title: Which is most pungent: isoflurane, sevoflurane or desflurane?
abstract: We compared the pungency and tolerability of three inhaled anaesthetics in a randomized, double-blind study. Eighty-one unpremedicated patients (n = 27, each group) inhaled 2 MAC of isoflurane (2.3%), desflurane (12%) or sevoflurane (4%) for 60 s from an anaesthetic breathing circuit via a mask. Two blinded observers recorded coughing, complaints of burning and irritation, and how long the inhalation was tolerated. One sevoflurane patient coughed, but completed the study period, whereas 11 isoflurane patients and 20 desflurane patients coughed, objected verbally or removed the mask forcefully. All sevoflurane, 20 isoflurane and seven desflurane patients completed the study period (average 60, 49 and 33 s, respectively, P < 0.05). The irritability grading was: desflurane > isoflurane > sevoflurane (P < 0.05). Sevoflurane is the least irritating agent for inhalation at 2 MAC concentration.
authors.affiliation: Anesthesiology Service, VA Medical Center, Miami, FL 33125, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: TerRiet
authors.forename: G J
authors.initials: GJ
authors.lastname: DeSouza
authors.forename: J S
authors.initials: JS
authors.lastname: Jacobs
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.forename: M C
authors.initials: MC
authors.lastname: Lewis
authors.forename: C
authors.initials: C
authors.lastname: Herrington
authors.forename: M I
authors.initials: MI
authors.lastname: Gold
mesh_terms: D000764:Anesthesia, Closed-Circuit; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000077335:Desflurane; D004311:Double-Blind Method; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects* / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D017060:Patient Satisfaction; D000077149:Sevoflurane; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane