Sevoflurane. Features, Organ Effects and Contraindications.

    Sevoflurane used as an inhalational (volatile) anaesthetic for induction and maintenance of general anesthesia. Sevoflurane acts as a positive allosteric modulator of the GABAA receptor and an NMDA receptor antagonist.



    Rapid increases in alveolar anesthetic concentration provides fast induction, but low blood solubility results in a rapid fall in alveolar anesthetic concentration upon discontinuation and rapid emergence.
sevoflurane doses

sevoflurane effects


Toxicity:
  • There has been no association with peak fluoride levels following sevoflurane and any renal concentrating abnormality. 
  • Alkali such as barium hydroxide lime or soda lime (but not calcium hydroxide) can degrade      sevoflurane, producing another proven nephrotoxic end product (compound A). Accumulation of compound A increases with increased respiratory gas temperature, lowflow anesthesia, dry barium hydroxide absorbent, high sevoflurane concentrations, and anesthetics of long duration.
  • some clinicians recommend that fresh gas flows be at least 2 L/min for anesthetics lasting more than a few hours and that sevoflurane not be used in patients with preexisting renal dysfunction.
  • Sevoflurane can also be degraded into hydrogen fluoride (can produce an acid burn on contact with respiratory mucosa.)
  • Sevoflurane may  sensitize the heart to catecholamine-induced arrhythmias.


Contraindications:
  • severe hypovolemia
  • susceptibility to malignant hyperthermia
  • intracranial hypertension.


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