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Flashcards in Sevoflurane Deck (20)
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1
Q

What is the trade name of Sevoflurane?

A

Ultane

2
Q

What is the drug classification?

A

Volatile inhalational anesthetic drug

3
Q

What is Sevoflurane (chemically speaking)?

A

Fluorinated methyl isopropyl ether

4
Q

What are the clinical uses of Sevoflurane?

A

Non-pungent and therefore, indicated for induction and maintenance of general anesthesia in adult and pediatric patients for inpatient and outpatient surgery

5
Q

What is the MOA of Sevoflurane?

A

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
Q

What is the metabolism of Sevoflurane?

A
  • 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
Q

Is halothane hepatitis a concern with Sevoflurane?

A

-chemical structure of sevoflurane prevents metabolism to anacetyl halide therefore halothane hepatitis is not a concern with this drug

8
Q

What is the redistribution of Sevoflurane?

A

Sevo has low blood solubility (blood/gas solubility coefficient 0.65%) and is rapidly taken up into the tissues

9
Q

How is Sevoflurane eliminated?

A
  • 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
Q

What is the Blood/Gas partition coefficient?

A

0.65 at 37C

11
Q

What is the Vapor Pressure of Sevo?

A

157mmHg at 20C

12
Q

What are the CV side effects of Sevo?

A
  • 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
Q

What are the Nuero/neuromuscular side effects of Sevoflurane?

A
  • 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
Q

What are the GI/Liver/GU side effects of Sevoflurane?

A
  • 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
Q

What are the contraindications with Sevo?

A
  • 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
Q

What are the drug interactions with Sevo?

A
  • 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
Q

What is the Dosage of Sevoflurane?

A

MAC= 2%

18
Q

What is the metabolite of sevo and what is it usually conjugated with and eliminated where?

A
  • hexafluoroisopropanol (HFIP)
  • glucuronic acid
  • urinary metabolite
19
Q

What is a concern with the pediatric population?

A

high rate of emergence delirium in pediatric population!

20
Q

What electrolyte abnormality is associated with Sevo?

A

Hyperkalemia!