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For example, enflurane metabolism results in a well-described injury to renal collecting tubules. The safety of sevoflurane may be the result of a rapid decline in plasma fluoride concentrations because of less availability of the anesthetic for metabolism from a fast elimination compared with enflurane. Spontaneous ventilation is preserved with a gas induction since patients essentially regulate their own depth of anesthesia too much sevoflurane would suppress ventilation. Clinical studies indicate that stage two excitation is avoided with high concentrations of sevoflurane. Sevoflurane also has been administered by mask as an approach to the difficult adult airway because it preserves spontaneous ventilation and does not cause salivation. The gas induction technique is improved by pretreatment with benzodiazepines and worsened with opioid pretreatment because of apnea. Some of the drawbacks to the use of the current volatile anesthetics are the absence of analgesic effects, their association with postoperative nausea and vomiting, their potential for carbon monoxide poisoning and hepatitis, their ability to induce neuroapoptosis leading to memory deficits in neonatal animal models, and greenhouse gas effects adding to the potential for global warming. The physiological and physical factors governing the uptake of anesthetic gases by the body. Recovery from sevoflurane anesthesia: a comparison to isoflurane and propofol anesthesia.

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