Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Sevoflurane Ultane · Sevorane	Desflurane Suprane	Isoflurane Forane
Class	Halogenated methyl isopropyl ether — volatile general anesthetic	Fully fluorinated halogenated methyl ethyl ether — volatile general anesthetic	Halogenated methyl ethyl ether — volatile anesthetic
Mechanism	Multi-site CNS depression: GABA-A potentiation, glycine receptor potentiation, NMDA + nicotinic ACh inhibition, two-pore K⁺ channel activation. Net: dose-dependent unconsciousness, amnesia, immobility, and analgesia (modest).	Same multi-site mechanism as sevoflurane: GABA-A + glycine potentiation, NMDA + nicotinic ACh inhibition, K⁺ channel activation.	Volatile anesthetic. Multiple sites: potentiates GABA-A, antagonizes NMDA, activates two-pore-domain K⁺ channels, modulates glycine. Lower potency than sevoflurane but produces deeper unconsciousness per MAC. Pungent — not used for inhalation induction.
Indications	· GA induction (mask, especially pediatric) · GA maintenance · Bronchospasm rescue (volatile bronchodilation)	· GA maintenance (favored for fast emergence in obese / outpatient / long cases) · Not recommended for inhalational induction (pungency)	· Maintenance of general anesthesia · ICU sedation in long cases (less popular now; propofol or dexmedetomidine generally preferred) · Long surgical cases where slow emergence is acceptable and cost is a factor (cheapest of the three modern volatiles)
Dosing	Mask induction (peds): Up to 8% inspired with O₂ ± N₂O; titrate down post-LOC · peds 8% inspired (single-breath or stepwise) — tolerated due to non-pungent character Adult induction (slow): Stepwise 1→8% over several breaths; bridge to IV induction more common in adults Maintenance: 0.5–2.5% inspired (1 MAC ≈ 2.05% age 40; declines ~6%/decade) · peds MAC age 1–6 mo ≈ 3.2%; MAC neonate ≈ 3.3%; declines to ~2.5% through childhood	Maintenance (adult): 3–8% inspired (1 MAC = 6.0% age 40; declines ~6%/decade) Maintenance (pediatric): 1 MAC age 1–5 y ≈ 8.6%; not used for mask induction (cough/breath-holding/laryngospasm)	MAC: 1.15% (age 40); decreases ~6% per decade of age Maintenance (1.0 MAC end-tidal): 1.0–1.5% inspired
PK (onset / duration)	Blood:gas partition coefficient 0.65 (low → fast on/off). MAC 2.05% age 40, drops ~6% per decade. Minimally metabolized (~5% by CYP2E1 to inorganic fluoride + hexafluoroisopropanol). Standard wash-in/wash-out within minutes.	Lowest blood:gas partition coefficient of clinical volatiles: 0.42 (vs sevo 0.65, iso 1.4). Translates to fastest emergence — particularly meaningful in obese patients and long cases. Negligible metabolism (~0.02%) → no fluoride or hepatotoxic intermediate concerns. Vapor pressure 681 mmHg at 20°C (almost atmospheric) requires HEATED, PRESSURIZED Tec 6 vaporizer.	Blood:gas partition coefficient 1.4 (slower than des [0.42] or sevo [0.65]). Slower onset and offset than the modern alternatives. Hepatic metabolism 0.2% (lowest of the three).
Hemodynamics	Dose-dependent ↓SVR + ↓MAP (mild–moderate). Cardiac output relatively preserved vs other volatiles. Minimal coronary vasodilation (no clinically significant 'coronary steal'). HR usually stable; can rise mildly at >1.5 MAC.	Dose-dependent ↓SVR + ↓MAP (similar to sevo). UNIQUE: rapid increases in inspired concentration (>6%) cause sympathetic stimulation → HR + BP spike (mediated by airway irritation activating tracheo-bronchial receptors). Mitigate by gradual increase or pretreating with opioid/β-blocker.	Dose-dependent ↓SVR > sevo > des; mild ↑HR; minimal contractility effect at <2 MAC. Coronary vasodilation more pronounced than other volatiles.
