Sevoflurane
Sevoflurane Uses, Dosage, Side Effects, Food Interaction and all others data.
Sevoflurane is a volatile halogenated general anaesthetic that has a minimum alveolar concentration (MAC) value ranging from 1.4% to 3.3%. It alters the activity of fast synaptic neurotransmitter receptors like nicotinic acetylcholine, GABA, and glutamate. It may depress myocardial contractility and decrease both BP and sympathetic nervous activity. Additionally, it has muscle relaxant properties w/o analgesia.
Sevoflurane induces muscle relaxation and reduces pains sensitivity by altering tissue excitability with a fast onset of action. It does so by decreasing the extent of gap junction mediated cell-cell coupling and altering the activity of the channels that underlie the action potential.
| Trade Name | Sevoflurane |
| Availability | Prescription only |
| Generic | Sevoflurane |
| Sevoflurane Other Names | Sevofluran, Sevoflurane, Sevoflurano, Sevofluranum |
| Related Drugs | fentanyl, lidocaine, ketamine, hyoscyamine, propofol, glycopyrrolate |
| Weight | 7.85g/l, 108g/l, 3.632g/l, 7.96g/l, 181g/l, 1975g/l, |
| Type | Solution |
| Formula | C4H3F7O |
| Weight | Average: 200.0548 Monoisotopic: 200.007212153 |
| Groups | Approved, Vet approved |
| Therapeutic Class | General (Inhalation) anesthetics |
| Manufacturer | Piramal Critical Care Ltd, Lahore Chemical & Pharmaceutical Works (pvt) Ltd |
| Available Country | United Kingdom, Pakistan, United States, Netherlands |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Sevoflurane is used for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery. Sevoflurane should be administered only by persons trained in the administration of general anesthesia. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitationmust be immediately available. Since level of anesthesia may be altered rapidly, only vaporizers producing predictable concentrations of sevoflurane should be used.
Sevoflurane is also used to associated treatment for these conditions: General Anesthesia, Induction and Maintenance of General Anesthesia
How Sevoflurane works
Sevoflurane induces a reduction in junctional conductance by decreasing gap junction channel opening times and increasing gap junction channel closing times. Sevoflurane also activates calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane. It also appears to bind the D subunit of ATP synthase and NADH dehydogenase and also binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the glutamate receptor, and the glycine receptor.
Dosage
Sevoflurane dosage
he concentration of sevoflurane being delivered from a vaporizer during anesthesia should be known. This may be accomplished by using a vaporizer calibrated specifically for sevoflurane. The administration of general anesthesia must be individualized based on the patient's response.
Replacement Of Desiccated CO2Absorbents: When a clinician suspects that the CO2absorbent may be desiccated, it should be replaced. The exothermic reaction that occurs with sevoflurane and CO2absorbents is increased when the CO2absorbent becomes desiccated, such as after an extended period of dry gas flow through the CO2absorbent canisters
Pre-anesthetic Medication: No specific premedication is either indicated or contraindicated with sevoflurane. The decision as to whether or not to premedicate and the choice of premedication is left to the discretion of theanesthesiologist
Induction: Sevoflurane has a nonpungent odor and does not cause respiratory irritability; it is suitable for mask induction inpediatricsand adults
Maintenance: Surgical levels of anesthesia can usually be achieved with concentrations of 0.5-3% sevoflurane with or without the concomitant use ofnitrous oxide. Sevoflurane can be administered with any type of anesthesia circuit
Side Effects
Cardiorespiratory depression, hypotension, bradycardia; laryngospasm, increased cough and salivation; urinary retention, acute renal failure, changes in liver enzyme values, liver damage; nausea, vomiting, delirium, seizure; rash, urticaria, pruritus, dyspnoea, wheezing, chest discomfort, bronchospasm, anaphylactic/anaphylactoid reaction; agitation, dystonic movements (childn).
Toxicity
LC50=49881 ppm/hr (rat), LD50=10.8 g/kg (rat)
Precaution
Patient with increased intracranial pressure, neuromuscular disease (esp Duchenne muscular dystrophy), mitochondrial disorders. Patient who are hypovolaemic, hypotensive, haemodynamically compromised, at risk of QT prolongation. Hepatic and renal impairment. Childn. Pregnancy and lactation.
Interaction
Increased metabolism and toxicity with drugs that induce CYP2E1 isoenzyme (e.g. isoniazid). Reduced MAC with benzodiazepines, opioids. May cause ventricular arrhythmia with β-sympathomimetic agents (e.g. isoprenaline), and α- and β-sympathomimetic agents (e.g. adrenaline, noradrenaline). May cause crisis during operation with nonselective MAO inhibitors. May lead to marked hypotension and risk of additive negative inotropic effect with Ca antagonists (esp dihydropyridines).
Food Interaction
No interactions found.Sevoflurane Drug Interaction
Major: epinephrineModerate: azithromycin, ciprofloxacin, hydromorphone, ondansetronUnknown: aspirin, charcoal, amoxicillin, multivitamin, dexamethasone, heparin, acetaminophen, procaine penicillin, vitamin a topical, bioflavonoids, ketorolac, valproic acid, cyanocobalamin, cholecalciferol, phytonadione
Sevoflurane Disease Interaction
Major: hyperthermiaModerate: hepatic dysfunction, hyperkalemia, intracranial pressure, renal impairment, seizures
Elimination Route
Rapidly absorbed into circulation via the lungs, however solubility in the blood is low.
