title: High concentrations of isoflurane do not block the sympathetic nervous system activation from desflurane.
abstract: OBJECTIVE
  The volatile anesthetic desflurane has been associated with neurocirculatory responses that have been relatively refractory to adjuvant treatment. We have employed desflurane to evaluate the integrity of the sympathetic nerve recording after establishment of the anesthetized state with another anesthetic agent. This retrospective evaluation of data from volunteers determined if higher concentrations of isoflurane that were sufficient to block the neurocirculatory response to laryngeal and tracheal stimulation would abolish the neurocirculatory response to desflurane.
  
  
  METHODS
  Data from eight, healthy, young volunteers met our criteria for inclusion. They had been anesthetized with propofol or thiopental and intubated after neuromuscular blockade. Each subject was monitored with radial artery blood pressure (BP), heart rate (HR)(ECG), and sympathetic microneurography. Isoflurane had been administered to achieve a steady state concentration of 1.5 MAC (minimum alveolar concentration) while oxygenation and carbon dioxide were monitored with pulse oximetry and infrared spectrometry, respectively. A deep level of anesthesia was confirmed when laryngoscopy and endotracheal tube movement failed to elicit a neurocirculatory response. A brief exposure to 11% desflurane in the inspired gas was then provided.
  
  
  RESULTS
  The responses to desflurane included significant increases in HR, range 32-84 b/min, and BP, range 15-72 mm Hg (P < 0.05). Sympathetic nerve activity increased substantially in the three volunteers with functional nerve recordings.
  
  
  CONCLUSIONS
  In healthy volunteers receiving 1.5 MAC isoflurane, which was sufficient to block the neurocirculatory response to laryngoscopy and tracheal stimulation, there were striking increases in sympathetic outflow, HR and BP when 11% desflurane was substituted for isoflurane.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin and VA Medical Center, Milwaukee 53295, USA. tjebert@mcw.edu
authors.forename: T J
authors.initials: TJ
authors.lastname: Ebert
authors.forename: T S
authors.initials: TS
authors.lastname: Trotier
authors.forename: S R
authors.initials: SR
authors.lastname: Arain
authors.forename: T D
authors.initials: TD
authors.lastname: Uhrich
authors.forename: J A
authors.initials: JA
authors.lastname: Barney
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology*; D007830:Larynx / Q000187:drug effects; D010614:Pharynx / Q000187:drug effects; D012189:Retrospective Studies; D013564:Sympathetic Nervous System / Q000187:drug effects*
chemical_list: D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane