A novel intravenous general anesthetic--- emulsified isoflurane: from bench to bedside

Abstract

Application of volatile anesthetics greatly alters modern medicine. There are obvious advantages of volatile anesthetics such as strong anesthetic potency, rapid onset and elimination through respiration system. Isoflurane is one of the most widely used volatile anesthetics in clinic. Emulsified isoflurane, the emulsion of isoflurane, is a novel intravenous general anesthetic. With the development of emulsified isoflurane in the past fifteen years, its utility has spread from intravenous general anesthesia to various fields including regional anesthesia, organ protection, as well as anesthetic pharmacological study. In this review, we will summarize literatures of emulsified isoflurane about its history, clinical application and future potential utility in the above mentioned fields.

Keywords

emulsified isoflurane (EI) / general anesthesia / regional anesthesia / organ protection / anesthetic pharmacological study

References

[1] Mazze RI. Methoxyflurane revisited: tale of an anesthetic from cradle to grave. Anesthesiology2006; 105(4): 843–846

[2] Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM. Halothane-induced hepatitis: a forgotten issue in developing countries. Hepat Mon2011; 11(1): 3–6

[3] Brasil LJ, San-Miguel B, Kretzmann NA, Amaral JL, Zettler CG, Marroni N, González-Gallego J, Tuñón MJ. Halothane induces oxidative stress and NF-kappaB activation in rat liver: protective effect of propofol. Toxicology2006; 227(1–2): 53–61

[4] Lucchinetti E, Schaub MC, Zaugg M. Emulsified intravenous versus evaporated inhaled isoflurane for heart protection: old wine in a new bottle or true innovation? Anesth Analg2008; 106(5): 1346–1349

[5] Spencer JA, Green NM. Suicide by ingestion of halothane. JAMA1968; 205(10): 702–703

[6] Sutton J, Harrison GA, Hickie JB. Intravenous halothane. Lancet1971; 297(7694): 345–346

[7] Sandison JW, Sivapragasam S, Hayes JA, Woo-Ming MO. An experimental study of pulmonary damage associated with intravenous injection of halothane in dogs. Br J Anaesth1970; 42(5): 419–424

[8] Sutton J, Harrison GA, Hickie JB. Accidental intravenous injection of halothane. Case report. Br J Anaesth1971; 43(5): 513–520

[9] Krantz JC Jr, Cascorbi HF, Rudo FG. Anesthesia. 64. The intravenous administration of methoxyflurane (Penthrane) emulsions in animals and man. Anesth Analg1962; 41: 257–262

[10] Cascorbi HF, Helrich M, Krantz JC Jr, Baker LR, Rozman RS, Rudo FG. Hazards of methoxyflurane emulsions in man. Anesth Analg1968; 47(5): 557–559

[11] Eger RP, MacLeod BA. Anaesthesia by intravenous emulsified isoflurane in mice. Can J Anaesth1995; 42(2): 173–176

[12] Ma HX, Li J, Yang ZB, Yang XL, Liu AJ, Yang JW, Rao Y, Luo NF, Zhang WS, Liu J. Comparison of emulsified isoflurane and propofol with intravenous injection in Beagle dogs. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi) 2006; 26(9): 862–863 (in Chinese)

[13] Johannesson G, Alm P, Biber B, Lennander O, Werner O. Halothane dissolved in fat as an intravenous anaesthetic to rats. Acta Anaesthesiol Scand1984; 28(4): 381–384

[14] Fast JP, Perkins MG, Pearce RA, Mecozzi S. Fluoropolymer-based emulsions for the intravenous delivery of sevoflurane. Anesthesiology2008; 109(4): 651–656

[15] Jee JP, Parlato MC, Perkins MG, Mecozzi S, Pearce RA. Exceptionally stable fluorous emulsions for the intravenous delivery of volatile general anesthetics. Anesthesiology2012; 116(3): 580–585

[16] Jia MX, Luo NF, Zhang WS, Zhou JX, Liu J. Partition coefficients of volatile anesthetics in lipid emulsion and its components. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi) 2004; 19(6): 422–425 (in Chinese)

[17] Zhou JX, Liu J. The effect of temperature on solubility of volatile anesthetics in human tissues. Anesth Analg2001; 93(1): 234–238

[18] Zhou JX, Liu YQ, Liu J. Combined effect of hypothermia and crystalloid hemodilution on the solubility of volatile anesthetics in human blood. Chin Med J (Engl)2002; 115(7): 1014–1019

[19] Zhou JX, Luo NF, Liu J. Saturated concentration of emulsified isoflurane at 20°C and its anesthetic potency for intravenous injection in rats. J Beijing Med (Bei Jing Yi Xue) 2004; 26(6): 376–378 (in Chinese)

[20] Zhou JX, Luo NF, Liang XM, Liu J. The efficacy and safety of intravenous emulsified isoflurane in rats. Anesth Analg2006; 102(1): 129–134

