Sevoflurane

Sevoflurane is a fluorinated methyl isopropyl ether volatile anesthetic with a low blood:gas partition coefficient (~0.65), enabling rapid induction and emergence from anesthesia. It is non-pungent and non-irritating to airways, making it the preferred agent for inhalational induction in pediatric patients. Sevoflurane potentiates GABA-A receptor inhibition and attenuates NMDA-mediated excitation in the CNS. It is minimally metabolized (~2-3%) to inorganic fluoride, and while fluoride levels can exceed 50 μmol/L, clinically significant nephrotoxicity is rare.

Adult

Induction of anaesthesia (in oxygen or nitrous oxide–oxygen): Initially 0.5–1%, then increased gradually according to response, up to 8%, to be administered using a specifically calibrated vaporiser. Maintenance of anaesthesia (in oxygen or nitrous oxide–oxygen): 0.5–3%, adjusted according to response, to be administered using a specifically calibrated vaporiser.

Renal adjustment

Use with caution in renal impairment.

Max dose

Up to 8% concentration for induction; up to 3% concentration for maintenance.

• use with an anesthesia machine in which the CO2 absorbent has been dried (risk of exothermic reaction, airway burns, spontaneous ignition, explosion, fire; carbon monoxide production)