Organophosphate Insecticides: A Brief Overview of Global Use and Their Treatment with Short-Duration Isoflurane

Organophosphate (OP) insecticide poisoning remains a significant world health issue. Despite attempts to reduce OP insecticide use in some countries, they continue to be used extensively in many regions, putting agricultural workers at risk of excess exposure. Furthermore, the high toxicity and ready availability of OP insecticides in agricultural settings have created an additional public health issue due to their use in attempted suicides. Tens of thousands of people are admitted to hospitals every year after intentional ingestion of OP insecticides. The standard treatment regimen for OP poisoning can prevent mortality, even in some severe cases, but these treatments do not protect the central nervous system (CNS) from excitotoxic damage, and therefore, additional neuroprotective treatments are needed. One promising treatment is the use of halogenated ether anesthetics, including isoflurane, a common anesthetic available in hospitals throughout the world. Isoflurane can be administered by inhalation using vaporizer equipment, or it can be injected intravenously as a lipid–water emulsion. In both cases, excellent neuroprotection has been observed in preclinical models, even when administered up to 1 h after the onset of OP insecticide poisoning. Prolonged administration was not necessary for neuroprotective efficacy, with administration times of only 5 min being sufficient. Including inhalational anesthetics as an adjunct to the standard treatment for OP poisoning could significantly reduce chronic morbidities, especially long-term CNS damage. Research is ongoing to bring this promising treatment to human trials.