Universal reference book for medicines
Product name: AERRANE

Active substance: isoflurane

Type: The drug for inhalation anesthesia

Manufacturer: BAXTER HEALTHCARE Corp.
(Puerto Rico)
Composition, form of production and packaging
Fluid for inhalation 1 fl.
isoflurane 100%
100 ml - bottles of dark glass (6) - packs of cardboard.
250 ml - bottles of dark glass (6) - packs of cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2010.
PHARMACHOLOGIC EFFECT
Aerran is a halogenated anesthetic. Causes rapid introduction to general anesthesia. With the use of the drug, pharyngeal and laryngeal reflexes are rapidly suppressed, which facilitates intubation.
PHARMACOKINETICS
Aerran is metabolized significantly less than other halogenated anesthetics, such as halothane or enflurane. On average, 95% of Aerran is found in the exhaled air; 0.2% of the drug introduced into the body is metabolized to the main metabolite of trifluoroacetic acid. The average concentration in the serum of inorganic fluoride in patients receiving Aerran during anesthesia is 3-4 μmol / l.
In the body Aerran undergoes a slight metabolism. In the postoperative period, only 0.17% of the administered dose of the drug is defined as metabolites in the urine. In patients for 4 hours after anesthesia with Aernan, plasma inorganic fluoride concentrations are less than 5 μmol / L, and a decrease to normal values ​​occurs within 24 hours after anesthesia. Such indicators do not interfere with kidney function.
INDICATIONS
- inhalation anesthesia


DOSING MODE
The route of administration is inhalation. To maintain the accuracy of the Aerran concentration, special evaporators calibrated for isoflurane should be used.
Below is a table of minimum alveolar concentrations of Aerran as a function of age in a mixture with oxygen and nitrous oxide.
Age (years) About 2 -100% About 2 + N 2 O (60%)
Newborns 1.60 -
1-6 months 1.87 -
7-11 months 1.80 -
1-2 years 1.60 -
3-5 years old 1.62 -
6-10 years old 1.40 -
10-15 years old 1.16 -
Age (years) About 2 -100% About 2 + N 2 O (70%)
26 ± 4 1.28 0.56
44 ± 7 1.15 0.50
64 ± 5 ​​1.05 0.37
When using Aerran for introductory anesthesia, an initial concentration of 0.5% is recommended. Concentrations of 1.3-3.0% lead to a surgical stage of anesthesia after 7-10 minutes. It is recommended that soporific doses of barbiturates or other drugs such as propofol, etomidate or imidazolam be used to prevent the occurrence of cough or laryngospasm that may occur with an initial anesthesia using Aerran alone or a combination with oxygen or a combination with nitrous oxide.
Maintaining anesthesia:
Maintenance of anesthesia during surgical interventions is recommended with the use of concentrations of 1.0-2.5% with the simultaneous introduction of N 2 O or O 2 .
Higher concentrations of 1.5-3.5% Aerran may be necessary when used with simultaneous introduction of pure oxygen.
Inference from anesthesia:
It is necessary to reduce the Aerran concentration to 0.5% by the end of the operation, or to 0% during the suturing phase of the surgical wound, which ensures rapid withdrawal of the patient from anesthesia.
If the administration of all anesthetics is discontinued, ventilation for a time with 100% oxygen should be performed until the patient is fully awakened.
If the vector gas is a mixture of 50% O 2 and 50% N 2 O, the minimum alveolar Arran concentration is approximately 0.65%.
SIDE EFFECT
Like other drugs of this type, the use of Aerran leads to a hypermetabolic state of skeletal muscle cells, which can cause an increase in oxygen consumption and the development of the syndrome of malignant hyperthermia. This syndrome includes: hypercapnia, muscle stiffness, tachycardia, tachypnea, cyanosis, arrhythmia and unstable blood pressure. An increase in the intensity of the general exchange may be accompanied by an increase in temperature. Treatment should include the abolition of anesthetic, intravenous administration of sodium dantrolene and the conduct of symptomatic therapy.
Reduction of blood pressure is a dose-dependent side effect.
The increase in heart rate is most likely with hypercapnia.
Suppression of respiratory function - in rare cases, the development of bronchospasm.
Trembling, nausea, vomiting - when leaving after anesthesia.
Possible: a violation of liver function, jaundice, necrosis of hepatocytes; irritating effect on the mucous membranes during an introductory anesthesia, which can be accompanied by coughing, respiratory depression and, in rare cases, laryngospasm and bronchospasm; an increase in the number of leukocytes, even in the absence of surgical intervention; rash, drowsiness, trembling, transient increase in glucose, creatinine, respiratory center depression (respiratory arrest), increased blood loss during an operation to artificially terminate a pregnancy.
CONTRAINDICATIONS
- in patients with genetically determined malignant hyperthermia or suspected of its existence;
- patients with impaired liver function;
- jaundice;
fever of unclear etiology;
- leukocytosis or eosinophilia, which arose after previous use of halogenated anesthetics;
- chronic obstructive pulmonary diseases, incl. in the anamnesis;
- with obstetric interventions;
- in patients using non-selective MAO inhibitors;
- hypersensitivity to halogenated anesthetics;
C use caution in patients with cirrhosis of the liver, hepatitis, with myasthenia gravis, intracranial hypertension.
PREGNANCY AND LACTATION
Since there is insufficient evidence to confirm the safety of Aerran during pregnancy, the use of this drug in pregnant women is contraindicated.
The use of the drug is possible only with short-term obstetric interventions, such as caesarean section.
Breastfeeding should be stopped for at least 12 hours after the end of anesthesia


APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindicated:
- patients with impaired liver function;
- jaundice.
C use caution in patients with cirrhosis of the liver, hepatitis.
When using halogenated anesthetics, liver function, jaundice and liver necrosis are rare in rare cases. Such reactions indicate an increased sensitivity to the anesthetic used. Cirrhosis, viral hepatitis, or any other liver disease may be the basis for choosing another anesthetic.
APPLICATION FOR CHILDREN
Below is a table of minimum alveolar concentrations of Aerran as a function of age in a mixture with oxygen and nitrous oxide.
Age (years) About 2 -100% About 2 + N 2 O (60%)
Newborns 1.60 -
1-6 months 1.87 -
7-11 months 1.80 -
1-2 years 1.60 -
3-5 years old 1.62 -
6-10 years old 1.40 -
10-15 years old 1.16 -
During anesthesia in children, increased salivation and bronchial secretion can lead to laryngospasm.
SPECIAL INSTRUCTIONS
Aerran should only be used by qualified personnel. Since the depth of anesthesia can be changed quickly and easily with the drug, evaporators, calibrated specifically for isoflurane, should be used. The degree of decrease in blood pressure and suppression of respiratory activity indicate the degree of analgesia. Spontaneous respiratory activity should be carefully monitored and, if necessary, maintained.
Aerran. like other inhalation anesthetics, when passing through dried carbon dioxide absorbents (CO 2 ), can form carbon monoxide, which can lead to an increase in the concentration of carboxyhemoglobin in some patients. If the CO 2 absorbents are suspected to dry out , you should change the absorbent before applying Aerran.
When using halogenated anesthetics, liver function, jaundice and liver necrosis are rare in rare cases. Such reactions indicate an increased sensitivity to the anesthetic used. Cirrhosis, viral hepatitis, or any other liver disease may be the basis for choosing another anesthetic.
AERRAN has a pronounced effect on the reduction in respiratory function, which is enhanced by premedication with drugs or with the joint use of other inhalants. Care should be taken to monitor respiratory activity and, if necessary, use auxiliary ventilation. The data on repeated anesthesia with the use of Aerran are limited and do not allow us to recommend anything on the dosage regimen. As with other halogenated anesthetics, short-term anesthesia should be performed with caution.
It is recommended to use controlled ventilation during neurosurgical interventions. With superficial anesthesia, cerebral blood flow remains unchanged.
However, there is a tendency to increase it with an increase in anesthesia. The increase in intracranial pressure can be leveled by hyperventilation before or during the intervention.
When performing neurosurgical interventions should closely monitor the function of breathing. Like other halogen anesthetics, Aerran enhances cerebral blood flow and temporarily increases intracranial pressure. In most cases, these reactions are eliminated by hyperventilation.
Aerran causes the expansion of the coronary arteries at the level of arterioles. Aerran, like other vasodilators acting on the coronary arteries, can cause redistribution of blood along collaterals (a symptom of stealing). Clinical trials have not revealed evidence that Aerran can cause ischemic myocardial damage, heart attack or death, due to the development of steal syndrome in patients with coronary heart disease.
Aerran has an irritant effect on the mucous membranes, so the drug is difficult to apply with inhalation anesthesia using a mask.
During anesthesia in children, increased salivation and bronchial secretion can lead to laryngospasm.
