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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

What electrolyte abnormality is associated with Sevo?

Hyperkalemia!