Half Life
15-23 hours
Elimination Route
The low solubility of sevoflurane facilitates rapid elimination via the lungs. In vivo metabolism studies suggest that approximately 5% of the sevoflurane dose may be metabolized. Up to 3.5% of the sevoflurane dose appears in the urine as inorganic fluoride.
Pregnancy & Breastfeeding use
Pregnancy Category B. Reproduction studies have been performed in rats and rabbits at doses up to 1 MAC (minimum alveolar concentration) without CO2 absorbent and have revealed no evidence of impaired fertility or harm to the fetus due to sevoflurane at 0.3 MAC, the highest nontoxic dose. Developmental and reproductive toxicity studies of sevoflurane in animals in the presence of strong alkalies (i.e., degradation of sevoflurane and production of Compound A) have not been conducted. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, sevoflurane should be used during pregnancy only if clearly needed.
Labor And Delivery: Sevoflurane has been used as part of general anesthesia for elective cesarean section in 29 women. There were no untoward effects in mother or neonate (see Pharmacodynamics - Clinical Trials). The safety of sevoflurane in labor and delivery has not been demonstrated.
Nursing Mothers: The concentrations of sevoflurane in milk are probably of no clinical importance 24 hours after anesthesia. Because of rapid washout, sevoflurane concentrations in milk are predicted to be below those found with many other volatile anesthetics.
Contraindication
Sevoflurane can cause malignant hyperthermia. It should not be used in patients with known sensitivity to sevoflurane or to other halogenated agents nor in patients with known or suspected susceptibility to malignant hyperthermia.
Special Warning
Geriatric Use: MAC decreases with increasing age. The average concentration of sevoflurane to achieve MAC in an 80 year old is approximately 50% of that required in a 20 year old.
Pediatric Use: Induction and maintenance of general anesthesia with sevoflurane have been established in controlled clinical trials in pediatric patients aged 1 to 18 years. Sevoflurane has a nonpungent odor and is suitable for mask induction in pediatric patients.
The concentration of sevoflurane required for maintenance of general anesthesia is age dependent. When used in combination with nitrous oxide, the MAC equivalent dose of sevoflurane should be reduced in pediatric patients. MAC in premature infants has not been determined.
The use of sevoflurane has been associated with seizures. The majority of these have occurred in children and young adults starting from 2 months of age, most of whom had no predisposing risk factors. Clinical judgement should be exercised when using sevoflurane in patients who may be at risk for seizures.
Acute Overdose
In the event of overdosage, or what may appear to be overdosage, the following action should be taken: discontinue administration of sevoflurane, maintain a patent airway, initiate assisted or controlled ventilation with oxygen, and maintain adequate cardiovascular function.
Storage Condition
Store between 15-30° C. Protect from light.
Innovators Monograph
You find simplified version here Sevoflurane
Sevoflurane contains Sevoflurane see full prescribing information from innovator Sevoflurane Monograph, Sevoflurane MSDS, Sevoflurane FDA label
FAQ
What is Sevoflurane used for?
Sevoflurane used to treat induction and maintenance of general anesthesia in adults and pediatric patients for inpatient and outpatient surgery.
How safe is Sevoflurane?
it has no effect on the normal cardiac conduction pathways and therefore is considered a safe agent that can also be used in cardiac electrophysiological procedures.
How does Sevoflurane work?
These work by temporarily reducing the activity of the body's central nervous system.
What are the common side effects of Sevoflurane?
The most common side effects of Sevoflurane are include: nausea, vomiting, hypotension, agitation, and cough.
Is Sevoflurane safe during pregnancy?
Sevoflurane should be used during pregnancy only if clearly needed.
Is Sevoflurane safe during breastfeeding?
Advise women to skip breastfeeding for 48 hours after administration and discard milk produced during this period.
Can I drink alcohol with Sevoflurane?
drink alcohol containing drinks on a regular basis may require higher doses of Sevoflurane and are at increased risk of developing severe liver side effects. Limit or avoid Alcoholic beverages before and after surgery.
Can I drive after taking Sevoflurane?
It may also cause problems with coordination and ability to think. Therefore, for about 24 hours (or longer if necessary) after receiving Sevoflurane, do not drive, operate moving machinery, or do anything else that could be dangerous if you are not alert .
How long does it take for Sevoflurane to work?
Sevoflurane usually produce surgical anaesthesia in less than 2 minutes.
How long does Sevoflurane stay in my system?
The duration of anesthesia was not different between groups and averaged 114.3 min and 119.0 min for Sevoflurane and isoflurane, respectively.
Is Sevoflurane a muscle relaxant?
Sevoflurane increased sensitivity to muscle relaxants but no direct muscle relaxation.
How do I give Sevoflurane?
Sevoflurane is administered via inhalation of the vaporised liquid.
Does Sevoflurane increase blood pressure?
Sevoflurane progressively decrease blood pressure and this decrease appears similar to isoflurane and desflurane.
Does Sevoflurane cause tachycardia?
Sevoflurane was not associated with increases in heart rate in adult patients and volunteers, whereas higher MACs of isoflurane and desflurane and rapid increases in the inspired concentrations of these two anesthetics have been associated with tachycardia.
Does Sevoflurane cause hypotension?
Sevoflurane did not alter heart rate, but decreased mean arterial pressure and mean pulmonary artery pressure.
Can I take overdose of Sevoflurane?
In the event of Sevoflurane, or what may appear to be overdosage, the following action should be taken: discontinue administration of Sevoflurane, maintain a patent airway, initiate assisted or controlled ventilation with oxygen, and maintain adequate cardiovascular function.
What happen If I missed Sevoflurane?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
