Enflurane

Cardiovascular

Despite conflicting results, enflurane is generally considered to have little effect on the cardiovascular system. Cardiac output was mildly influenced in healthy men and the negative inotropic effects of enflurane [ ] were more pronounced in patients with congestive heart failure [ ]. Myocardial damage was suggested to be an unlikely complication of enflurane anesthesia, even in patients with ischemic heart disease [ ].

Cardiac dysrhythmias are generally considered to be less frequent, or at least less severe, with enflurane than with halothane [ , ]. However, caution in the use of adrenaline is advisable, especially in patients with cardiac disease or hyperthyroidism. Isorhythmic atrioventricular dissociation was seen in 16 of 105 patients after the use of 1.0–1.5% enflurane [ ].

Respiratory

Enflurane is usually not irritant to the respiratory tract, although bronchospasm has been reported [ ]. However, it is generally considered to be a bronchodilator. It causes respiratory depression at concentrations over 2%.

Nervous system

Cerebral irritability is a potential consequence of enflurane anesthesia, as evidenced by electroencephalographic recordings and by reported cases of convulsions [ ]. Enflurane should be used with care (although it is probably not absolutely contraindicated) in patients with epileptiform tendencies, especially if they are deeply anesthetized and hyperventilated. There are reports of delayed convulsions after light general anesthesia not involving hyperventilation. A patient had a convulsion in a car after being discharged from a day-care anesthetic involving enflurane [ ].

Motor neuron disease has been attributed to enflurane [ ]. The authors proposed that enflurane-induced release of glutamate may have caused changes in the spinal cord motor neurons. It is not clear what role alcohol abuse had in this case.

Neuromuscular function

Enflurane increased the sensitivity of the neuromuscular junction to d-tubocurarine in man [ ].