Overview
Sevoflurane is a halogenated volatile inhalation anesthetic agent used for induction and maintenance of general anesthesia in adult and pediatric patients. It provides rapid onset and offset of anesthesia with minimal airway irritation.
Mechanism of Action
Sevoflurane acts as a general anesthetic by potentiating GABA-A receptor activity and inhibiting NMDA receptor activity in the central nervous system, leading to depression of neuronal excitability and consciousness.
Indications
- Induction and maintenance of general anesthesia in adult and pediatric patients
- Maintenance of anesthesia in adults during outpatient surgery
Dosage
Induction: 0.5-8% inspired concentration with or without nitrous oxide. Maintenance: 0.5-3% inspired concentration with or without nitrous oxide. Dosage should be individualized based on patient response and monitored with end-tidal sevoflurane concentration.
Black Box Warning
General anesthetics, including sevoflurane, may cause neurotoxicity in the developing brain when used for lengthy procedures or repeated exposures in children younger than 3 years.
Contraindications
- Known hypersensitivity to sevoflurane or other halogenated anesthetics
- Patients with known or suspected genetic susceptibility to malignant hyperthermia
- History of severe hepatic dysfunction following previous sevoflurane anesthesia
Side Effects
- Hypotension
- Bradycardia
- Nausea
- Vomiting
- Cough
- Laryngospasm
- Agitation
- Headache
- Drowsiness
- Increased salivation
- Shivering
- Hypoxia
- Hyperkalemia (in pediatric patients)
Interactions
- Non-depolarizing muscle relaxants: Potentiates neuromuscular blockade
- Opioids: Additive respiratory depression
- Benzodiazepines: Additive CNS depression
- St. John's Wort: May reduce anesthetic effectiveness
- MAC reducing agents: Lower sevoflurane requirements