Universal reference book for medicines
Product name: SEVORAN ® (SEVORANE)

Active substance: sevoflurane

Type: The drug for inhalation anesthesia

Manufacturer: ABBOTT LABORATORIES (UK) manufactured by AESICA QUEENBOROUGH (UK) packed AESICA QUEENBOROUGH (UK) packed by R-PHARM (Russia)
The liquid for inhalation is clear, colorless, volatile.
1 f.

sevoflurane 100%

100 ml - bottles of polyethylene naphthalate of dark color (1) - packs cardboard.

250 ml - bottles of polyethylene naphthalate dark color (1) - packs cardboard.

100 ml - bottles made from polyethylene naphthalate of dark color (6) - corrugated cardboard boxes with cardboard separator.

250 ml - bottles made from polyethylene naphthalate of dark color (6) - corrugated cardboard boxes with cardboard separator.

INSTRUCTION FOR THE SPECIALIST.

Description of the drug approved by the manufacturer for the printed edition of 2016.

PHARMACHOLOGIC EFFECT

The drug for inhalation anesthesia.

Sevoflurane provides a quick introduction to anesthesia and rapid exit from it.

The depth of anesthesia can vary rapidly depending on the change in the concentration of sevoflurane in the inspired mixture.

The induction of anesthesia with sevoflurane is accompanied by a slightly pronounced excitation or minimal signs of irritation of the upper respiratory tract, does not cause excessive secretion in the tracheobronchial tree and stimulation of the CNS.

Like other powerful agents for inhalation anesthesia, sevoflurane causes a dose-dependent suppression of respiratory function and a decrease in blood pressure.
In studies in children, it was shown that the incidence of cough was statistically less frequent with the use of masked introductory anesthesia with sevoflurane than with halothane. The threshold of arrhythmogenic effect of epinephrine with the use of sevoflurane is the same as with isoflurane and higher than with halothane. The incidence of myocardial ischemia and myocardial infarction in patients with risk factors for these diseases is comparable with the use of sevoflurane and isoflurane.
Influence on blood circulation in the brain (intracranial pressure, cerebral blood flow, cerebral oxygen metabolism, cerebral perfusion pressure) is also comparable in sevoflurane and isoflurane.
Sevoflurane has a minimal effect on intracranial pressure and does not reduce the response to CO 2 . Sevoflurane does not affect the concentration function of the kidneys, even with prolonged anesthesia (up to about 9 hours).
The minimum alveolar concentration (MAC) is the concentration at which 50% of patients do not have a motor response to a single irritation (incision of the skin).MAQ of sevoflurane in different age groups are given in the section "Dosage regimen".

MAQ of sevoflurane in oxygen is 2.05% for a 40-year-old adult.
MAK sevoflurana, like other halogenated preparations, decreases with age and with the addition of dinitrogen oxide.
Properties of sevoflurane

Sevoflurane does not ignite and does not explode in accordance with the requirements of the International Electrotechnical Commission 601-2-13.

Sevoflurane does not contain additives or chemical stabilizers.
Sevoflurane is not very good. It mixes with ethanol, ether, chloroform and benzene and is very slightly soluble in water.
Decomposition products of sevoflurane

