Flashcards in Sevoflurane Deck (20)
What is the trade name of Sevoflurane?
What is the drug classification?
Volatile inhalational anesthetic drug
What is Sevoflurane (chemically speaking)?
Fluorinated methyl isopropyl ether
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
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
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
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
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
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
What is the Blood/Gas partition coefficient?
0.65 at 37C
What is the Vapor Pressure of Sevo?
157mmHg at 20C
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
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
What are the GI/Liver/GU side effects of Sevoflurane?
-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
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!
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
What is the Dosage of Sevoflurane?
What is the metabolite of sevo and what is it usually conjugated with and eliminated where?
What is a concern with the pediatric population?
high rate of emergence delirium in pediatric population!