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 anesthesia in such a case is:
**Core Concept**
The underlying principle being tested is the selection of an appropriate inhalational anesthetic agent for maintenance of anesthesia in a long surgical procedure. The ideal agent should have a favorable balance of potency, rapid onset and offset, and minimal cardiovascular and respiratory side effects.
**Why the Correct Answer is Right**
Sevoflurane is the best choice for maintenance of anesthesia in this case due to its rapid onset and offset, making it suitable for long surgical procedures. It also has a low pungency, which reduces the risk of airway irritation and coughing during induction. Additionally, sevoflurane has a minimal effect on cardiovascular function, which is beneficial in elderly patients who may have pre-existing cardiovascular disease. Sevoflurane undergoes hepatic metabolism, which is a safety feature, as it reduces the risk of nephrotoxicity associated with other inhalational agents.
**Why Each Wrong Option is Incorrect**
* **Option A:** Isoflurane has a slower onset and offset compared to sevoflurane, making it less suitable for long surgical procedures.
* **Option B:** Desflurane has a high pungency, which increases the risk of airway irritation and coughing during induction, making it less ideal for elderly patients.
* **Option D:** Halothane is associated with a higher risk of cardiovascular and respiratory side effects, as well as hepatotoxicity, making it a less desirable choice for maintenance of anesthesia in elderly patients.
**Clinical Pearl / High-Yield Fact**
Sevoflurane is a commonly used inhalational anesthetic agent in elderly patients due to its favorable pharmacokinetic profile and minimal side effects. However, it is worth noting that sevoflurane can cause a mild decrease in blood pressure due to vasodilation, which may be beneficial in patients with hypertension.
**Correct Answer:** C. Sevoflurane.