Index of drugs

Induction and maintenance of general anesthesia in adults and children.

250 ml liquid for steam inhalation contains sevoflurane 100%.

An inhalation worm. Sevoflurane is a halogenated methyl-isopropyl ether for inhalation of general anesthesia characterized by rapid induction of anesthesia and rapid arousal. MAC (the lowest concentration in the alveoli) depends on age. It causes loss of consciousness, reversible abolition of pain sensations and physical activity, weakening of autonomic reflexes, inhibition of respiratory function and circulatory system. These effects depend on the dose. Sevoflurane has a low blood / gas partition coefficient (0.65), which allows for quick recovery from anesthesia. The drug may cause a concentration-dependent decrease in blood pressure. It shows the action sensitizing the myocardium to the arrhythmogenic effect of exogenously administered adrenaline. Sevoflurane is sparingly soluble in blood and tissues, resulting in rapid achievement of adequate alveolar concentration to induce anesthesia and subsequent rapid elimination until complete anesthesia is discontinued. Less than 5% of absorbed sevoflurane is metabolized in the liver to hexafluoro isopropanol (HFIP), with inorganic fluorides and CO₂ (or one-carbon compounds). Once formed, HFIP undergoes rapid conjugation with glucuronic acid and elimination in the urine. Fast and intensive elimination of sevoflurane by the lungs reduces to a minimum the amount of the drug available for metabolism. The metabolism of sevoflurane is not induced by barbiturates.

Hypersensitivity to sevoflurane or other halogen anesthetics. History of unexplained moderate or severe hepatic dysfunction with jaundice, fever and eosinophilia after anesthesia with sevoflurane. Confirmed or suspected susceptibility to malignant hyperthermia.

Special care should be taken when selecting doses in patients with low blood pressure, reduced circulating volume and in patients who are impaired, as well as in patients with impaired renal function (serum creatinine ≥1,5 mg / dl or 135 μmol / l; post-operative renal function should be monitored) and in the use of anesthesia in obstetrics (due to the loosening effect of sevoflurane on the uterus and the severity of uterine hemorrhage). While maintaining anesthesia, increasing sevoflurane causes dose-related drops in blood pressure. Excessive anesthesia can be corrected by reducing sevoflurane levels. Caution should be exercised with repeated use. It is important to maintain haemodynamic stability to avoid myocardial ischemia in patients with ischemic heart disease. In patients at risk of increased intracranial pressure, sevoflurane should be administered with caution while using intracranial pressure lowering procedures. In susceptible patients, sevoflurane may cause increased skeletal muscle metabolism, leading to an increase in oxygen demand and the occurrence of a clinical syndrome known as malignant hyperthermia. Treatment consists of discontinuation of sevoflurane, intravenous administration of dantrolene sodium, maintenance treatment and monitoring and maintenance of urine production. Patients at risk for seizures should undergo clinical evaluation when using sevoflurane, therefore it is important to limit depth of anesthesia in children (wide use of brain function monitoring may facilitate optimal dose selection and help avoid sudden suppression and seizure-like symptoms of large seizures in particularly vulnerable patients , especially very young and elderly people). Caution is advised when administering the drug in patients with co-existing liver disease or in patients receiving medications that may potentially cause liver problems.

It may be used in pregnant women only if the benefits clearly outweigh the risks to the fetus. Sevoflurane has a relaxing effect on the uterus, hence there is a risk of increased macrovascular bleeding. The safety of using the medicine during natural delivery has not been studied. Limited data are available on the safety of the medicine for mother and baby during planned cesarean surgery. Caution should be exercised when using the medicine during breastfeeding

Sevoflurane may induce dose-dependent depression of cardiac function and respiratory depression. Most of the side effects are mild to moderate and they are transient. Very common: agitation (23%, pediatric patients); bradycardia (elderly people); reduction in blood pressure; cough (pediatric patients); nausea (24%), vomiting (17%). Common: agitation; drowsiness, headache, dizziness, tremors; bradycardia, tachycardia; hypertension; cough, respiratory depression, laryngospasm; increased salivation; fever, chills; increased AST activity; hypothermia. Uncommon: leukocytosis, leukopenia; hyperglycemia; entanglement; cardiac arrhythmias (including ventricular arrhythmias), atrial fibrillation, additional spasms (ventricular, supraventricular, twin-beat), total atrioventricular block; apnea, asthma, hypoxia; urinary retention, glycosuria; increased activity of LDH, alkaline phosphatase and ALT, increased serum creatinine. Rare: dystonic movements; liver dysfunction, hepatitis; malignant hyperthermia. Very rare: epileptiform convulsions; pulmonary oedema; acute renal failure. Side effects seen after the medicine has been on the market: rare cases of rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions have been reported. In addition, convulsions were observed during or shortly after induction of anesthesia with sevoflurane, during recovery from anesthesia and in the postoperative period up to 1 day after anesthesia.

The medicine can only be administered by people who are adequately trained in the use of general anesthesia and immediate availability of devices to maintain airway patency, artificial ventilation, oxygen therapy and cardiopulmonary resuscitation. The drug should be administered via vaporizers specially calibrated for administration of sevoflurane, so that precise control of the administered drug concentration is possible. The MAC values ​​(the smallest follicular concentration) of sevoflurane decrease with the patient's age and with the addition of N₂A. Dosage should be selected individually and adjusted to achieve the desired effect depending on the age and clinical condition of the patient. Before inhalation of sevoflurane, short-acting barbiturates or other intravenous agents may be used to induce anesthesia. Anesthesia can be induced with sevoflurane alone by inhalation of 0.5-1% sevoflurane in₂with the addition of N₂With or without and increasing the concentration of sevoflurane by 0.5-1% to a maximum concentration of 8% in adults and children, until the desired depth of anesthesia is achieved. In adults, inhalation of sevoflurane up to 5% usually results in anesthesia required for surgery in less than 2 minutes. In children, inhalation of sevoflurane up to 7% usually results in anesthesia required for surgery in less than 2 minutes. Levels of anesthesia required for surgery can be maintained by inhalation of 0.5-3% sevoflurane in O₂ with the addition of N₂With or without.