Which volatile anesthetic is most likely to sensitize the heart to epinephrine?

Which volatile anesthetic is most likely to sensitize the heart to epinephrine?

• A. Halothane
• B. Sevoflurane
• C. Isoflurane
• D. Desflurane

Answer: (A)

Volatile anesthetics can change how stable the heart’s electrical activity is, making it more vulnerable to the pro-arrhythmic effects of catecholamines like epinephrine. Halothane stands out because it markedly increases this sensitivity, so when epinephrine is present, the heart is much more likely to develop ventricular ectopy or tachyarrhythmias. This happens through disruption of calcium handling and membrane excitability in cardiac cells, which lowers the threshold for epinephrine-induced arrhythmias. The other commonly used agents—sevoflurane, isoflurane, and desflurane—have a much weaker sensitizing effect, so the risk of epinephrine-triggered arrhythmias is lower with them.

Volatile anesthetics can change how stable the heart’s electrical activity is, making it more vulnerable to the pro-arrhythmic effects of catecholamines like epinephrine. Halothane stands out because it markedly increases this sensitivity, so when epinephrine is present, the heart is much more likely to develop ventricular ectopy or tachyarrhythmias. This happens through disruption of calcium handling and membrane excitability in cardiac cells, which lowers the threshold for epinephrine-induced arrhythmias. The other commonly used agents—sevoflurane, isoflurane, and desflurane—have a much weaker sensitizing effect, so the risk of epinephrine-triggered arrhythmias is lower with them.