Respiratory	Non-pungent — gold standard for pediatric mask induction. Dose-dependent ↓TV and ↑RR (rapid shallow). Bronchodilator. Blunts hypoxic + hypercarbic ventilatory drive.	PUNGENT — causes coughing, breath-holding, laryngospasm if increased rapidly. Contraindicated for inhalational induction. Otherwise similar respiratory profile to sevo (↓TV, ↑RR, bronchodilator, blunted CO₂ response).	Pungent — coughing and laryngospasm on inhalation induction. Bronchodilator. Dose-dependent CO₂-response curve flattening.
Side effects	· Compound A formation in CO₂ absorbents (esp. desiccated soda lime with NaOH/KOH bases) — theoretical nephrotoxicity at FGF <1 L/min × prolonged exposure; modern Amsorb-class absorbents eliminate. Clinical relevance in humans remains unproven. · Emergence delirium in pediatric patients (20–80% incidence; mitigate with dexmedetomidine 0.3 mcg/kg, propofol 1 mg/kg at end, or fentanyl) · MH trigger (all halogenated agents are) · Postoperative shivering (volatile-class effect) · Mild hepatotoxicity (rare; lower than des/iso/halothane)	· Sympathetic stimulation with rapid inspired concentration changes (>6%) — ↑HR, ↑BP, can precipitate myocardial ischemia in CAD · Carbon monoxide formation in DESICCATED CO₂ absorbents (especially old Baralyme; minimized with modern absorbents kept hydrated, FGF cycled off overnight) · MH trigger · Emergence cough/agitation if not weaned smoothly · Highest greenhouse warming potential of clinical volatiles (~2540 GWP-100; ~25× sevo) — environmental consideration	· Pungency → coughing, breath-holding on induction (use only for maintenance) · Hypotension (greater SVR drop than sevo) · Tachycardia · Malignant hyperthermia trigger (any halogenated volatile) · Theoretical coronary steal in fixed CAD
Contraindications	· MH susceptibility (any volatile) · Severe hepatic dysfunction (relative) · Pheochromocytoma (relative — sympathetic stim with high-dose volatiles)	· MH susceptibility · Inhalational induction (pungency) · Severe coronary disease (relative — sympathetic surge risk with rapid concentration changes)	· Known or suspected MH susceptibility · Hypersensitivity
Reversal	—	—	—
Pearls	· FAST induction + FAST emergence: blood:gas 0.65 means changes in inspired concentration reach effect-site within 1–2 min. · Pediatric induction of choice — non-pungent, no breath-holding, no laryngospasm trigger like desflurane. · MAC additive with N₂O: 1 MAC sevo (2.05%) + 50% N₂O (≈ 0.48 MAC) = ~1.48 MAC total. · Compound A is essentially a non-issue with modern (Amsorb-class) absorbents and FGF >1 L/min.	· FASTEST emergence of any volatile — clinically meaningful for obese patients (where redistribution is slowed by adipose) and long surgeries. · Increase concentration GRADUALLY: 1% increments every few breaths to avoid sympathetic surge. · Tec 6 vaporizer is heated (39°C) and electrically controlled — different from variable-bypass vaporizers; needs power. · CO formation risk: turn off FGF overnight only with fresh hydrated absorbent OR keep absorbent moist; modern Amsorb eliminates risk.	· CHEAPEST VOLATILE: per-MAC-hour cost ~1/3 of sevoflurane and ~1/5 of desflurane. Long cases at low fresh-gas-flow with careful CO2 monitoring make iso the budget winner. · SLOW EMERGENCE: blood:gas coefficient 1.4 → 30–60 min wake-up after long maintenance. Not preferred for short cases. · CORONARY STEAL: theoretical concern in patients with severe fixed multi-vessel CAD (Slogoff/Keats 1989); subsequent data soft. Most centers no longer treat this as a hard contraindication, but sevo is the cardiac-favored choice anyway. · PEDIATRIC INDUCTION: too pungent for inhalation induction — sevoflurane is the only modern volatile suitable.

