Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section C. Anesthesia Drugs and Drug Delivery Systems > Chapter 36. Mechanisms of General Anesthetic Action Max B. Kelz, MD, PhD, Jay Yang, MD, PhD, and Roderic G. Eckenhoff, MD

Key Points

"1. The mechanisms by which the inhaled general anesthetics work are not fully understood. No single molecular target has been proven to transduce anesthesia.

2. Correlation of the physicochemical character of anesthetics with their potency suggests target sites are dominantly hydrophobic, with a small degree of polarity and chirality. Internal protein cavities best fit this description.

3. Inhaled anesthetic binding site character is not highly specific, predicting more than a few anesthetic binding targets. The interaction at some of these targets may not contribute significantly to anesthetic action.

4. Use of the lipid membrane as a direct target for inhaled anesthetics has been dismissed prematurely. Some components of anesthetic action may occur via this interaction.

5. Many potential protein targets in the synapse have been identified, suggesting that inhaled anesthetic action results from disruption of the specific process of synaptic transmission rather than from a receptor-like interaction with a single molecular target.

6. Anesthetic effects on a process, such as synaptic transmission, may have a different system-level effect depending on placement in the neural circuitry. The circuits that regulate sleep and arousal are well positioned to mediate the hypnotic properties of anesthetics.

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