With the use of Aerran, there is a temporary increase in the delay of bromosulfalein, an increase in the concentration of blood glucose and serum creatinine, a decrease in plasma concentrations of urea, cholesterol and alkaline phosphatase.
In the case of Aerran in sensitized patients, the drug can cause hypermetabolic status in skeletal muscle cells, which leads to increased oxygen consumption and is clinically expressed by the syndrome of malignant hyperthermia.
Impact on the ability to drive vehicles and manage mechanisms
After conducting anesthesia with Aerran, the patient should not drive the car for 24 hours. The patient should not take alcohol.
OVERDOSE
In case of an overdose, it is necessary to stop the drug administration, check the air passages, and, depending on the clinical situation, continue the auxiliary or controlled oxygenation with pure oxygen. Carry out activities to maintain adequate hemodynamics.
DRUG INTERACTION
Simultaneous use of Aerran and other medicines requires careful monitoring of clinical and biological indicators.
Aerran can not be used with nonselective MAO inhibitors. Use of MAO inhibitors should be discontinued no less than 15 days before anesthesia
Combinations that require caution:
Beta-adrenoblockers : the negative inotropic effect is enhanced.
Isoniazid: the risk of hepatotoxicity increases, which is associated with an increase in the synthesis of the toxic metabolite of isoniazid. The use of isoniazid should be discontinued one week before surgery and within 15 days of the postoperative period.
Epinephrine, which is used for local haemostatic action with p / to administration: the risk of severe ventricular arrhythmia increases as a result of an increase in the heart rate, although the sensitivity of the myocardium to epinephrine decreases with Aerran, unlike other halogenated anesthetics. Therefore, the dosage should be limited, for example. 0.1 mg epinephrine for 10 min or 0.3 mg for 1 h for adults.
Indirect sympathomimetics (amphetamines and their derivatives, psychostimulants, agents that reduce appetite, ephedrine and its derivatives): the risk of episodes of hypersensitivity during surgery. It is preferable to stop taking these drugs several days before the operation.
If the use of drugs is necessary, anesthesia should not be discontinued prior to anesthesia. It is enough to inform the anesthetist about the drugs used.
Muscle relaxants: the risk of increasing the effect of polarizing and, in particular, non-polarizing relaxants. Therefore, it is recommended to administer from one-third to one-half of the usual dose of relaxants. Disappearance of the myoneurial effect occurs long enough with the use of Aerran than with the use of conventional anesthetics. Neostigmine has an effect on the relaxants of a non-polarizing action, but does not affect the relaxing effect of Aerran.
Analgesics of the morphine group: these drugs potentiate the depressive effect of Aerran on the respiratory system.
Calcium channel antagonists: Aerran can lead to a marked decrease in blood pressure when used in patients treated with calcium channel antagonists, especially dihydropyridine derivatives.
TERMS OF RELEASE FROM PHARMACY
Only for hospitals.
TERMS AND CONDITIONS OF STORAGE
List B. Store at a temperature of no higher than 30 ° C, in an upright position. Keep out of the reach of children. To avoid leakage of the drug, it is necessary to use a tight fitting, but not too tight, stopper. The drug should be stored in its original packaging until use.
Shelf life 5 years. Do not use after the expiration date.
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