Sevoflurane remains stable if stored under normal indoor lighting.
In the presence of strong acids or under the influence of heat, there is no significant decomposition of sevoflurane. Sevoflurane does not cause corrosion of stainless steel, copper, aluminum, copper, coated with nickel, copper coated with chromium, and copper-beryllium alloy.
Anesthetic can be destroyed by contact with a CO 2 absorber in the anesthesia apparatus.
When using fresh absorbers, according to the recommendations, the destruction of sevoflurane is minimal, the decay products are not determined and are not toxic. The destruction of sevoflurane and the formation of decomposition products increases with an increase in the absorber temperature, using a dry absorber (especially a potassium hydroxide, for example, Baralyme ® ), with increasing sevoflurane concentration and a decrease in the flow of fresh gas. The destruction of sevoflurane under the action of alkalis proceeds along two paths. In the first of the molecule, hydrogen fluoride is split off and pentofluoroisopropyl fluoromethyl ether (compound A) is formed. The destruction of sevoflurane in the second way occurs only in the presence of a dry absorber of CO 2 , while sevoflurane is converted to hexafluoroisopropanol and formaldehyde.
Hexafluoroisopropanol is not active, is not genotoxic, rapidly combines with glucuronic acid and is excreted from the body, the toxicity is comparable to the toxicity of sevoflurane.
Formaldehyde is present in the reactions of normal metabolism and, in contact with the dried sorbent, in turn decomposes to methanol and formate.From formate, carbon monoxide is subsequently formed under the influence of high temperature. Methanol can be reacted with Compound A, as a result of methoxylation, Compound B is further formed. Upon further elimination of hydrogen fluoride from compound B, compounds C, D and E are formed. Formaldehyde, methanol, carbon monoxide, Compound A and, optionally, certain degradation products, Compounds B, C and D can form when the drug contacts a very dry absorber, especially if it contains potassium hydroxide (eg, Baralyme ® ).
The decomposition of sevoflurane upon interaction with Lewis acids:

The preparation contains at least 300 ppm of water as a reaction inhibitor with Lewis acids.

PHARMACOKINETICS

Solubility

The low solubility of sevoflurane in the blood provides a rapid increase in alveolar concentration when administered to general anesthesia and a rapid decrease after discontinuation of inhalation.
The ratio of alveolar concentration at the end of inspiration and concentration in the inhaled mixture 30 minutes after the inhalation of sevoflurane is 0.85. In the elimination phase, the ratio of alveolar concentrations 5 minutes after the inhalation of sevoflurane is 0.15.
Distribution and Metabolism

The rapid removal of sevoflurane from the lungs minimizes the metabolism of the drug.
In humans less than 5% of the absorbed dose of sevoflurane is metabolized by cytochrome P450 (isoenzyme CYP2E1) into hexafluoroisopropanol with the release of inorganic fluorine and carbon dioxide (or one carbon dioxide). The resulting hexafluoroisopropanol is not active, not genotoxic, rapidly conjugated to glucuronic acid and excreted from the body by the kidneys, the toxicity is comparable to the toxicity of sevoflurane. Other ways of metabolism of sevoflurane are not established. Sevoflurane is the only fluorinated volatile agent for anesthesia that is not metabolized to trifluoroacetic acid.
The concentration of fluoride ions depends on the duration of general anesthesia, the concentration of sevoflurane administered and the composition of the mixture for anesthesia.

Barbiturates do not cause defluorination of sevoflurane.

Approximately 7% of adults who had in clinical studies measured concentrations of inorganic fluoride, they exceeded 50 μmol / l;
clinically significant changes in renal function were not detected in any of these patients.
INDICATIONS

- introductory and supportive general anesthesia in adults and children in surgical operations in the hospital and outpatient settings.

DOSING MODE

Premedication

Means for premedication should be selected by an anesthesiologist individually.

General anesthesia during surgical interventions

When carrying out general anesthesia, it is necessary to know the concentration of sevoflurane coming from the evaporator.
For precise control of the applied concentration of sevoflurane, specially calibrated evaporators should be used.
Introduction to general anesthesia

The dose is selected individually and titrated until the desired effect is achieved, taking into account the age and condition of the patient.
Before inhalation of sevoflurane, a high-speed barbiturate or another drug for intravenous general anesthesia may be administered. For administration to a general anesthetic, sevoflurane can be used in a mixture with oxygen or with oxygen and dinitrogen oxide. Prior to surgical interventions in adults and children, inhalation of sevoflurane at a concentration of up to 8% usually provides administration to a general anesthetic for less than 2 minutes.
Supportive general anesthesia

The required level of general anesthesia can be maintained by inhaling sevoflurane at a concentration of 0.5-3% in combination with or without dinitrogen.