[21] Ma HX, Yang ZB, Yang XL, Liu AJ, Yang JW, Rao Y, Luo NF, Zhang WS, Liu J. Determination of intravenous emulsified isoflurane MAC and its circulatory effects in Beagle dogs. J Clin Anesthesiol (Lin Chuang Ma Zui Xue) 2007; 23(10): 836–838 (in Chinese)

[22] Yang XL, Ma HX, Yang ZB, Liu AJ, Luo NF, Zhang WS, Wang L, Jiang XH, Li J, Liu J. Comparison of minimum alveolar concentration between intravenous isoflurane lipid emulsion and inhaled isoflurane in dogs. Anesthesiology2006; 104(3): 482–487

[23] Rao Y, Wang YL, Zhang WS, Yang XL, Ma HX, Yang JW, Liu AJ, Yang ZB, Liu J. The hemolytic effect of emulsified isoflurane after single bolus in Beagle dogs. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi)2006; 7(26): 666–667 (in Chinese)

[24] Yang ZB, Yang XL, Zhang WS, Ma HX, Liu AJ, Rao Y, Yang JW, Liu J. Toxicity study on long-term intravenous administration of emulsified isoflurane in rats. J Clin Anesthesiol (Lin Chuang Ma Zui Xue)2008; 24(9): 112–115 (in Chinese)

[25] Sun HF, Wang QY, Liang XM, Zhang ZX, Liu J. The efficacy and safety of emulsified isoflurane after intraperitoneal injection in rats. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi)2004; 24(1): 51–53(in Chinese)

[26] Lin HX, Luo NF, Liu J, Yang J, Li Q. The sedative and hypnotic effects and safety of oral emulsified isoflurane in rats. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban)2010; 41(5): 862–864, 887 (in Chinese)

[27] Yang JW, Yi ML, Chai YF, Zhang WS, Liu J. Fentanyl hypnotic interaction with emulsified isoflurane. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban)2007; 38(6): 973–976 (in Chinese)

[28] Yang JW, Chen Y, Gao AL, Zhang WS, Liu J. Interaction between fentanyl with emulsified isoflurane. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi)2007; 22(5): 529–532 (in Chinese)

[29] Haynes DH, Kirkpatrick AF. Long duration local anesthesia with lecithin-coated microdroplets of methoxyflurane: studies with human skin. Reg Anesth1991; 16(3): 173–180

[30] Kirkpatrick AF, Lavallee-Grey M, Haynes DH. Long duration local anesthesia with lecithin-coated microdroplets of methoxyflurane: studies with rat skin. Reg Anesth1991; 16(3): 164–172

[31] Haynes DH, Kirkpatrick AF. Ultra-long-duration local anesthesia produced by injection of lecithin-coated methoxyflurane microdroplets. Anesthesiology1985; 63(5): 490–499

[32] Chai YF, Yang J, Liu J, Song HB, Yang JW, Liu SL, Zhang WS, Wang QW. Epidural anaesthetic effect of the 8% emulsified isoflurane: a study in rabbits. Br J Anaesth2008; 100(1): 109–115

[33] Zhou C, Wu W, Liu J, Liao DQ, Kang Y, Chen XD. Inhibition of voltage-gated sodium channels by emulsified isoflurane may contribute to its subarachnoid anesthetic effect in beagle dogs. Reg Anesth Pain Med2011; 36(6): 553–559

[34] Zhou C, Gan J, Liu J, Luo WJ, Zhang WS, Chai YF. The interaction between emulsified isoflurane and lidocaine is synergism in intravenous regional anesthesia in rats. Anesth Analg2011; 113(2): 245–250

[35] Li Z, Yang J, Liu J, Gong CY, Gan J, Zhang X, Luo WJ, Li GH. Reversible conduction block in isolated toad sciatic nerve by emulsified isoflurane. Anesth Analg2010; 110(4): 1024–1029

[36] Chiari PC, Pagel PS, Tanaka K, Krolikowski JG, Ludwig LM, Trillo RA Jr, Puri N, Kersten JR, Warltier DC. Intravenous emulsified halogenated anesthetics produce acute and delayed preconditioning against myocardial infarction in rabbits. Anesthesiology2004; 101(5): 1160–1166

[37] Liu XL, Liu J. Effects of emulsified isoflurane and intralipid on ischemia-reperfusion injury in isolated rat heart. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi)2007; 22(5): 525–527(in Chinese)

[38] Hu Q, Wang J, Chang X, Long C. Cardioprotective effects of emulsified isoflurane strengthened cardioplegia on ischemia-reperfusion injury in isolated rat hearts. J Clin Med Pract (Shi Yong Lin Chuang Yi Yao Za Zhi)2009; 13(1): 5–8 (in Chinese)

[39] Huang H, Zhang W, Liu S, Yanfang C, Li T, Liu J. Cardioprotection afforded by St Thomas solution is enhanced by emulsified isoflurane in an isolated heart ischemia reperfusion injury model in rats. J Cardiothorac Vasc Anesth2010; 24(1): 99–103