Common compares

Propofol vs Etomidate vs Ketamine Sux vs Roc vs Cis Fentanyl vs Remi Phenylephrine vs Norepi Volatiles

Cells showing "—" indicate the drug doesn't have a detail entry for that field yet (most drugs do; some legacy class members haven't been fully populated). Education only — verify dosing against package insert + institutional protocol before bedside use.

Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Sevoflurane Ultane · Sevorane	Desflurane Suprane	Isoflurane Forane
Class	Halogenated methyl isopropyl ether — volatile general anesthetic	Fully fluorinated halogenated methyl ethyl ether — volatile general anesthetic	Halogenated methyl ethyl ether — volatile anesthetic
Mechanism	Multi-site CNS depression: GABA-A potentiation, glycine receptor potentiation, NMDA + nicotinic ACh inhibition, two-pore K⁺ channel activation. Net: dose-dependent unconsciousness, amnesia, immobility, and analgesia (modest).	Same multi-site mechanism as sevoflurane: GABA-A + glycine potentiation, NMDA + nicotinic ACh inhibition, K⁺ channel activation.	Volatile anesthetic. Multiple sites: potentiates GABA-A, antagonizes NMDA, activates two-pore-domain K⁺ channels, modulates glycine. Lower potency than sevoflurane but produces deeper unconsciousness per MAC. Pungent — not used for inhalation induction.
Indications	· GA induction (mask, especially pediatric) · GA maintenance · Bronchospasm rescue (volatile bronchodilation)	· GA maintenance (favored for fast emergence in obese / outpatient / long cases) · Not recommended for inhalational induction (pungency)	· Maintenance of general anesthesia · ICU sedation in long cases (less popular now; propofol or dexmedetomidine generally preferred) · Long surgical cases where slow emergence is acceptable and cost is a factor (cheapest of the three modern volatiles)
Dosing	Mask induction (peds): Up to 8% inspired with O₂ ± N₂O; titrate down post-LOC · peds 8% inspired (single-breath or stepwise) — tolerated due to non-pungent character Adult induction (slow): Stepwise 1→8% over several breaths; bridge to IV induction more common in adults Maintenance: 0.5–2.5% inspired (1 MAC ≈ 2.05% age 40; declines ~6%/decade) · peds MAC age 1–6 mo ≈ 3.2%; MAC neonate ≈ 3.3%; declines to ~2.5% through childhood	Maintenance (adult): 3–8% inspired (1 MAC = 6.0% age 40; declines ~6%/decade) Maintenance (pediatric): 1 MAC age 1–5 y ≈ 8.6%; not used for mask induction (cough/breath-holding/laryngospasm)	MAC: 1.15% (age 40); decreases ~6% per decade of age Maintenance (1.0 MAC end-tidal): 1.0–1.5% inspired
PK (onset / duration)	Blood:gas partition coefficient 0.65 (low → fast on/off). MAC 2.05% age 40, drops ~6% per decade. Minimally metabolized (~5% by CYP2E1 to inorganic fluoride + hexafluoroisopropanol). Standard wash-in/wash-out within minutes.	Lowest blood:gas partition coefficient of clinical volatiles: 0.42 (vs sevo 0.65, iso 1.4). Translates to fastest emergence — particularly meaningful in obese patients and long cases. Negligible metabolism (~0.02%) → no fluoride or hepatotoxic intermediate concerns. Vapor pressure 681 mmHg at 20°C (almost atmospheric) requires HEATED, PRESSURIZED Tec 6 vaporizer.	Blood:gas partition coefficient 1.4 (slower than des [0.42] or sevo [0.65]). Slower onset and offset than the modern alternatives. Hepatic metabolism 0.2% (lowest of the three).
Hemodynamics	Dose-dependent ↓SVR + ↓MAP (mild–moderate). Cardiac output relatively preserved vs other volatiles. Minimal coronary vasodilation (no clinically significant 'coronary steal'). HR usually stable; can rise mildly at >1.5 MAC.	Dose-dependent ↓SVR + ↓MAP (similar to sevo). UNIQUE: rapid increases in inspired concentration (>6%) cause sympathetic stimulation → HR + BP spike (mediated by airway irritation activating tracheo-bronchial receptors). Mitigate by gradual increase or pretreating with opioid/β-blocker.	Dose-dependent ↓SVR > sevo > des; mild ↑HR; minimal contractility effect at <2 MAC. Coronary vasodilation more pronounced than other volatiles.