The MAC values ​​for adults and children, taking into account the age

Age of patient Sevoflurane in oxygen Sevoflurane in 65% N 2 O / 35% O 2

0-1 month * 3.3%

1- <6 months 3.0%

6 months- <3 years 2.8% 2.0% **

3-12 years old 2.5%

25 years old 2.6% 1.4%

40 years 2.1% 1.1%

60 years old 1.7% 0.9%

80 years old 1.4% 0.7%

* - full-term newborns.
MAC in preterm infants was not determined.
** - in children from 1 year to 3 years 60% N 2 O / 40% O 2

With age, the MAC decreases.
The average concentration of sevoflurane providing the MAK of a patient aged 80 years is approximately 50% of that of a patient aged 20 years.
Patients usually leave the general anesthetic quickly with the drug Sevoran ® .
In this connection, postoperative analgesia may be required earlier.
SIDE EFFECT

Like all powerful agents for inhalation anesthesia, sevoflurane can cause a dose-dependent inhibition of heart and respiratory function.
Most adverse reactions are mild or moderate and transient. Often after surgery and general anesthesia, nausea, vomiting and delirium are noted, which may be associated with inhalation anesthetics, other drugs administered intraoperatively or in the postoperative period, as well as with the patient's response to surgery.
The most frequent adverse reactions were:

- in adult patients: decreased blood pressure, nausea, vomiting;

- in elderly patients: bradycardia, decreased blood pressure, nausea;

- in patients of childhood: agitation, cough, nausea and vomiting.

Undesirable reactions recorded in clinical studies and post-marketing observations, possibly associated with the use of sevoflurane, are reflected with a distribution according to organ systems and frequency of occurrence: very often (? 1/10);
often (? 1/100, <1/10); infrequently (? 1/1000, <1/100), unknown (frequency unknown).
From the side of the immune system: unknown - anaphylactic reactions **, pseudo-anaphylactic reactions, hypersensitivity.

From the side of metabolism: unknown - hyperkalemia;
infrequently hypercreatininaemia.
From the side of the psyche: very often - agitation.

From the nervous system: often - drowsiness, dizziness, headache;
infrequently - confusion of consciousness; unknown - cramps, dystonia, increased intracranial pressure.
From the cardiovascular system: very often - bradycardia, lowering blood pressure;
often - tachycardia, increased blood pressure; infrequent arrhythmia, ventricular extrasystole, supraventricular extrasystole, complete AV blockade, bigemia, T wave inversion, atrial fibrillation, atrial arrhythmia, AV blockade of II degree, ST segment reduction, bleeding, syncope; unknown - cardiac arrest (<0.01%), ventricular fibrillation, QT interval prolongation associated with ventricular pirouette tachycardia.
From the respiratory system: very often - cough;
often - breathing disorders, laryngospasm, airway obstruction, respiratory arrest; infrequently - apnea, bronchospasm, hypoxia; unknown - shortness of breath **, wheezing **, respiratory depression, pulmonary edema.
From the side of the digestive system: very often - nausea, vomiting;
often - increased salivation.
From the liver and bile ducts: unknown - hepatitis, hepatic insufficiency, liver necrosis, pancreatitis, jaundice.

From the skin and subcutaneous tissues: unknown - rash **, hives, itching, contact dermatitis **, edema of the face **.

From the musculoskeletal and connective tissue: unknown - muscle rigidity.

From the side of the urinary tract: unknown - tubular interstitial nephritis, acute renal failure;
infrequent - urinary retention, glucosuria.
Common reactions: often - chills, fever, hypothermia;
unknown - malignant hyperthermia, a feeling of discomfort in the chest area **.
Changes in laboratory indicators: often - transient violations of liver function, changes in blood glucose concentration, transient increase in fluoride concentrations *, increased activity of AST in the blood;
infrequently, an increase in ALT activity in the blood, an increase in LDH activity in the blood, a change in the number of leukocytes.
* During and after general anesthesia with sevoflurane, there may be a transient increase in the serum concentration of inorganic fluoride in the blood plasma.
Usually their concentration reaches a maximum within 2 hours after discontinuing sevoflurane administration and returns to the preoperative value within 48 hours. In clinical studies, an increase in the concentration of fluorides did not lead to impaired renal function.
** The effect may be associated with hypersensitivity reactions, especially in cases of prolonged occupational exposure to inhaled anesthetics.

