Sevoflurane

Registered South African indications:

• Induction and maintenance of general anaesthesia

Contraindications

• Known or suspected hypersensitivity to the active ingredient or any of its excipients
• Known or suspected hypersensitivity to other halogenated agents (e.g. history of hepatotoxicity, usually including elevated liver enzymes, fever, leukocytosis and/or eosinophilia temporally related to anaesthesia with one of these agents)
• Known or suspected genetic susceptibility to malignant hyperthermia
• Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Latent and overt neuromuscular disease
• Risk factors for QT prolongation
• Pompe's disease
• Mitochondrial disorders
• Hemodynamically compromised patients
• Coronary artery disease
• Obstetric anaesthesia
• Patients at risk from elevation of intracranial pressure
• Preexisting risk factors for seizures
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: liq

Induction of general anaesthesia

• Inhaled (liq): Up to 8% in oxygen or oxygen/ nitrous mixtures

Induces surgical anaesthesia within 2 minutes

Rapid emergence from anaesthesia occurs, therefore early post-operative analgesia may be required

Maintenance of general anaesthesia

• Inhaled (liq): 0.5-3% with or without comcomitant nitrous oxide 

MAC values according to age

See adult dosages

MAC values according to age

Pregnancy

• Caution
• Sevoflurane has a relaxant effect on the uterus, which can lead to increased uterine bleeding, as was reported in a study of its use during termination of pregnancy. Use during labour and delivery is limited to one small study in caesarean section. In animal reproduction studies, reduced foetal weights were noted following exposure to 1 MAC sevoflurane for three hours a day during organogenesis. There are no adequate and well-controlled studies in pregnant women; therefore, sevoflurane should be used during pregnancy only if clearly needed
• In a clinical trial, the safety of sevoflurane was demonstrated for mothers and infants when used for anaesthesia during Caesarean section. The safety of sevoflurane in labour and vaginal delivery has not been demonstrated

Breastfeeding

• Caution
• It is not known whether sevoflurane or its metabolites are excreted in human milk. Due to the absence of documented experience, women should be advised to skip breastfeeding for 48 hours after administration of sevoflurane and discard milk produced during this period

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Agitation
• Confusion
• Somnolence
• Dizziness
• Headache
• Seizures
• Dystonia

Cardiovascular Disorders

• Bradycardia
• Tachycardia
• Complete atrioventricular block
• Atrial fibrillation
• Ventricular extrasystoles
• Supraventricular extrasystoles
• Extrasystoles
• Cardiac arrest
• QT prolongation
• Hypotension
• Hypertension
• Chest discomfort

Respiratory Disorders

• Cough
• Respiratory disorder
• Laryngospasm
• Apnoea
• Hypoxia
• Asthma
• Bronchospasm
• Dyspnoea
• Wheezing
• Pulmonary oedema

Gastrointestinal Disorders

• Nausea and vomiting
• Salivary hypersecretion

Hepatobiliary Disorders

• Hepatitis
• Hepatic failure 
• Hepatic necrosis
• Abnormal liver function tests
• Increased aspartate aminotransferase
• Increased alanine aminotransferase

Genitourinary Disorders

• Urinary retention
• Glycosuria
• Acute renal failure
• Increased serum creatinine

Endocrine and Metabolic Disorders

• Hypothermia
• Malignant hyperthermia
• Abnormal blood glucose
• Increased blood fluoride 
• Increased blood lactate dehydrogenase

Musculoskeletal Disorders

• Muscle twitching

Skin and Subcutaneous Tissue Disorders

• Contact dermatitis 
• Pruritus
• Rash
• Swollen face 
• Urticaria

Immune, Blood and Lymphatic System Disorders

• Anaphylactic reaction
• Anaphylactoid reaction
• Hypersensitivity
• Leukopenia
• Leukocytosis
• Pyrexia
• Abnormal white blood cell count

• Sympathomimetic agents
• Non-selective monoamine oxidase inhibitors
• Calcium channel blockers 
• Succinylcholine
• Beta blockers 
• Verapamil
• CYP2E1 inducers
• St John's wort
• Opioids 
• Nitrous oxide
• Neuromuscular blocking agents

None routine

Sevoflurane decreases gap junction channel opening times and increases gap junction channel closing times thereby reducing junctional conduction. Sevoflurane also activates calcium dependent adenosine triphosphatase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane.

Liquid 100ml

• Ultane (AbbVie) originator

Liquid 250ml

• Sevoflurane (Safeline)
• Sojourn (Safeline)