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Isoflurane
 
 
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Isoflurane (2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-ethane) is a halogenated ether
Halogenated ether

A halogenated ether is a subcategory of a larger group of chemicals known as ethers. An ether is an organic chemical that contains an ether group — an oxygen atom connected to two alkyl groups....
 used for inhalational anesthesia
Anesthesia

Anesthesia, or anaesthesia , has traditionally meant the condition of having sensation blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience....
. Together with enflurane
Enflurane

Enflurane is a halogenated ether that was commonly used for inhalational anesthesia during the 1970s and 1980s. Developed by Ross Terrell in 1963, it was first used clinically in 1966....
 and halothane
Halothane

Halothane vapour is an inhalational general anaesthetic. Its IUPAC name is 2-bromo-2-chloro-1,1,1-trifluoroethane. It is the only inhalational anaesthetic agent containing a bromine atom; there are several other halogenated anesthesia agents which lack the bromine atom and do contain the fluorine and chlorine atoms present in halothane....
, it replaced the flammable ethers
Diethyl ether

Diethyl ether, also known as ether and ethoxyethane, is a clear, colorless, and highly flammable liquid with a low boiling point and a characteristic odor....
 used in the pioneer days of surgery
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
. Its use in human medicine is now starting to decline, being replaced with sevoflurane
Sevoflurane

Sevoflurane , also called fluoromethyl hexafluoroisopropyl ether, is a sweet-smelling, non-flammable, highly fluorinated methyl isopropyl ether used for induction and maintenance of general anesthesia....
, desflurane
Desflurane

Desflurane is a highly fluorinated methyl ethyl ether used for maintenance of general anaesthesia. Together with sevoflurane, it is gradually replacing isoflurane for human use, except in the third world where its high cost precludes its use....
 and the intravenous anaesthetic propofol
Propofol

Propofol is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopies and endoscopies....
. Isoflurane is still frequently used for veterinary anaesthesia.

Isoflurane is always administered in conjunction with air
AIR

Air is the part of Earth's atmosphere that humans breath and as such Air .Air may also refer to:...
 and/or pure oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
.






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Isoflurane (2-chloro-2-(difluoromethoxy)-1,1,1-trifluoro-ethane) is a halogenated ether
Halogenated ether

A halogenated ether is a subcategory of a larger group of chemicals known as ethers. An ether is an organic chemical that contains an ether group — an oxygen atom connected to two alkyl groups....
 used for inhalational anesthesia
Anesthesia

Anesthesia, or anaesthesia , has traditionally meant the condition of having sensation blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience....
. Together with enflurane
Enflurane

Enflurane is a halogenated ether that was commonly used for inhalational anesthesia during the 1970s and 1980s. Developed by Ross Terrell in 1963, it was first used clinically in 1966....
 and halothane
Halothane

Halothane vapour is an inhalational general anaesthetic. Its IUPAC name is 2-bromo-2-chloro-1,1,1-trifluoroethane. It is the only inhalational anaesthetic agent containing a bromine atom; there are several other halogenated anesthesia agents which lack the bromine atom and do contain the fluorine and chlorine atoms present in halothane....
, it replaced the flammable ethers
Diethyl ether

Diethyl ether, also known as ether and ethoxyethane, is a clear, colorless, and highly flammable liquid with a low boiling point and a characteristic odor....
 used in the pioneer days of surgery
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
. Its use in human medicine is now starting to decline, being replaced with sevoflurane
Sevoflurane

Sevoflurane , also called fluoromethyl hexafluoroisopropyl ether, is a sweet-smelling, non-flammable, highly fluorinated methyl isopropyl ether used for induction and maintenance of general anesthesia....
, desflurane
Desflurane

Desflurane is a highly fluorinated methyl ethyl ether used for maintenance of general anaesthesia. Together with sevoflurane, it is gradually replacing isoflurane for human use, except in the third world where its high cost precludes its use....
 and the intravenous anaesthetic propofol
Propofol

Propofol is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopies and endoscopies....
. Isoflurane is still frequently used for veterinary anaesthesia.

Isoflurane is always administered in conjunction with air
AIR

Air is the part of Earth's atmosphere that humans breath and as such Air .Air may also refer to:...
 and/or pure oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
. Often nitrous oxide
Nitrous oxide

Nitrous oxide, commonly known as "laughing gas", is a chemical compound with the chemical formula Nitrogen2Oxygen. At room temperature, it is a colorless Flammability gas, with a pleasant, slightly sweet odor and taste....
 is also used. Although its physical properties means that anaesthesia can be induced more rapidly than with halothane
Halothane

Halothane vapour is an inhalational general anaesthetic. Its IUPAC name is 2-bromo-2-chloro-1,1,1-trifluoroethane. It is the only inhalational anaesthetic agent containing a bromine atom; there are several other halogenated anesthesia agents which lack the bromine atom and do contain the fluorine and chlorine atoms present in halothane....
, its pungency can irritate the respiratory system, negating this theoretical advantage conferred by its physical properties. It is usually used to maintain a state of general anesthesia that has been induced with another drug, such as thiopentone or propofol
Propofol

Propofol is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopies and endoscopies....
. It vaporizes readily, but is a liquid at room temperature. It is completely non-flammable.

A major advantage of isoflurane is that the patent
Patent

A patent is a set of exclusive rights granted by a state to an inventor or his assignee for a term of patent in exchange for a disclosure of an invention....
 covering its use has expired, therefore it is very economical to use.