Liver and bile ducts

In the postoperative period, cases of hepatitis or liver dysfunction (of mild, moderate and severe course, with or without jaundice) were noted.
However, histologically, none of the cases of hepatitis was confirmed by histological examination. In most cases, patients with a history had already had liver function abnormalities, or the use of drugs capable of causing such disorders was noted. Most of the reported reactions were transient and resolved on their own.
CNS

Convulsions: according to post-marketing surveillance, seiz- flurane has been reported in cases of seizures.
The majority of cases have been reported in children and adult patients of young age without indication of occurrence of seizures in the anamnesis. In several cases, concomitant therapy has not been reported; At least 1 case of seizures is confirmed by EEG. In most cases, single episodes of seizures have been reported that were resolved on their own or after appropriate therapy;nevertheless, cases of multiple seizures were also noted. Seizures arose during induction with sevoflurane, or soon after, during withdrawal from anesthesia and in the postoperative period - for up to 1 day after anesthesia.
Hypersensitivity

Hypersensitivity cases have been reported (including cases of contact dermatitis, rash, dyspnoea, wheezing, feelings of chest discomfort, facial swelling, anaphylactic reactions);
in particular, such cases were noted against a background of prolonged professional contact with inhalation anesthetics, including. sevoflurane.
Hypermetabolism of muscles

In sensitive patients, powerful inhalation anesthetics, incl.
sevoflurane, can provoke the development of hypermetabolic state of skeletal muscles, which leads to an increase in the need for oxygen and manifests itself as a clinical syndrome of malignant hyperthermia.
CONTRAINDICATIONS

- hypersensitivity to sevoflurane or other halogenated drugs (for example, history of associated hepatotoxicity associated with the use of these drugs, usually including increased hepatic enzyme activity, fever, leukocytosis and / or eosinophilia);

- confirmed or suspected genetic predisposition to the development of malignant hyperthermia;

- the period of breastfeeding.

Carefully:

- kidney failure;

- increased intracranial pressure;

- neuromuscular diseases;

- mitochondrial diseases;

- IHD;

- violations of the liver function;

- simultaneous use of drugs that can cause damage to liver function;

- propensity to occurrence of cramps;

- use in obstetrical operations;

- propensity to lengthen the QT interval and tachycardia of the "pirouette" type in the anamnesis;

- simultaneous use with beta-sympathomimetics, such as isoprenaline and c alpha and beta sympathomimetics such as epinephrine and norepinephrine because of the possible risk of developing ventricular arrhythmia;

- simultaneous use with blockers of slow calcium channels.

PREGNANCY AND LACTATION

In reproductive studies in animals, sevoflurane in doses up to 1 MAK had no effect on reproductive function and damaging effects on the fetus.

Studies in pregnant women have not been conducted.

Sevoflurane can be used during pregnancy only if the potential benefit to the mother justifies the possible risk to the fetus.

There are no data on sevoflurane and breast milk.
Women who breastfeed should refrain from breastfeeding during the period of drug use and within 48 hours after use.
Childbirth

The clinical study demonstrated the safety of sevoflurane for the mother and newborn when used for general anesthesia in a caesarean section.
The safety of sevoflurane during labor and delivery is not established through the natural birth canal.
Sevoflurane, like other drugs for inhalation anesthesia, causes relaxation of the uterus musculature, as a result of which there is a potential risk of uterine bleeding.

In midwifery operations, sevoflurane should be used with caution.

APPLICATION FOR CHILDREN

The use of funds for inhalation anesthesia in children caused, in rare cases, an increase in serum potassium levels, which led to the development of cardiac arrhythmias and death in the postoperative period.
This condition can occur especially in patients with latent or explicitly occurring neurological diseases, especially in patients with Duchenne muscular dystrophy.
SPECIAL INSTRUCTIONS