Respiratory	Non-pungent — gold standard for pediatric mask induction. Dose-dependent ↓TV and ↑RR (rapid shallow). Bronchodilator. Blunts hypoxic + hypercarbic ventilatory drive.	PUNGENT — causes coughing, breath-holding, laryngospasm if increased rapidly. Contraindicated for inhalational induction. Otherwise similar respiratory profile to sevo (↓TV, ↑RR, bronchodilator, blunted CO₂ response).	Pungent — coughing and laryngospasm on inhalation induction. Bronchodilator. Dose-dependent CO₂-response curve flattening.
Side effects	· Compound A formation in CO₂ absorbents (esp. desiccated soda lime with NaOH/KOH bases) — theoretical nephrotoxicity at FGF <1 L/min × prolonged exposure; modern Amsorb-class absorbents eliminate. Clinical relevance in humans remains unproven. · Emergence delirium in pediatric patients (20–80% incidence; mitigate with dexmedetomidine 0.3 mcg/kg, propofol 1 mg/kg at end, or fentanyl) · MH trigger (all halogenated agents are) · Postoperative shivering (volatile-class effect) · Mild hepatotoxicity (rare; lower than des/iso/halothane)	· Sympathetic stimulation with rapid inspired concentration changes (>6%) — ↑HR, ↑BP, can precipitate myocardial ischemia in CAD · Carbon monoxide formation in DESICCATED CO₂ absorbents (especially old Baralyme; minimized with modern absorbents kept hydrated, FGF cycled off overnight) · MH trigger · Emergence cough/agitation if not weaned smoothly · Highest greenhouse warming potential of clinical volatiles (~2540 GWP-100; ~25× sevo) — environmental consideration	· Pungency → coughing, breath-holding on induction (use only for maintenance) · Hypotension (greater SVR drop than sevo) · Tachycardia · Malignant hyperthermia trigger (any halogenated volatile) · Theoretical coronary steal in fixed CAD
Contraindications	· MH susceptibility (any volatile) · Severe hepatic dysfunction (relative) · Pheochromocytoma (relative — sympathetic stim with high-dose volatiles)	· MH susceptibility · Inhalational induction (pungency) · Severe coronary disease (relative — sympathetic surge risk with rapid concentration changes)	· Known or suspected MH susceptibility · Hypersensitivity
Reversal	—	—	—
Pearls	· FAST induction + FAST emergence: blood:gas 0.65 means changes in inspired concentration reach effect-site within 1–2 min. · Pediatric induction of choice — non-pungent, no breath-holding, no laryngospasm trigger like desflurane. · MAC additive with N₂O: 1 MAC sevo (2.05%) + 50% N₂O (≈ 0.48 MAC) = ~1.48 MAC total. · Compound A is essentially a non-issue with modern (Amsorb-class) absorbents and FGF >1 L/min.	· FASTEST emergence of any volatile — clinically meaningful for obese patients (where redistribution is slowed by adipose) and long surgeries. · Increase concentration GRADUALLY: 1% increments every few breaths to avoid sympathetic surge. · Tec 6 vaporizer is heated (39°C) and electrically controlled — different from variable-bypass vaporizers; needs power. · CO formation risk: turn off FGF overnight only with fresh hydrated absorbent OR keep absorbent moist; modern Amsorb eliminates risk.	· CHEAPEST VOLATILE: per-MAC-hour cost ~1/3 of sevoflurane and ~1/5 of desflurane. Long cases at low fresh-gas-flow with careful CO2 monitoring make iso the budget winner. · SLOW EMERGENCE: blood:gas coefficient 1.4 → 30–60 min wake-up after long maintenance. Not preferred for short cases. · CORONARY STEAL: theoretical concern in patients with severe fixed multi-vessel CAD (Slogoff/Keats 1989); subsequent data soft. Most centers no longer treat this as a hard contraindication, but sevo is the cardiac-favored choice anyway. · PEDIATRIC INDUCTION: too pungent for inhalation induction — sevoflurane is the only modern volatile suitable.