Pharmacodynamic Differences Between Sevoflurane and Isoflurane

Cardiovascular Effects

Both sevoflurane and isoflurane cause dose-dependent depression of myocardial contractility and afterload reduction, with more similarities than differences in their cardiovascular profiles, as noted by the American College of Cardiology 1
Both agents demonstrate cardioprotective effects, decreasing troponin release and enhancing left ventricular function compared to propofol or midazolam in cardiac surgery patients, according to the American College of Cardiology and supported by Praxis Medical Insights 1, 2

Both sevoflurane and isoflurane suppress immune cell function, but with some agent-specific differences, as reported by the American Society of Anesthesiologists 3, 4
Both agents decrease neutrophil adhesion to human endothelial cells, which may provide beneficial effects in ischemic settings, as found by the American Society of Anesthesiologists 3
Isoflurane and sevoflurane bind to lymphocyte function-associated antigen-1 (LFA-1), blocking its interaction with ICAM-1 and inhibiting immune cell adhesion, as described by the American Society of Anesthesiologists 4
Isoflurane, but not sevoflurane, has an inhibitory effect on Macrophage-1 antigen (MAC-1), demonstrating a difference in their immunomodulatory profiles, according to the American Society of Anesthesiologists 4

The French Society of Anesthesia and Resuscitation strongly recommends sevoflurane over isoflurane when choosing an inhalational anesthetic, when clinical benefits are equal, due to its pharmacodynamic properties 5

Sevoflurane has a higher metabolism rate (4-5%) compared to isoflurane (0.2%), resulting in less unmetabolized agent being released into the atmosphere, as noted in Anaesthesia 6, 7