General recommendations

Preparation Sevorane ® can only be used by specialists who have been trained for the general anesthesia, at offices equipped with all necessary to ensure airway of the ventilator, oxygen therapy and resuscitation.
Application of sevoflurane may lead to respiratory depression; This effect can be amplified premedication narcotic analgesics or the use of other drugs that can cause respiratory depression. It is necessary to monitor and maintain the patient's respiratory function.
It should monitor all patients carried anesthesia using Sevoflurane including ECG monitoring, blood pressure, oxygen saturation and partial pressure of carbon dioxide (CO 2 ) at the end of exhalation.
During anesthesia, increasing the concentration of sevoflurane leading to the development of dose-dependent decrease in blood pressure. Since sevoflurane insoluble in blood, these hemodynamic changes can be earlier than in the case of other inhalation anesthetics. Deep anesthesia can be associated with a significant decrease in blood pressure and respiratory depression; correction for the above phenomena is recommended to reduce sevoflurane concentration in the gas mixture.
Should pay special attention to the selection of a dose of sevoflurane in patients with hypovolemia, hypotension or other hemodynamic disturbances that have developed, for example, due to concomitant treatment.
The concentration of the drug coming from the evaporator, must be precisely known. Since inhalation anesthetics differ in their physical properties, for supplying the drug Sevoran ® only specially calibrated vaporizers for Sevoran the drug should be used ® . Dosing of the drug during general anesthesia should be adjusted individually depending on the patient response. When deepening general anesthesia may be a build-up of arterial hypotension and depression of respiratory function.
Individual messages were received on lengthening QT interval, very rarely associated with tachycardia type pirouette (in some cases, lethal). Sevorane ® should be used with caution in patients prone to complications data.
Some were reported cases of ventricular arrhythmias in pediatric patients with Pompe disease.
Drugs for general anesthesia, including Sevoran ® , should be used with caution in patients with mitochondrial diseases.
Increasing the concentration of sevoflurane to maintain general anesthesia causes a dose-dependent decrease in blood pressure. Excessive blood pressure reduction could be due to deep general anesthesia; in such cases, it can be increased by reducing the concentration of the feed sevoflurane.
In applying the drug Sevorane ® , as well as other means for general anesthesia in patients with ischemic heart must maintain a stable hemodynamic, to prevent myocardial ischemia.
After recovery from anesthesia patients require additional observation before being transferred to the separation profile.
Since the use of sevoflurane is a rapid recovery from anesthesia may be necessary in the early relief of postoperative pain. Despite the fact that the recovery of consciousness during anesthesia with sevoflurane usually occurs within a few minutes, the effect of the drug on the intellectual function for 2-3 days following anesthesia has not been studied. As with use of other anesthetic agents, there may be minor changes in mood, which may persist for several days after anesthesia. Quick recovery from anesthesia in children may be accompanied by agitation and decreased communication skills (approximately 25% of cases).
Substitution overdried sorbents CO 2
In applying the drug Sevorane ® in apparatus for anesthesia, overdried sorbents containing CO 2 (particularly containing potassium hydroxide), described rare cases of excessive overheating and / or spontaneous smoke and / or ignition apparatus for anesthesia. If overheating tanks sorbent CO 2 may be a delay unusual increase or decrease unexpected respirable drug concentration Sevorane ® , despite the evaporator configuration.
The exothermic reaction to form sevoflurane degradation of the decomposition products occurring in the interaction with Sevoflurane sorbent CO 2Amplified if the sorbent dries; for example, during prolonged passing dry gas through the vessel with sorbent CO 2 . The formation of degradation products of sevoflurane (methanol, formaldehyde, carbon monoxide, and components A, B, C and D) was observed in the breathing circuit experimental anesthesia machines with over dried sorbents when the concentration reached a maximum sevoflurane (8%) for 2 hours or more. Concentrations of formaldehyde generated in these conditions, reach values which could cause respiratory tract irritation. Clinical evaluation of the impact of sevoflurane degradation products on the body was not carried out in extreme conditions.
If the anesthesiologist suspects that the sorbent CO 2too dry, it must be replaced before using sevoflurane. When drying of the sorbent CO 2 indicator color changes are not always. Consequently, the lack of color change of the indicator can not be considered evidence of adequate hydration. Sorbents CO 2 need to regularly change regardless of the color of the indicator.
Hyperkalemia in the perioperative period
The use of funds for inhalation anesthesia in children resulted in rare cases, an increase in serum potassium concentration, which led to the development of cardiac arrhythmias and death in the postoperative period. The risk is higher in patients with latent and clinically manifested neuromuscular disorders, especially in patients with Duchenne muscular dystrophy. In most cases, there was a connection between the development of these complications with simultaneous application of suxamethonium. These patients were also observed a significant increase in the activity of CK in the serum and in some cases, changes in urine composition, indicating myoglobinuria. Despite some similarities with the manifestations of malignant hyperthermia, none of these cases have not been marked muscle rigidity or symptoms associated with increased metabolism in the muscles.Should immediately initiate action to relief of hyperkalemia and resistant arrhythmias and conduct a survey to identify the latent flowing neuromuscular disease.
Renal dysfunction
safety of the drug Sevorane ® in this group of patients not been definitively established, it should be used with caution in patients with renal insufficiency.
Materials controlled studies with low gas mixture feed rate is limited, however, clinical and experimental data indicate the possibility of kidney damage, presumably due to component A. According to these data, the use of sevoflurane over 2 MACH? Hours at feed rates of the gas mixture less 2 l / min may be associated with the development of proteinuria and glycosuria.
A component exposure level at which the possibility of clinical nephrotoxicity is not installed; however, should take into account all of the factors leading to an increase in component A exposure in humans, in particular the duration of exposure, the feed rate of the gas mixture and the concentration of sevoflurane. During anesthesia should be titrated concentration inhaled sevoflurane and controlling the feed rate of the gas mixture to reduce the exposure of component A to a minimum. For this sevoflurane exposure should not exceed 2 MACH? Hours, at a feed rate from 1 to <2 liters / minute. The feed rate of the gas mixture <1 L / min is not suitable for use.
Clinical experience of sevoflurane in renal failure patients (CC> 1.5 mg / dL) is limited; Thus, the safety of the drug in these patients has not been established.
Impaired liver function

