Compound A is a halogenated inhalational agent. At a blood:gas partition coefficient of 0.69, it has the fastest induction and recovery of all clinical volatile agents. Which agent is this, and what complication limits its use at high concentrations (>1 MAC) without adequate fresh gas flow?
- A Sevoflurane; nephrotoxic compound A formation
- B Isoflurane; hepatotoxicity
- C Desflurane; pungency causing airway irritation (unsuitable for inhalational induction); compound A formation is not the primary concern for desflurane ✓
- D Halothane; malignant hyperthermia as primary concern
Correct answer: C. Desflurane; pungency causing airway irritation (unsuitable for inhalational induction); compound A formation is not the primary concern for desflurane
Explanation
Desflurane has the lowest blood:gas partition coefficient (0.42) of clinically used volatile agents, giving the fastest onset and offset. However, its high pungency (irritant to airway mucosa) makes inhalational induction impractical — it causes coughing, breath-holding, laryngospasm, and excessive secretions, so it is only used for maintenance after IV induction. Sevoflurane degrades in soda lime to compound A (a nephrotoxic vinyl ether compound), not desflurane. Isoflurane is not significantly hepatotoxic in clinical doses.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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