Sevoflurane
A nonpungent halogenated inhaled anesthetic for inducing and maintaining general anesthesia, well suited to mask induction.
Drug card
- Class
- Inhaled anesthetic
- How it works
- Depressing brain signaling, partly by enhancing GABA-A receptors
- Used for
- Inducing and maintaining general anesthesia
- Mask induction in adults and children
- Known for
- Nausea and vomiting after surgery
- Malignant hyperthermia
- Its name
- -flurane means an inhaled general anesthetic
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does sevoflurane work?
Sevoflurane is a fluorinated ether whose exact mechanism is unknown; it may enhance GABA-A receptors and alter ion channel gating in neurons. Its low blood solubility (blood/gas partition coefficient 0.63 to 0.69) gives fast induction and waking, and its nonpungent odor, which does not irritate the airway, suits mask induction. Its MAC, about 2% in middle age, falls with age.
Uses
What is sevoflurane used for?
- Inducing and maintaining general anesthesia
- Mask induction in adults and children
Side effects
Side effects of sevoflurane
- Nausea and vomiting after surgeryKnown for
- Malignant hyperthermiaKnown forSerious
- Low blood pressure
- Breathing depressionSerious
- Agitation on waking, especially in children
- Cough, breath holding and laryngospasm at inductionSerious
- Slow heart rate
- Long QT and torsades de pointesSerious
- High potassium in children with muscle diseaseSerious
- Kidney injury from compound A at low gas flowsSerious
- Seizures, mostly in children and young adultsSerious
- Post-operative hepatitis, rarely liver failureSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated in known or suspected susceptibility to malignant hyperthermia.
- Keep fresh gas flow adequate and avoid KOH-containing carbon dioxide absorbents, which favor compound A.
- Children with neuromuscular disease, such as Duchenne dystrophy, risk hyperkalemic arrhythmias, mostly with succinylcholine.
- Take care in congenital long QT or with QT-prolonging drugs; epinephrine raises arrhythmia risk.
Good to know: Low blood solubility and a nonpungent smell suit it to mask induction; in trials some recovery steps came sooner than with isoflurane or propofol.
Remember it
A way to remember it
Volatiles and sux set the body on fire; dantrolene puts it out.
Halogenated inhaled anesthetics such as sevoflurane, and suxamethonium, trigger malignant hyperthermia in susceptible people; treatment is to stop the triggers and give dantrolene IV.
Written for biofideX
Its name
-flurane means inhaled general anesthetic
Sevoflurane, desflurane and isoflurane are halogenated anesthetics given by inhalation. Halothane, an older one, lacks the stem.
- Every drug name stem
Its class
Inhaled anesthetics
Inhaled anesthetics are breathed in and taken up from the lungs into the blood and brain. Their exact mechanism is not settled: they are thought to enhance inhibitory GABA-A receptors and change ion channel gating in neuronal membranes. Potency is expressed as the minimum alveolar concentration (MAC); low solubility in blood, as with sevoflurane, gives fast induction and quick recovery.
Easily mixed up with intravenous anesthetics and depolarizing neuromuscular blockers.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Anesthesia and muscle relaxants
Sevoflurane is one of 8 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
Start Practicing