[40] Liu SL, Liu J. Apoptosis mechanism of intralipid postconditioning to reduce ischemia reperfusion injury of isolated rat hearts. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban)2007; 38(4): 663–666 (in Chinese)

[41] Chen YQ, Jin XJ, Dai ZP, Zhang WS, Liu J. Effects of emulsified isoflurane induced preconditioning on cardiac hemodynamic during myocardiac ischemia-reperfusion injury in rabbits. J Anesthesiol Resusc (Guo Ji Ma Zui Xue Yu Fu Su Za Zhi)2006; 27(4): 224–226 (in Chinese)

[42] Rao Y, Wang YL, Zhang WS, Liu J. Emulsified isoflurane produces cardiac protection after ischemia-reperfusion injury in rabbits. Anesth Analg2008; 106(5): 1353–1359

[43] Rao Y, Wang YL, Chen YQ, Zhang WS, Liu J. Protective effects of emulsified isoflurane after myocardial ischemia-reperfusion injury and its mechanism in rabbits. Chin J Traumatol2009; 12(1): 18–21

[44] Yang MC, Chen YP, Cao DJ, Qian X, Li P. The optimal concentration for the protective effect of emulsified isoflurane on the neonatal rat cardiac myocytes hypoxia/reoxygenation injury of primary culture. J Sichuan Univ (Med Sci Ed) (Sichuan Da Xue Xue Bao Yi Xue Ban)2009; 40(6): 1075–1077, 1090 (in Chinese)

[45] Hu ZY, Luo NF, Liu J. The protective effects of emulsified isoflurane on myocardial ischemia and reperfusion injury in rats. Can J Anaesth2009; 56(2): 115–125

[46] Tan XQ, Chen YP, Zhang WS, Liu J. Effect of emulsified isoflurane on myocardial apoptosis and expressions of bcl-2 and bax induced by hypoxia-reoxygenation. J Third Mil Med Univ (Di San Jun Yi Da Xue Xue Bao) 2008; 30(17): 1611–1614 (in Chinese)

[47] Tan XQ, Chen YP. Emulsified isoflurane protects hypoxia/reoxgenation injury in cultured neonatal rat myocardial cells by suppressing caspase-3 expression. J Third Mil Medical Univ (Di San Jun Yi Da Xue Xue Bao)2009; 31(14): 1341–1344 (in Chinese)

[48] Lv H, Yang LQ, Yu WF, Li Q, Ren HM, Zhu M, Xu LY. Protection of liver against ischemia/reperfusion injury by Kupffer cell mediated emulsified isoflurane preconditioning: experiment with rats. Natl Med J China (Zhonghua Yi Xue Za Zhi)2007; 35(87): 2468–2471(in Chinese)

[49] Zhang L, Luo N, Liu J, Duan Z, Du G, Cheng J, Lin H, Li Z. Emulsified isoflurane preconditioning protects against liver and lung injury in rat model of hemorrhagic shock. J Surg Res2011; 171(2): 783–790

[50] Lv X, Wang ZM, Huang SD, Song SH, Wu FX, Yu WF. Emulsified isoflurane preconditioning reduces lung injury induced by hepatic ischemia/reperfusion in rats. Int J Med Sci2011; 8(5): 353–361

[51] Wang Y, Zhang WS, Deng L, Liu J. Protective effect of 8% emulsified isoflurane against focal cerebral ischemia-reperfusion injury in rats. West China J Pharm Sci (Hua Xi Yao Xue Za Zhi)2008; 23(2): 140–142(in Chinese)

[52] Wang YL, Wang ZP, Zhu W. Effect of preconditioning with different doses of emulsified isoflurane on focal cerebral ischemia-reperfusion injury in rats. Chin J Anesthesiol (Zhonghua Ma Zui Xue Za Zhi)2010; 30(10): 1243–1246 (in Chinese)

[53] Yang J, Chai YF, Gong CY, Li GH, Luo N, Luo NF, Liu J. Further proof that the spinal cord, and not the brain, mediates the immobility produced by inhaled anesthetics. Anesthesiology2009; 110(3): 591–595

[54] Yang J, Li Z, Gong CY, Chai YF, Li T, Li GH, Luo N, Luo NF, Zhu L, Liu J. A model for the preferential delivery of isoflurane to the spinal cord of the goat. Vet J2011; 187(2): 239–244

[55] Hang LH, Shao DH, Yang YH, Dai TJ, Zeng YM. Spinal alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors may mediate the analgesic effects of emulsified halogenated anaesthetics. Clin Exp Pharmacol Physiol 2007; 34(11): 1121–1125

[56] Hang LH, Dai TJ, Zeng YM. Spinal N-methyl-D-aspartate receptors may mediate the analgesic effects of emulsified halogenated anesthetics. Pharmacology2006; 76(3): 105–109

[57] Chen Y, Dai TJ, Zeng YM. Strychnine-sensitive glycine receptors mediate the analgesic but not hypnotic effects of emulsified volatile anesthetics. Pharmacology2007; 80(2-3): 151–157

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