The observations were reported post-marketing very rare cases of liver dysfunction (from light to heavy) or hepatitis B (with or without jaundice) in the postoperative period.
Sevoflurane should be used with caution in patients with impaired liver function, as well as the combined use of drugs that can cause hepatic dysfunction.
There is evidence that the use of halogenated anesthetic agents in history, especially during the previous 3 months, may increase the risk of liver damage.
It has been reported that exposure of halogenated hydrocarbons in history can increase the risk of liver damage.
Reported rare cases of mild, moderate or severe postoperative dysfunction of the liver or hepatitis (with or without jaundice). Caution is recommended when using sevoflurane on the background of violations of the liver, or in patients who receive treatment with drugs known to cause liver dysfunction. Patients undergoing after applying other inhalation anesthetics liver injury, jaundice, fever of unknown origin or eosinophilia, it is recommended to avoid the use of sevoflurane, if there exists the possibility of using a general anesthetic drugs for in / or administration of regional anesthesia.
malignant hyperthermia
In susceptible people powerful tools for inhalation anesthesia, including sevoflurane, can cause a state of hypermetabolism of skeletal muscle, which leads to an increase in their oxygen demand and the development of the clinical syndrome known as malignant hyperthermia. The first sign of this syndrome is hypercapnia. Also, there may be muscle rigidity, tachycardia, tachypnea, cyanosis, arrhythmias, and / or unstable blood pressure. Some of these nonspecific signs may also appear during light anesthesia, acute hypoxia, hypercapnia, and hypovolemia.
In clinical trials, one case of malignant hyperthermia was reported. In addition, cases of malignant hyperthermia (including fatal) reported in post-marketing observations.
Treatment of malignant hyperthermia involves the cancellation of drugs that have caused its development (e.g., sevoflurane) / in a dantrolene (detailed information on the use of dantrolene refer to its instructions for use) and maintenance intensive symptomatic therapy, including maintenance of normal body temperature, respiration and circulation functions control of water and electrolyte and acid-base balance. It can later develop renal failure, so you should monitor and maintain urine output possible.
Neurosurgery
If the patient has a threat of increased intracranial pressure, the drug Sevorane ®should be used with caution in combination with measures aimed at reducing intracranial pressure, such as hyperventilation.
Convulsions
have been reported rare cases of seizures associated with the use of sevoflurane.
The use of sevoflurane was associated with episodes of convulsions in children and young adults as well as older people with no predisposing risk factors. Careful examination of patients at risk of seizures before using sevoflurane. In children the depth of anesthesia should be limited. When selecting a dose of sevoflurane in patients with seizures of risk is necessary to the EEG to optimize dosing sevoflurane.
Use in Pediatrics

