. Portorož, 8.-10. maj 2009. Zbornik predavanj. Ljubljana: Slovensko združenje za anesteziologijo in intenzivno medicino, Slovensko zdravniško društvo, 2009: 253-62.

26. Potočnik I, Novak-Jankovič V, Šoštarič M, Jerin A, Štupnik T, Skitek M, et al. Antiinflammatory effect of sevoflurane in open lung surgery with one-lung ventilation. Croatian medical journal, ISSN 0353-9504, 2014, vol. 55, iss. 6, str. 628-637.

27. Markovic-Bozic J, Karpe B, Potocnik I, Jerin A, Vranic A, Novak-Jankovic V. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiol 2016; 16:18 DOI 10.1186/s12871-016-0182-5.

28. Schifilliti D, Grasso G, Conti A, Fodale V. Anaesthetic-related neuroprotection: intravenous or inhalational agents? CNS Drugs 2010 Nov; 24(11): 893-907.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time