HE most favorable physiologic conditions for anesthesia in neurosurgery are provided bv diethyl ether, because it is least depressant to respiratory function and maintains a stable cardiovascular system. The definite hazard of fire or explosion, particularly in the presence of the electrocautery, has influenced many neurosurgeons to accept anesthetic agents and techniques which, while providing nonflammability, nevertheless introduce the less favorable physiologic conditions inherent in the employment of multiple drug techniques. The main ingredient of the nonexplosive technique currently preferred by many neurosurgeons is nitrous oxide. However, because of its low potency there may be insufficient analgesia for many procedures, there is an increased hazard of hypoxia, and the patient frequently reacts on the endotracheal tube. In an attempt to compensate for the inadequacies of nitrous oxide, anesthetists have added intravenous drugs such as barbiturates, narcotics, and muscle relaxants, as well as inhalation anesthetics such as trichloroethylene (Trilene | Trimar | or halothane (Fluothane| Each of these supplements may produce unwanted effect on respiration or circulation. In an attempt to find a nonflammable anesthetic agent as innocuous as nitrous oxide but with greater potency, Van Poznak and Artusio 1-4 in 1956 began screening a number of fluorinated hydrocarbons and fluorinated ethers.* The most useful compound so far examined has been given the generic name methoxyflurane. It is 1,1-difluoro e,e-dichloro ethyl methyl ether, with the following structural formula: CH3-O-CF2CHC12. It is a clear, colorless liquid of characteristic odor. The boiling point is 103~ and the vapor pressure at e0~ is e5 mm. Hg. It is stable in the presence of light, soda, lime, and Baralyme | Presently available samples have dibenzylamine 0.01 per cent added as a stabilizer. At room temperature it is nonflammable in any mixture of air or oxygen. Pharmacologically, its behavior is in many ways similar to that of diethyl ether. Methoxyflurane can be administered by any technique used for diethyl ether, including open drop, semiclosed circle, and closed circle. A special vaporizer is not needed. It is compatible with other agents such as * Many of these compoumls were synthesized in tim laboratories of the Dow Chemical Company.
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