Sevorane

• Approved Indications:
• Induction and maintenance of general anesthesia in adults and pediatric patients undergoing surgical procedures.
• Suitable for both inpatient and outpatient anesthesia requiring rapid onset and recovery.
• Off-label or Clinically Accepted Uses:
• Sedation in intensive care settings (less common).
• Anesthesia in patients with reactive airway disease due to bronchodilatory properties.

• Adults:
• Induction: 3% to 8% inhaled concentration in oxygen or oxygen/air mixture.
• Maintenance: 1% to 4% inhaled concentration titrated according to surgical stimulus and patient response.
• Pediatrics:
• Induction: 6% to 8% inhaled concentration with oxygen or oxygen/air mixture.
• Maintenance: 1% to 4%, adjusted as needed.
• Elderly:
• Dose reduction may be required due to increased sensitivity.
• Special Populations:
• No specific dose adjustments recommended for hepatic or renal impairment, but monitor closely.
• Avoid in patients susceptible to malignant hyperthermia.
• Route:
• Inhalational via anesthetic vaporizer connected to anesthesia delivery systems.
• Duration:
• Administer throughout surgery; discontinued at procedure end to allow rapid recovery.

Sevoflurane is a volatile inhaled anesthetic that produces its effect primarily through modulation of the central nervous system. It enhances the activity of gamma-aminobutyric acid type A (GABA_A) receptors, increasing inhibitory neurotransmission by facilitating chloride ion influx, which leads to neuronal hyperpolarization and decreased excitability. It also modulates other ion channels, including two-pore-domain potassium channels and NMDA receptors, contributing to its anesthetic and analgesic properties. These combined effects result in sedation, hypnosis, muscle relaxation, and loss of consciousness.

• Absorption:
  Rapid uptake via pulmonary alveoli due to low blood-gas partition coefficient (~0.65).
• Distribution:
  Distributes quickly to highly perfused organs such as the brain, heart, and kidneys.
• Metabolism:
  Approximately 2–5% metabolized hepatically by cytochrome P450 enzymes (mainly CYP2E1), producing inorganic fluoride ions and hexafluoroisopropanol.
• Excretion:
  Primarily eliminated unchanged through exhalation. Metabolites are excreted renally.
• Onset:
  Rapid induction within 1–2 minutes.
• Elimination Half-life:
  Variable but generally rapid due to pulmonary excretion.

• Pregnancy:
  FDA Category C. Animal studies have shown some fetal effects at high doses; human data are insufficient. Use only if benefits outweigh potential risks.
• Lactation:
  Limited data; rapid elimination and minimal systemic absorption suggest low risk. Use caution.

• General anesthetic
• Volatile inhalation anesthetic agent

• Hypersensitivity to sevoflurane or other halogenated anesthetics.
• Known or suspected susceptibility to malignant hyperthermia.
• Severe hepatic impairment (relative contraindication).

• Risk of malignant hyperthermia; immediate discontinuation and treatment required if symptoms develop.
• Monitor for hypotension and respiratory depression during anesthesia.
• Use caution in patients with respiratory diseases; although bronchodilatory, airway irritation may occur.
• Prolonged use may cause renal toxicity due to fluoride metabolites; monitor renal function.
• Use caution in patients with increased intracranial pressure.

• Common:
  Hypotension, respiratory depression, nausea, vomiting, cough, breath-holding, agitation on emergence.
• Serious but rare:
  Malignant hyperthermia, arrhythmias, hepatotoxicity, seizures.
• Side effects typically occur during or immediately after administration and are dose-dependent.

• Potentiates central nervous system depressants such as opioids, benzodiazepines, and muscle relaxants.
• Concomitant use with other volatile anesthetics increases risk of cardiovascular depression and toxicity.
• CYP2E1 inducers may alter metabolism; caution with chronic alcohol use.
• Avoid simultaneous use with other halogenated anesthetics.

• Recent guidelines emphasize sevoflurane’s suitability for outpatient surgery due to rapid induction and recovery profiles.
• Updated recommendations on monitoring for malignant hyperthermia susceptibility and minimizing duration to reduce nephrotoxicity risk.
• Emphasis on individualized anesthetic depth monitoring.

• Store at controlled room temperature: 20°C to 25°C (68°F to 77°F).
• Protect from light and heat.
• Keep container tightly closed when not in use.
• Do not freeze.
• Use appropriate vaporizer containers for administration.