Understanding Anesthesiology - The Global Regional Anesthesia ...

SEVOFLURANE
Class
Volatile inhaled anesthetic. Used for maintenance of anesthesia.
Can be used for induction of anesthesia particularly
in children. Rarely may be used as a treatment
for status asthmaticus.
Mechanism of Action
Uncertain
Dose
Titrated to effect; MAC (age 40) = 2.1%.
Onset
Low solubility allows rapid uptake and equilibration.
Onset of effect is hastened by using higher flows of carrier
gases and by using higher concentrations of volatile
agent.
Duration
Clinical recovery in less than 10 minutes (usually). If
given for prolonged periods, wake-up will be slower as
adipose stores have been saturated and are slow to offload.
Elimination
Pulmonary (major); hepatic (2-5%); renal (metabolites
excretion only)
Effects
CNS
Sevoflurane produces an additive central nervous system
(CNS)-depressant effect along with other sedative/
hypnotics and analgesics. Has the potential to increase
intracranial pressure which can be mitigated with hyperventilation.
Delirium.
CVS
Dose-related hypotension (vasodilation).
Respiratory
Respiratory depression with a rapid, shallow respiratory
pattern. Loss of intercostal muscle function creates
a rocking boat appearance. Causes bronchodilation.
Sevoflurane is sweet-smelling and not as irritating to
the respiratory tract as desflurane.
GI
Nausea, vomiting.
MSK
Potentiates neuromuscular blockade. Malignant hyperthermia
trigger.
Misc.
Potential nephrotoxicity due to Compound A which is
produced through contact with soda lime. Compound
A can be produced if sevoflurane is used with very low
fresh gas flows or for long MAC-hours. Therefore, sevoflurane
must be used with a minimum of 2 litres/
minute of fresh gas flow.
Contraindications
Malignant hyperthermia susceptibility
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