Isoflurane possibly better than ECT for refractory depression

ruler of kolob · Aug 30, 2013

We were discussing this study the other day when I was doing ECTs..The future of ECT might be non electric but magnetic. The one problem I see about the Iso is I have seen practitioners who have never used it!.. Ketamine is showing real promise as an anti-depressant.

Personally, I prefer Iso over Sevo...and Des when indicated. I think Sevo is terribly over rated. ESPECIALLY in reactive airway patients.

Iso is on our CPB machines.. it's a safe, effective, cheap and proven drug.

MeTheRN, BSN, MSN, RN · Sep 2, 2013

I think Sevo is terribly over rated. ESPECIALLY in reactive airway patients.

Since sevo has the most bronchodilating properties and is the least pungent of the commonly used volatiles, I would respectfully disagree.

allnurses Guide · Sep 2, 2013

It is more about what you get used to then anything else, but of the three volatile anesthetics commonly used sevoflurane is the only one that does not increase inflammation.

http://www.pnas.org/content/105/25/8784.full.pdf

ruler of kolob · Sep 2, 2013

Since sevo has the most bronchodilating properties and is the least pungent of the commonly used volatiles, I would respectfully disagree.

Dr Miller disagrees with you...Volatile anesthetics are all bronchodilators, but some controversy remains about which volatile anesthetic exerts the most potent bronchodilation. In many studies using animal models, it appears that halothane has the most pronounced effect of relaxing airway smooth muscle. It is important to eliminate the indirect effects of arterial carbon dioxide tension when examining the actions of volatile agents on bronchial tone, especially during spontaneous ventilation, because hypercapnia-induced bronchodilation and hypocapnia-induced bronchoconstriction are both attenuated by isoflurane.^[13] What may be interpreted as a dose-dependent effect of deepening the level of anesthesia with volatile anesthetics may actually be due to an indirect action mediated by a progressive increase in carbon dioxide tension. Isoflurane and halothane (1.5 minimum alveolar concentration [MAC]) produce similar reductions in airway resistance in a canine model of bronchospasm induced by aerosolized Ascaris antigen. Similar results were obtained with volatile agents during methacholine-induced airway constriction. Taken together, these data suggest that isoflurane and halothane produce direct bronchodilation and depress airway reflexes. Isoflurane appears to share significant bronchodilating properties with halothane and enflurane, but halothane increases dynamic compliance (a measure of small airway resistance) to a greater extent than isoflurane does. This finding may be particularly important in view of the fact that isoflurane preferentially relaxes bronchioles rather than bronchi in vitro.^[14] The structure of the respiratory epithelium changes from pseudostratified columnar cells of the large airways to thinner, cuboidal cells of the bronchioles, and thus a relatively large amount of histologic heterogeneity exists between these regions. Although all volatile anesthetics bronchodilate, their specific effects on bronchioles depend on the location in and structure of the respiratory tree. Park and colleagues^[15] demonstrated that isoflurane and halothane dilate fourth-order bronchi at equivalent MAC values. Halothane, isoflurane, sevoflurane, and desflurane, at concentrations of up to 1 MAC, similarly attenuated methacholine-induced bronchoconstriction in open-chest, pentobarbital-anesthetized rats.^[16]

... as for pungency.. If you are doing a mask induction it would be an advantage.. but I've been at this a long time and I can count the adult mask inductions I have done on one hand.