There have been cases of seizures during treatment with sevoflurane. Many of these cases have occurred in children (starting at 2 months of age) and adolescents ; most of them did not have risk factors for seizures.
Sevoflurane should be used with caution in patients with a tendency to develop seizures.
The children who were prescribed sevoflurane for the induction of anesthesia, observed dystonic movements, disappear on their own without requiring treatment. A causal relationship with sevoflurane has not been confirmed.
Children with Down syndrome have an increased risk of bradycardia and hypotension during and after sevoflurane induction.
Anesthesia in Obstetrics
Caution must be exercised when using sevoflurane in obstetric practice. Sevoflurane has a relaxing effect on the uterus, which can increase the risk of uterine bleeding, as evidenced by a study carried out at the termination of pregnancy. Available data support the safety of sevoflurane for mother and child during elective cesarean section. sevoflurane security for vaginal birth canal has not been studied.
Impact on the ability to drive vehicles and manage mechanisms

Although after a power sevoflurane consciousness is usually restored after a few minutes, its effects on cognitive function for 2-3 days after general anesthesia has not been studied. Within a few days after the application of sevoflurane as other means for general anesthesia, may experience small changes in mood. Patients should be informed that, after general anesthesia can impair the ability to perform tasks requiring psychomotor speed reactions, such as driving a car or working with machinery that requires special attention. The possibility of the resumption of activities in these activities defines an anesthesiologist.
OVERDOSE

Treatment: you need to stop the introduction of sevoflurane, maintain a patent airway, start supporting or controlled ventilation with the introduction of oxygen and maintain adequate function of the cardiovascular system


DRUG INTERACTION

Safety and efficacy of sevoflurane confirmed while the use of various drugs, which are frequently used in surgical practice, including drugs affecting the central nervous system, autonomic nervous system, muscle relaxants, antimicrobial agents (including aminoglycosides), hormones and their synthetic analogues , blood products and cardiovascular drugs, including epinephrine.
Beta-sympathomimetics such as isoprenaline and alpha- and beta-sympathomimetics, such as epinephrine and norepinephrine should be used with caution in conjunction with sevoflurane because of the possible risk of ventricular arrhythmias.
Non-selective MAO-inhibitors the risk of hypertensive crisis during surgery. It is recommended to discontinue treatment of non-selective MAO inhibitors 2 weeks prior to surgery.
Application of sevoflurane may cause a marked reduction of blood pressure in patients receiving calcium channel blockers slow, particularly dihydropyridine derivatives. Caution should be exercised when using calcium channel blockers slow simultaneously with inhaled anesthetics because of the risk of amplification of negative inotropic effect.
Concomitant use of suxamethonium and volatile anesthetics in children in rare cases, caused an increase in the level of potassium in the blood serum, which led to the emergence of cardiac arrhythmias and death in the postoperative period.
It has been shown that other volatile fluorinated compounds for inhalation anesthetic drugs displace from its association with blood proteins and tissues in vitro. The ability to displace sevoflurane medicaments of communication with serum and tissue proteins has not been studied.
Aude
The information is provided for your information, do not self-medicate, it is dangerous for your health.

Alphabetical index of medicines:
A  B  V  G  D  E  J
Z  I  Y  K  L  M  N
O  P  R  S  T  U  F
H  C  CH  SH  E  U  Y
Rambler's Top100
Privacy policy:
Copyright 2009 - 2017. Universal reference book of medicines. All rights reserved.
When using site materials, an active hyperlink is required!