Flashcards in Sevoflurane Deck (20):
1
What is the trade name of Sevoflurane?
Ultane
2
What is the drug classification?
Volatile inhalational anesthetic drug
3
What is Sevoflurane (chemically speaking)?
Fluorinated methyl isopropyl ether
4
What are the clinical uses of Sevoflurane?
Non-pungent and therefore, indicated for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery
5
What is the MOA of Sevoflurane?
Current theory is that target proteins (most likely ion channels and/or receptors) are the site of action of the inhaled anesthetics
Separate sites of action for loss of consciousness and immobility have been proposed
6
What is the metabolism of Sevoflurane?
-Estimated 3-5% of absorbed sevoflurane is metabolized by CYP450 2E1 to hexafluoroisopropanol (HFIP) with release of inorganic fluoride and CO2
-Once formed HFIP is rapidly conjugated with glucuronic acid and eliminated as urinary metabolite
7
Is halothane hepatitis a concern with Sevoflurane?
-chemical structure of sevoflurane prevents metabolism to anacetyl halide therefore halothane hepatitis is not a concern with this drug
8
What is the redistribution of Sevoflurane?
Sevo has low blood solubility (blood/gas solubility coefficient 0.65%) and is rapidly taken up into the tissues
9
How is Sevoflurane eliminated?
-Majority is eliminated unchanged via the lungs
-Up to 3.5% of the sevo dose appears in the urine as inorganic fluoride
-renal toxicity is not expected because of the low blood/gas solubility and rapid elimination
10
What is the Blood/Gas partition coefficient?
0.65 at 37C
11
What is the Vapor Pressure of Sevo?
157mmHg at 20C
12
What are the CV side effects of Sevo?
-Dose-related cardiac depression
-Does NOT increase HR at doses <2 MAC, thus with arterial BP decrease CO may drop more than with other agents
-Hyperkalemia that has resulted in cardiac arrhythmias and death in pediatric patients
-SVR and BP decrease (less than Des and Iso)
-NO evidence of coronary steal
-Does not cause SNS activation response with increases in concentration
13
What are the Nuero/neuromuscular side effects of Sevoflurane?
-Increases CBF and ICP, Decreases CPP, particularly 1 MAC or >
-Muscle relaxant properties thus, potentiates the effects of NMBs
-High rate of emergence delirium particularly in the pediatric population
-Seizure
14
What are the GI/Liver/GU side effects of Sevoflurane?
-PONV
-Decreased RBF, GFR, and UO similar to other volatiles
-Potential nephrotoxicity presumed to be from compound A (association with proteinuria and glycosuria when sevo is administered for more than 2 MAC hours with FGF of <2L/min
-Malignant hyperthermia
15
What are the contraindications with Sevo?
-should NOT be used in patients with known sensitivity to sevo or other halogenated agents nor inpatients with known or suspected susceptibility to malignant hyperthermia!
-Use with caution in patients who are hypotensive, hypertensive, elderly, obese, or who have renal insufficiency!
16
What are the drug interactions with Sevo?
-Extremely rare, but potentially life-threatening complication related to strong-based absorbent such as BARALYME used is the development of fire
-No significant adverse rxns ocurred with other drugs commonly used in periop period
17
What is the Dosage of Sevoflurane?
MAC= 2%
18
What is the metabolite of sevo and what is it usually conjugated with and eliminated where?
-hexafluoroisopropanol (HFIP)
-glucuronic acid
-urinary metabolite
19
What is a concern with the pediatric population?
high rate of emergence delirium in pediatric population!
20