Renal Dose Adjustment (Based on serum creatinine)
- >1.5 mg/dL: Caution advised; safety has not been fully established
Hepatic Dose Adjustment
- Mild-to-moderate impairment: No dose adjustments
- Severe impairment: Dose adjustments not defined
- Therapy should be administered by persons well trained and experienced in the administration of general anesthesia; appropriate equipment must be readily available for the maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation
- Risk of renal injury may exist due to exposure to metabolites such as Compound A (pentafluoroisopropenyl fluoromethyl ether)
- Adjust inspired concentration of sevoflurane and fresh gas flow rate to minimize exposure to Compound A during sevoflurane anesthesia; do not exceed 2 MAC hours at flow rates of 1 to <2 L/min. Fresh gas flow rates <1 L/min are not recommended
- Administration of sevoflurane for more than 2 MAC hours and at low flow rates of <2 L/min may be associated with proteinuria and glycosuria
- Therapy may present an increased risk in patients with known sensitivity to volatile halogenated anesthetic agents. Do not use KOH containing CO2 absorbents with sevoflurane
- Potent inhalation anesthetic agents, including sevoflurane, may induce malignant hyperthermia in susceptible individuals. The clinical syndrome is manifested by hypercapnia, and may include muscle rigidity, tachycardia, tachypnea, arrhythmias, cyanosis, and unstable blood pressure; some of these nonspecific signs may also appear during light anesthesia such as acute hypoxia, hypercapnia, and hypovolemia. Discontinue therapy in case of malignant hyperthermia and administer intravenous dantrolene sodium with supportive therapy
- Inhaled anesthetic agents have been associated with rare increases in serum potassium levels resulting in cardiac arrhythmias and death in pediatric patients during the postoperative period. Patients with latent as well as overt neuromuscular disease (Duchenne muscular dystrophy) are most vulnerable. Significant elevations in serum creatine kinase levels and, in some cases, changes in urine consistent with myoglobinuria have also been observed
- During the maintenance of anesthesia, increasing the concentration of sevoflurane produces dose-dependent decrease in blood pressure, which may occur more rapidly than with other volatile anesthetics. These hemodynamic changes may be related to depth of anesthesia and may be corrected by decreasing the inspired concentration of sevoflurane
- Assess the patient carefully during the recovery from general anesthesia, before being discharged from the post-anesthesia care unit
Cautions: Use cautiously in
- Renal insufficiency (creatinine >1.5 mg/dL)
- Hepatic impairment
- Concomitant hepatotoxic drugs
- Neuromuscular disease
- Hx or risk of seizure
- Elderly patients
- Hypotension
- QT prolongation
- Increased ICP
- Head injury
Pregnancy Category:B
Breastfeeding: There is a lack of published data regarding the use of sevoflurane during breastfeeding. Due to the short serum half-life of sevoflurane in the mother, it is not expected to be absorbed by the infant; hence, no waiting period or discarding of milk is required. Breastfeeding can be resumed on sufficient recovery of the mother from general anesthesia. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/ht mlgen?LACT last accessed 24 October 2011). As per manufacturer's data, the concentrations of sevoflurane in milk are probably of no clinical importance 24 hrs after anesthesia. Due to rapid washout, sevoflurane concentrations in milk are predicted to be below those found with many other volatile anesthetics.
