A seventy year old patient is posted for a surgery which is likely to last 4–6 hours. The best inhalational agent of choice for maintenance of anaesthesia in such a case is –
## **Core Concept**
The question tests the knowledge of inhalational anesthetic agents and their characteristics, particularly in the context of prolonged surgeries in elderly patients. The ideal agent should have properties such as low solubility in blood, minimal cardiovascular and respiratory depression, and rapid recovery profile.
## **Why the Correct Answer is Right**
Sevoflurane is often considered the best inhalational agent for maintenance of anesthesia in elderly patients undergoing long surgeries. This is because it has a relatively low blood solubility (around 0.69), which allows for quick induction and recovery. Sevoflurane also causes less respiratory and cardiovascular depression compared to other inhalational agents, making it safer for elderly patients. Additionally, it has a pleasant odor, making it suitable for inhalational induction.
## **Why Each Wrong Option is Incorrect**
* **Option A:** Isoflurane has a higher blood solubility (around 1.4) compared to sevoflurane, which results in slower induction and recovery. It also causes more respiratory depression.
* **Option B:** Desflurane has a very low blood solubility (around 0.42), which allows for very rapid induction and recovery. However, it can cause airway irritation and is less commonly used for induction.
* **Option D:** Halothane has a high blood solubility (around 2.3) and is associated with significant hepatotoxicity and cardiac depression, making it less suitable for elderly patients.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that sevoflurane is often the preferred inhalational agent in pediatric and elderly patients due to its favorable pharmacokinetic profile and minimal side effects. Its low blood-gas partition coefficient allows for rapid changes in depth of anesthesia.
## **Correct Answer:** . Sevoflurane