Keywords

The inhalational anesthetics are such a part and parcel of anesthesia practice that we take for granted that we have mastered their pharmacology. Right at the beginning of training, we learn the minimum alveolar concentration (MAC) of each anesthetic. We learn the effects of altitude on the delivery of the anesthetics and other facts regarding the use and maintenance of vaporizers. We listen to but don’t concentrate on the folklore and historical anecdotes about each inhalational anesthetic. We listen to and do concentrate on the inhalational anesthetic preferences of our teachers and mentors. And then, confident we have achieved competency with these drugs, we become complacent in our use of them. Too often, as we are busy with the other many pressing aspects of learning and doing anesthesia, we are in serious risk of regarding the inhalational anesthetics simply as agents that we turn on and off or turn up and down. But this complacency is something of a mistake. Collectively, the editors have frequently seen problems occur in the operating room because of clinicians’ failure to keep in mind that inhalational anesthetics are among the most potent drugs given in the perioperative period—and that they are often administered to patients on a panoply of other potent medications.

With this in mind, this section presents case scenarios covering a number of clinical situations. We have included the basics such the additive nature of MACs as well as discussing in more detail the interactions of inhalational anesthetics with several of the ubiquitous antihypertensive drugs and the interactions of inhalational anesthetics in patients having somatosensory evoked potential monitoring.