desflurane + oxygen + nitric oxide

This is a combination of three inhaled agents—desflurane, oxygen, and nitric oxide—used in anesthesia. Desflurane is a volatile halogenated ether anesthetic with rapid onset and offset due to its low blood-gas solubility. It acts primarily as a positive allosteric modulator at the GABA(A) receptor, also agonizing glycine receptors, antagonizing glutamate receptors (notably NMDA), inducing potassium channels, and inhibiting NADH-ubiquinone oxidoreductase chain 1 and calcium transporting ATPases[8]. Oxygen serves as an essential carrier gas for respiration during anesthesia. Nitric oxide (NO), when used in medical settings (distinct from nitrous oxide), acts as a selective pulmonary vasodilator by activating soluble guanylate cyclase in vascular smooth muscle cells, increasing cGMP levels and causing vasodilation; it is primarily used for pulmonary hypertension but may be included in specialized anesthetic regimens. The combination of these agents can provide general anesthesia with hemodynamic stability while allowing titration of oxygenation and pulmonary vascular resistance.