The Perfluorocarbon Paradox: Historical Legacy and Residual Use of Isoflurane and Enflurane in Anesthesia Practice

Abstract

This review article critically examines the paradoxical persistence of isoflurane and enflurane in anesthesia practice, despite well-documented concerns about their perfluorocarbon (PFC) composition and environmental impact. While these agents historically offered advantages in rapid induction, ease of administration, and cost-effectiveness, their continued use must now be weighed against newer, more environmentally sustainable alternatives such as sevoflurane and desflurane. Recent regulatory frameworks and updated studies emphasize the need to reduce volatile anesthetic emissions, as PFCs contribute significantly to global warming potential. Clinical considerations including enflurane’s association with epileptiform EEG activity have contributed to its withdrawal from most markets. By integrating historical perspectives, updated comparative pharmacology, and regulatory and environmental considerations, this article highlights multifaceted challenges and risk mitigation strategies, including engineering controls, administrative policies, and sustainable practice guidelines.