No

General Anesthetic

General induction and maintenance of anesthesia (inhalation)

B

Previous hypersensitivity to sevoflurane or other halogenated anesthetics

Malignant hyperthermia has been reported in susceptible patients, due to its potential for fluoride nephropathy, renal function should be closely monitored, similar to isoflurane, sevoflurane has the potential to increase cerebral blood flow and intracranial pressure and therefore, must be used with caution in patients with pre-existing increases in CSF pressure.

>1%:

Central nervous system: Agitation, headache, somnolence, dizziness, fever, early emergence movement, hypothermia

Gastrointestinal: Nausea (25%) and vomiting (18%), increased salivation

Respiratory: Laryngospasm, airway obstruction, breath holding, increased cough, apnea

Miscellaneous: Shivering

CYP2E1 enzyme substrate

Store at controlled room temperature (15°C to 30°C); use cautiously in low-flow or closed-circuit systems, since sevoflurane is unstable potentially toxic breakdown products have been liberated

Sevoflurane has a low blood/gas partition coefficient and therefore is associated with a rapid onset of anesthesia and recovery

Emergence time: 4 to 14 minutes

Metabolism: In the liver to inorganic fluoride, hexafluoroisopropanol and hexafluoroisopropanol glucuronide

Induction: Usually administered in concentrations of 1.8% to 5% in N₂O/O₂. It has also been given via the vital capacity rapid inhalation technique as 4.5% in N₂O/O₂

Maintenance: Surgical levels of anesthesia can usually be obtained with concentrations of 0.75% to 3%

Blood pressure, temperature, heart rate, neuromuscular function, oxygen saturation, end-tidal CO₂ and end-tidal sevoflurane concentrations should be monitored prior to and throughout anesthesia; the dose of sevoflurane may be adjusted by monitoring blood pressure, since the depth of anesthesia is inversely related to blood pressure in the absence of other complications

Liquid for inhalation: 250 mL

Doi M and Ikeda K, "Airway Irritation Produced by Volatile Anaesthetics During Brief Inhalation: Comparison of Halothane, Enflurane, Isoflurane and Sevoflurane," Can J Anaesth, 1993, 40(2):122-6.

Frink EJ Jr, Ghantous H, Malan TP, et al, "Plasma Inorganic Fluoride With Sevoflurane Anesthesia: Correlation With Indices of Hepatic and Renal Function," Anesth Analg, 1992, 74(2):231-5.

Jones RM, "Desflurane and Sevoflurane: Inhalation Anaesthetics for This Decade?" Br J Anaesth, 1990, 65(4):527-36.

Katoh T, Suguro Y, Nakajima R, et al, "Blood Concentrations of Sevoflurane and Isoflurane on Recovery From Anaesthesia," Br J Anaesth, 1992, 69(3):259-62.

Smith I, Ding Y, and White PF, "Comparison of Induction, Maintenance, and Recovery Characteristics of Sevoflurane-N20 and Propofol-Sevoflurane-N(2)O With Propofol-Isoflurane-N(2)O Anesthesia," Anesth Analg, 1992, 74(2):253-9.

Strum DP and Eger EI 2d, "Partition Coefficients for Sevoflurane in Human Blood, Saline, and Olive Oil," Anesth Analg, 1987, 66(7):654-6.