Farmakologi Isoflurane

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dr. Felicia

Farmakologi isoflurane, seperti halnya anestesi umum lain, adalah untuk menginduksi amnesia, penurunan kesadaran, dan imobilitas terhadap stimulus nyeri. Namun, hal-hal ini bersifat reversible dan akan kembali setelah pemberian isoflurane dihentikan.[4]

Isoflurane memiliki efek sistemik ke berbagai sistem organ, seperti sistem saraf pusat, sistem kardiovaskular, hepar, dan renal. Hal inilah yang menyebabkan isoflurane dapat memengaruhi hemodinamika pasien, sehingga penggunaannya perlu dilakukan dengan kontrol dan pemantauan ketat.[6,7]

Hanya sebagian kecil isoflurane yang masuk ke dalam tubuh akan dimetabolisme di hati. Sebagian besar isoflurane akan dieliminasi lewat paru-paru. Untuk isoflurane yang sudah dimetabolisme di hati, metabolitnya akan diekskresi lewat urine.[7,9,10]

Referensi

2. Akhondzadeh R, Ghomeishi A, Soltani F, et al. The Effect of Different Doses of Isoflurane on Hemodynamic Changes and Bleeding in Patients Undergoing Endoscopic Sinus Surgery under General Anesthesia. Anesthesiol Pain Med. 2019 Feb 28;9(1). http://anesthpain.com/en/articles/57864.html
4. Food and Drug Administration (FDA). Forane (Isoflurane, USP). Liquid for Inhalation. 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/017624s036lbl.pdf
6. Crystal GJ. Isoflurane and the Coronary Steal Controversy of the 1980s: Origin, Resolution, and Legacy. J Anesth Hist. 2017 Apr;3(2):56–62.
7. Jerath A, Parotto M, Wasowicz M, et al. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?. Am J Respir Crit Care Med. 2016 Mar 22;193(11):1202–12.
8. Formularium Nasional. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.02.02/MENKES/137/201. 2016.
9. Yakan S, Aksoy O. Comparison of the Effects of Isoflurane and Sevoflurane General Anaesthesia after Induction by Propofol on Clinical and Physiological Measurements in Calves. Acta Sci Vet. 2019 May 23;47. https://seer.ufrgs.br/ActaScientiaeVeterinariae/article/view/92279
10. Lehmann F, Müller M, Zimmermann J, et al. Inhalational Isoflurane Sedation in Patients with Decompressive Craniectomy Suffering from Severe Subarachnoid Hemorrhage: A Case Series. J Neuroanaesth Crit Care. 2019 Aug 29. http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1693525
11. Ruxanda F, MICLĂUŞ V, Rus V, et al. Impact of Isoflurane and Sevoflurane Anesthesia on Kidney Structure and Function in Rats. Bull UASVM Vet Med. 2014 Nov 28;71:343–8.
12. Meng T, Ren X, Chen X, et al. Anesthetic Agents Isoflurane and Propofol Decrease Maximal Ca2+-Activated Force and Thus Contractility in the Failing Myocardium. J Pharmacol Exp Ther. 2019 Dec 1;371(3):615–23.
13. Hawkley TF, Maani CV. Isoflurane. StatPearls Publishing. 2019. http://www.ncbi.nlm.nih.gov/books/NBK532957/
14. Kassiri N, Seyed A, Rashidi F, et al. Inhalational anesthetics agents: The pharmacokinetic, pharmacodynamics, and their effects on human body. BBJR. 2018;2(3):173–7.
15. Ganjoo P, Kapoor I. Chapter 6 - Neuropharmacology. In: Prabhakar H, editor. Essentials of Neuroanesthesia. Academic Press; 2017.p.103–22. http://www.sciencedirect.com/science/article/pii/B9780128052990000063
16. TerRiet MF, DeSouza GJA, Jacobs JS, et al. Which is most pungent: isoflurane, sevoflurane or desflurane?. BJA Br J Anaesth. 2000 Aug 1;85(2):305–7.
17. Feria OP, Gazzaneo M. P219 Isoflurane therapy for severe refractory status asthmaticus in children. Ann Allergy Asthma Immunol. 2017 Nov 1;119(5):S55.
18. Gent T, Adamantidis A. Anaesthesia and sleep: Where are we now?. Clin Transl Neurosci. 2017 Jun 1;1(1):2514183X17726281.
19. Michelson NJ, Kozai TDY. Isoflurane and ketamine differentially influence spontaneous and evoked laminar electrophysiology in mouse V1. J Neurophysiol. 2018 Aug 1;120(5):2232–45.
20. Cho H-J, Sung Y-H, Lee S-H, et al. Isoflurane Induces Transient Anterograde Amnesia through Suppression of Brain-Derived Neurotrophic Factor in Hippocampus. J Korean Neurosurg Soc. 2013 Mar;53(3):139–44.
21. Torturo CL, Zhou Z-Y, Ryan TA, et al. Isoflurane Inhibits Dopaminergic Synaptic Vesicle Exocytosis Coupled to CaV2.1 and CaV2.2 in Rat Midbrain Neurons. eNeuro. 2019 Jan 24;6(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345200/
22. Khan KS, Hayes I, Buggy DJ. Pharmacology of anaesthetic agents II: inhalation anaesthetic agents. Contin Educ Anaesth Crit Care Pain. 2014 Jun 1;14(3):106–11.
23. Dalal A, Lang JDJ. Anesthetic Considerations for Patients with Liver Disease. Hepatic Surg. 2013 Feb 13. https://www.intechopen.com/books/hepatic-surgery/anesthetic-considerations-for-patients-with-liver-disease
24. Gatecel C, Losser M-R, Payen D. The Postoperative Effects of Halothane Versus Isoflurane on Hepatic Artery and Portal Vein Blood Flow in Humans. Anesth Analg. 2003 Apr 1;96:740–5.
25. Nishiyama T. Effects of repeat exposure to inhalation anesthetics on liver and renal function. J Anaesthesiol Clin Pharmacol. 2013 Jan 1;29(1):83.
26. Topal A, Gül N, Ilcol Y, et al. Hepatic Effects of Halothane, Isoflurane or Sevoflurane Anaesthesia in Dogs. J Vet Med A Physiol Pathol Clin Med. 2004 Jan 1;50:530–3.
27. Mraovic B, Simurina T, Gan TJ. Nitrous oxide added at the end of isoflurane anesthesia hastens early recovery without increasing the risk for postoperative nausea and vomiting: a randomized clinical trial. Can J Anesth Can Anesth. 2018 Feb 1;65(2):162–9.
28. Lu C-C, Ho S-T, Wong C-S, et al. Pharmacokinetics of Isoflurane: Uptake in the Body. Pharmacology. 2003;69(3):132–7.
29. Isoflurane. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018. http://www.ncbi.nlm.nih.gov/books/NBK548501/
30. Kharasch ED, Hankins DC, Cox K. Clinical Isoflurane Metabolism by Cytochrome P450 2E1. Anesthesiol J Am Soc Anesthesiol. 1999 Mar 1;90(3):766–71.

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