I'm with Jet. I love sevo. Iso is nice too if you have a really long case and want to save the hospital some money. I love Iso\Sevo wake ups, they are so smooth. If you know how and when to dial down your vapors, emergence is almost instant if you do it right. Iso is a bit trickier but you have a lot of leeway if you dial it down early because patients won't be bucking for awhile. I truly hate Des, I stopped using it 6 months ago. I don't even care if they are super obese, its just a dirty volatile. I mean the pungency is so strong it causes sympathetic surge during initial maintenance..
To each their own, but it's worth pointing out that the pungency of des isn't what causes the (brief, and usually overstated) sympathetic surge. That's just an inherent property of the gas. Pungency bothers awake people, but not anesthetized people. Hence, running des in an LMA is no problem. Also, I don't mind a bit of sympathetic activity during the time when BP usually sags, which is the time between intubation and incision.
I think desflurane is a superior anesthetic in most ways to sevo. I believe it's significantly faster. You can make sevo wakeups fast, but it involves turning it down early/adding N20/generalized fussing. You can pretty much run a MAC of des up until skin sutures are going in, turn it off and have them wake up lickety split.
I've never sat in the OR waiting for the last .2 MAC to blow off with des, ever. I've definitely done that with sevo.
You can run low flows/closed circuit flows with des, which conserves heat (and anesthetic), and serves as a poor man's cardiac output monitor when looking at the ET concentration.
I also like that the des vaporizer has a "fill me up please" alarm, but that's just frosting.
I can see not using it in a very sick heart or someone who won't tolerate even a few minutes of sympathetic surge when you jack up the concentration, or in a terrible asthmatic since sevo is probably a better bronchodilator, but all in all, I think its speed makes it superior.
But again, to each their own. Use what works for you.
As for nitrous, since there's a chance (however slight) of it causing some increased long term cardiac morbidity, I avoid it as much as possible. If granny won't tolerate much volatile, I'll put a BIS on her and turn down the vaporizer beyond what would otherwise be my comfort level. If BIS is 60ish and she's still hypotensive, I'll use nitrous. That and the rare GA c-section. That's really about it. I try to avoid polypharmacy in general, and avoiding N20 falls in line with that.