Sevoflurane and Anesthesia for Neurosurgery

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Abstract
Summary: This review assesses the extent to which sevoflurane fulfills the requirements of the ideal inhalational agent for use in neuroanesthetic practice. Sevoflurane's phar- macokinetic profile is outlined. Data from animal and human studies are used to discuss its effects on cerebral hemodynamics, central nervous system monitoring, and cardio- vascular parameters. Where possible, sevoflurane is compared with isoflurane, currently considered the inhalational agent of choice in neuroanesthesia. Sevoflurane's potential for toxicity is reviewed. Key Words: Anesthetics-Autoregulation-Blood flow-Brain- Compound A-Renal-Sevoflurane-Toxicity-Volatile Sevoflurane is a relatively new fluorinated ether inha- lational agent which is characterized by a low blood/gas partition coefficient. This confers titratability making sevoflurane a potentially useful drug in the neurosurgical setting. Table 1 lists those properties considered to be ideal in an inhalational agent for use in neuroanesthesia. The effects of sevoflurane on the central nervous system have been extensively studied in both animal models and humans and appear to compare favorably with conven- tionally used agents, in particular isoflurane. However, sevoflurane's potential for toxicity due to its relatively high rate of metabolism and its reaction with carbon di- oxide (CO2) absorbents has been a source of considerable concern. This review addresses the extent to which sevo- flurane fulfills the requirements of a safe neuroanesthetic drug and whether it is a useful addition to our practice. HISTORY