Postoperative nausea and vomiting (PONV) represents the most frequent adverse effect associated with the use of inhaled anesthetic agents. To mitigate this issue, medications such as ondansetron, metoclopramide, and dexamethasone are often administered both as a preventive measure and for symptomatic relief to lower the chances of nausea and vomiting.
Isoflurane, sevoflurane, and desflurane are known to reduce systemic blood pressure by lowering systemic vascular resistance. Generally, these anesthetic agents maintain cardiac output; however, cardiac depression may occur when they are used in combination with other intravenous agents or in patients experiencing acute cardiogenic shock. These changes are more profound in hypovolemic patients. Rapid administration of desflurane has been associated with hypertension and tachycardia.
Another serious adverse effect linked to inhaled anesthetics is Malignant Hyperthermia (MH), particularly with the use of halothane. This condition is generally triggered in patients who have genetic variations affecting muscle cell calcium balance. Exposure to certain anesthetics can lead to a dangerous increase in calcium release within the skeletal muscles, manifesting as severe hyperthermia, accelerated heart rate, muscle stiffness, high potassium levels, and other metabolic disturbances.
Treatment involves the administration of dantrolene to reverse the symptoms, alongside efforts to stabilize body temperature and correct metabolic imbalances. It is critical for patients with a personal or familial history of Malignant Hyperthermia to avoid all volatile inhalation anesthetics and other known triggers like succinylcholine. In such cases, anesthetic vaporizers are usually removed from the operating equipment, and the system is flushed with high-flow air or oxygen for at least an hour before use to prevent any potential adverse reactions.
Desflurane and Isoflurane are known to potentially irritate the airways in patients who suffer from severe asthma. This irritation can lead to bronchospasm, largely due to the pungent odor these agents emit during induction.
