Consistent with its blood: gas partition coefficient, induction of anesthesia and recovery from enflurane are relatively slow (Table 13-1). Enflurane is metabolized to a modest extent (2-8% of absorbed enflurane) by hepatic CYP2E1. Fluoride ions are a by-product of enflurane metabolism, but plasma fluoride levels are low and nontoxic. Patients taking isoniazid exhibit enhanced metabolism of enflurane with a consequent elevation of serum fluoride.
CLINICAL USE Enflurane is primarily utilized for maintenance rather than induction of anesthesia, although surgical anesthesia can be induced in <10 minutes with an inhaled concentration of 4% in oxygen. Anesthesia can be maintained with concentrations from 1.5% to 3%. Concentrations required to produce anesthesia are reduced when enflurane is coadministered with nitrous oxide or opioids.
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