Sevoflurane

DEA Class;  Rx

Common Brand Names; Ultane

Known or suspected genetic susceptibility to malignant hyperthermia

Known or suspected sensitivity to sevoflurane or to other halogenated inhalational anesthetics

• Malignant hyperthermia
• Dose-dependent hypotension
• Bradycardia
• Tachycardia
• Hypotension
• Hypertension
• Nausea/vomiting
• Cough
• Agitation
• Increased salivation
• Airway obstruction
• Laryngospasm
• Apnea
• Increased BUN
• Increased ALT
• Respiratory irritation
• Nephrotoxicity
• Glycosuria
• Proteinuria
• Seizures (majority of cases in children and young adults, most had no medical history of seizures)
• Cardiac arrest
• Cases of mild, moderate and severe post-operative hepatic dysfunction or hepatitis with or without jaundice
• Malignant hyperthermia
• Allergic reactions (eg, rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions)
• Transient elevations in glucose, liver function tests, and WBC count
• Bradycardia in patients with Down syndrome

Volatile liquid; use appropriate vaporizer for inhalation

Agitation/delirium may occur

Postoperative hepatitis reported

Closely monitor patients with anemia, hepatic impairment, myxedema, renal impairment

Can induce malignant hyperthermia in genetically susceptible individuals

Advise patients that performance of activities requiring mental alertness, such as driving or operating machinery, may be impaired after sevoflurane anesthesia

Reports of QT prolongation, associated with torsade de pointes (in exceptional cases, fatalities reported); exercise caution when administering to susceptible patients (eg, congenital long QT syndrome, coadministration with drugs that prolong QT interval)

Should not be used as a sole agent of induction in patients with ventricular dysfunction

Risk of perioperative hyperkalemia in pediatric patients reported (rare); some resulting in cardiac arrhythmia and death

There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies, reduced fetal weights were noted following exposure to 1 MAC sevoflurane for three hours a day during organogenesis

The concentrations of sevoflurane in milk are probably of no clinical importance 24 hours after anesthesia; because of rapid washout, sevoflurane concentrations in milk are predicted to be below those found with many other volatile anesthetics