Home Drug Guide Sevoflurane

Drug Guide

Generic Name

Sevoflurane

Brand Names Ultane, Sojourn

Classification

Therapeutic: Inhalation anesthetic

Pharmacological: Volatile anesthetic agent

FDA Approved Indications

Induction and maintenance of anesthesia in adult and pediatric patients

Mechanism of Action

Sevoflurane acts primarily by enhancing the activity of GABA_A receptors, resulting in increased chloride ion influx and hyperpolarization of nerve cells, leading to CNS depression and anesthesia.

Dosage and Administration

Adult: Induction typically using 1-2 MAC (minimum alveolar concentration) with adjustments based on patient response. Maintenance doses vary accordingly.

Pediatric: Similar dosing, with titration based on age, weight, and clinical response.

Geriatric: Use lower initial concentrations due to increased sensitivity; titrate carefully.

Renal Impairment: No specific dose adjustment; monitor for emergence phenomena.

Hepatic Impairment: No specific dose adjustment; caution advised.

Pharmacokinetics

Absorption: Rapidly absorbed through the lungs following inhalation.

Distribution: Widely distributed, crossing the blood-brain barrier to effect anesthesia.

Metabolism: Minimal metabolic breakdown (~2-5%), primarily via CYP2E1 in the liver.

Excretion: Primarily exhaled unchanged via the lungs.

Half Life: Approximately 15-30 minutes for elimination

Contraindications

Known hypersensitivity to sevoflurane or other halogenated anesthetics

Precautions

Malignant hyperthermia susceptibility
History of genetic conditions affecting metabolism
Risk of hypotension and respiratory depression
Use with caution in patients with increased intracranial pressure

Adverse Reactions - Common

Hypotension (Common)
Delayed emergence (Common)
Nausea and vomiting (Common)

Adverse Reactions - Serious

Malignant hyperthermia (Rare)
Arrhythmias (Rare)
Respiratory depression (Rare)

Drug-Drug Interactions

Other CNS depressants may enhance sedative effects
Nitrous oxide co-administration can influence anesthetic potency

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs, oxygenation, and level of consciousness; assess for malignant hyperthermia symptoms.

Diagnoses:

Risk for hypotension
Altered breathing pattern
Potential for allergic reaction

Implementation: Ensure proper scavenging systems to prevent occupational exposure; titrate dose to clinical response.

Evaluation: Assess patient recovery, consciousness level, and vital stability post-anesthesia.

Patient/Family Teaching

Report any chest pain, muscle rigidity, or fever immediately during or after anesthesia.
Follow instructions regarding activity restrictions post-surgery.
Understand that nausea or dizziness may occur temporarily.

Special Considerations

Black Box Warnings:

Precaution for malignant hyperthermia in susceptible individuals

Genetic Factors: Genetic susceptibility to malignant hyperthermia due to RYR1 mutations.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Hypotension, arrhythmias, hyperthermia, muscle rigidity.

Treatment: Discontinue sevoflurane immediately; provide supportive care, administer dantrolene for malignant hyperthermia, ensure adequate cooling and hydration.

Storage and Handling

Storage: Store tightly closed in a cool, dry place away from heat and flames.

Stability: Stable under recommended storage conditions; check manufacturer's expiration date.