Physical properties

Molecular weight 184.5g/mol  
Boiling point
Boiling point

The boiling point of a liquid is the temperature at which the vapor pressure of the liquid equals the environmental pressure surrounding the liquid....
 (at 1 atm
Atmosphere (unit)

The standard atmosphere is an international reference pressure defined as 101,325 Pascal and formerly used as unit of pressure . For practical purposes it has been replaced by the Bar which is 100,000 Pa....
): 		48.5 °C  
Density
Density

The density of a material is defined as its mass per unit volume. The symbol of density is ....
 (at 25 °C): 		1.496 g/mL  
MAC
Minimum alveolar concentration

Minimum alveolar concentration or MAC is a concept used to compare the strengths of anaesthetic Volatile anaesthetic; in simple terms, it is defined as the concentration of the vapour in the lungs that is needed to prevent movement in 50% of subjects in response to surgical stimulus....
 : 		1.15 vol % 
Vapor pressure
Vapor pressure

Vapor pressure , is the pressure of a vapor in Thermodynamic equilibrium with its non-vapor Phase s. All liquids and solids have a tendency to evaporate to a gaseous form, and all gases have a tendency to Condensation back into their original form ....
: 		238 mmHg
Torr

The torr is a non-International System of Units unit of pressure defined as 1/760 of an Atmosphere . It was named after Evangelista Torricelli, an Italian physicist and mathematician who discovered the principle of the barometer in 1644....
 		 31.7 kPa
Pascal (unit)

The pascal is the SI derived unit of pressure, stress , Young's modulus and tensile strength. It is a measure of force per unit area i.e. equivalent to one newton per square meter or one joule per cubic meter....
 		 (at 20°C)
295 mmHg 39.3 kPa (at 25°C)
367 mmHg 48.9 kPa (at 30°C)
450 mmHg 60.0 kPa (at 35°C)
Water Solubility
Solubility

Solubility is often seen as a property of a substance; for instance the solubility of a solid substance usually refers to the concentration of the substance in a liquid that has reached equilibrium with the substance in solid phase ....
 		Insoluble
Blood:Gas Partition coefficient: 1.4
Oil:Gas Partition coefficient: 98


Mechanism of action

Isoflurane reduces pain sensitivity (analgesia) and relaxes muscles. The mechanism by which general anesthetics produce the anesthetic state is not clearly understood but likely involves interactions with multiple receptor sites to interfere with synaptic transmission. Isoflurane binds to GABA receptor
GABA receptor

The GABA receptors are a class of Receptor that respond to the neurotransmitter Gamma-aminobutyric acid , the chief inhibitory neurotransmitter in the vertebrate central nervous system....
s, glutamate receptor
Glutamate receptor

Glutamate receptors are transmembrane receptors located on neuron membranes. These receptors bind the neurotransmitter glutamate....
s and glycine receptor
Glycine receptor

The glycine receptor, or GlyR, is the receptor for the amino acid neurotransmitter glycine. It is one of the most widely distributed inhibitory receptors in the central nervous system and has important roles in a variety of physiological processes, especially in mediating inhibitory neurotransmission in the spinal cord and brain ste...
s, and also inhibits
Enzyme inhibitor

Enzyme inhibitors are molecules that bind to enzymes and decrease their enzyme activity. Since blocking an enzyme's activity can kill a pathogen or correct a metabolism imbalance, many drugs are enzyme inhibitors....
 conduction in activated potassium channel
Potassium channel

In the field of cell biology, potassium channels are the most widely distributed type of ion channel and are found in virtually all living organisms....
s. Glycine inhibition helps to inhibit motor function, while bonding to glutamate receptors mimics the effects of NMDA
NMDA

NMDA is an amino acid derivative acting as a specific agonist at the NMDA receptor, and therefore mimics the action of the neurotransmitter glutamate on that receptor....
. It activates calcium ATPase
Calcium ATPase

Calcium ATPase is a form of P-ATPase which transfers calcium after a muscle has contracted. The calcium ATPase are:*Plasma membrane Ca2+ ATPase...
 through an increase in membrane fluidity, and binds to the D subunit of ATP synthase
ATP synthase

An ATP synthase is a general term for an enzyme that can synthesize adenosine triphosphate from adenosine diphosphate and inorganic phosphate by using some form of energy....
 and NADH dehydrogenase
NADH dehydrogenase

NADH dehydrogenase is an enzyme located in the inner mitochondria membrane that catalyzes the transfer of electrons from NADH to coenzyme Q ....
. In addition, a number of general anesthetics attenuate gap junction communication, which could contribute to anesthetic action.

Possible link to cognitive decline

Isoflurane exposure has been shown to induce cognitive decline in mice. Exposure of cultured human cells to isoflurane has been reported to induce apoptosis
Apoptosis

Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Programmed Cell death involves a series of biochemical events leading to a characteristic cell Morphology and death, in more specific terms, a series of biochemical events that lead to a variety of morphological changes, including Bleb , changes...
 and accumulation and aggregation of amyloid beta
Amyloid beta

Amyloid beta is a peptide of 39?43 amino acids that appear to be the main constituent of amyloid plaques in the brains of Alzheimer's disease patients....
 protein. Further research will be required to establish whether or not clinical exposure to isoflurane leads to dementia
Dementia

Dementia is the progressive decline in cognition due to damage or disease in the body beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood....
 (Alzheimer's disease
Alzheimer's disease

Alzheimer's disease , also called Alzheimer disease, Senile Dementia of the Alzheimer Type or simply Alzheimer's, is the most common form of dementia....
).

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