Universal reference book for medicines
Product name: FORANE

Active substance: isoflurane

Type: The drug for inhalation anesthesia

Composition, form of production and packaging
The liquid for inhalation anesthesia is transparent, colorless, volatile, with a characteristic odor.
1 f. (100 ml)
isoflurane 100%
100 ml - bottles of dark glass (6) - plastic boxes.
250 ml - bottles of dark glass (6) - plastic boxes.
Description of the drug approved by the manufacturer for the printed edition of 2008.
The drug for inhalation anesthesia. It causes a rapid onset of general anesthesia and a quick exit from it. A minor irritant effect of isoflurane may limit the rate of administration to general anesthesia. The drug does not cause excessive secretion of salivary and tracheobronchial glands. Pharyngeal and laryngeal reflexes are rapidly suppressed.
The level of general anesthesia with the use of isoflurane can change rapidly. With an increase in the depth of general anesthesia, suppression of spontaneous breathing occurs, so it should be carefully monitored and, if necessary, maintained.
In the stage of introduction to general anesthesia, there is a decrease in blood pressure, which quickly normalizes in the surgical stage of anesthesia, the heart rhythm does not change.
With maintenance anesthesia, blood pressure decreases in proportion to the depth of anesthesia, but the heart rate remains stable. During ventilation for normal pCO 2, the minute volume of the heart remains constant, regardless of the depth of general anesthesia, and is maintained mainly by increasing the heart rate. With spontaneous breathing, developing hypercapnia can lead to an increase in heart rate and a minute volume of the heart, which exceed those on awakening.
With superficial anesthesia, cerebral blood flow does not change, but tends to increase with deep anesthesia, which can lead to a transient increase in cerebrospinal fluid pressure (CSF). An increase in CSF pressure can be prevented or reduced by hyperventilation before or during anesthesia.
Changes in the EEG and convulsive activity are extremely rare with isoflurane. In general, isoflurane causes changes in the EEG, comparable to those with other drugs for inhalation anesthesia.
Isoflurane significantly lessens the sensitivity of the myocardium to the action of adrenaline than enflurane. There is limited evidence that subcutaneous infiltration of up to 50 ml of an adrenaline solution 1: 200,000 does not cause ventricular arrhythmia in patients undergoing general anesthesia with isoflurane.
At a normal level of general anesthesia, muscle relaxation may be adequate for some intra-abdominal operations. If more expressed muscle relaxation is required, perhaps in / in the administration of small doses of muscle relaxants. The depth of anesthesia is easily controlled.
Isoflurane can be used to introduce into general anesthesia and maintain general anesthesia.
C max inorganic fluoride in serum is usually less than 5 μmol / L and is determined 4 hours after anesthesia. The level of fluoride returns to normal within 24 hours.
Metabolism and excretion
In the body, only a small amount of isoflurane is metabolized. The known metabolites of isoflurane did not have toxicity or were determined in too low concentrations.
In the postoperative period, only 0.17% of the isoflurane dose can be detected as metabolites in the urine.
- introductory and supporting general anesthesia.
The drug can be used for sedation for 48 hours in patients undergoing intensive ventilation.
Specially calibrated evaporators should be used to accurately control the feed concentration of isoflurane.
Levels of MAK isoflurane in oxygen depend on age.
Values ​​of MAK (minimum alveolar concentration) of isoflurane depending on age
Age 100% oxygen 70% N 2 O
0-1 month 1.6%
from 1 to 6 months 1.87%
from 6 to 12 months 1.8%
26 ± 4 years 1.28% 0.56%
44 ± 7 years 1.15% 0.56%
64 ± 5 ​​years 1.05% 0.37%
Drugs used for premedication should be selected individually, bearing in mind that isoflurane can cause depression of the respiratory center. Optionally, you can use anticholinergic drugs.
Short-acting barbiturates or other drugs used for induction anesthesia are usually applied with subsequent inhalation of isoflurane. As an alternative, isoflurane may be used with oxygen or with oxygen-base mixture.
When inhaled for general anesthesia with isoflurane, a 0.5% concentration is recommended at the beginning. Concentrations from 1.5% to 3.0% usually cause a surgical level of general anesthesia after 7-10 minutes.
Maintenance of the surgical level of anesthesia can be provided 1-2.5% isoflurane in the oxygen-base mixture. When using isoflurane in pure oxygen, its concentration should be increased by 0.5-1%. If necessary, additional use of muscle relaxants is possible.
To ensure anesthesia during caesarean section, it is sufficient to use 0.5-0.75% isoflurane in an oxygen-base mixture.
During maintenance of general anesthesia, the level of blood pressure in the absence of other factors is inversely proportional to the level of alveolar concentration of isoflurane. With deepening of anesthesia, the concentration of isoflurane in the inhaled mixture should be reduced in order to prevent an excessive decrease in blood pressure.
To maintain the surgical level of general anesthesia, elderly patients require lower concentrations of isoflurane.
Sedation can be maintained by 0.1-1% isoflurane in the oxygen-base mixture, the appropriate dose is selected individually.
Unwanted reactions that are recorded with Foran usually depend on the dose and reflect the pharmacological activity of the drug.
On the part of the respiratory system: possible respiratory depression.
From the cardiovascular system: possible violations of the heart rate, arterial hypotension.
On the part of laboratory indicators: a transient increase in the number of white blood cells, even in the absence of surgical stress.
On the part of the digestive system: in some cases - liver damage (from a small and transient increase in the activity of liver enzymes to necrosis of hepatocytes).
In the postoperative period: chills, nausea, vomiting and intestinal obstruction.
- malignant hyperthermia in the anamnesis;
- hypersensitivity to isoflurane.
With caution should be used foran with intracranial hypertension.
Safety of Forana application in pregnancy is not established.
The blood loss associated with abortion in cases of Foran use is comparable to blood loss when using other means for inhalation anesthesia.
Data on the efficacy and safety of Foran for general anesthesia in obstetrics are not available, except for caesarean section.
Isoflurane in concentrations up to 0.75% demonstrated safety for effective maintenance of anesthesia in cesarean section. There were no adverse reactions to the use of isoflurane in cesarean section.
There is no information on the excretion of isoflurane with breast milk. During the period of breastfeeding, Foran should be used with caution.
The drug significantly enhances cerebral blood flow, especially with deep anesthesia. There may be a transient increase in the pressure of cerebrospinal fluid, which is returned to the original in hyperventilation. With the use of Ioflurane, postoperative cerebral complications were relatively rare.
With the introduction of Foran, the level of general anesthesia can change quickly and easily, so it is recommended that only carefully calibrated evaporators be used or that monitoring be performed to assess the inhaled and exhaled concentration. With an increase in the depth of general anesthesia, there is an increase in arterial hypotension and suppression of respiratory function. The degree of arterial hypotension and respiratory depression can be an indication of the depth of general anesthesia.
Clinical experience with Foran administration, even with prolonged exposure, does not provide information on hepatotoxicity. However, the lack of a large experience of repeated use of the drug does not allow us to identify symptoms of effects on liver function.
Like other halogen-containing drugs, Foran should be used with caution in patients with increased intracranial pressure. In these cases, controlled hyperventilation may be necessary.
On the background of foran administration, a transient change in the bromsulflatein test, an increase in glucose and serum creatinine, and a decrease in residual urea nitrogen, serum cholesterol and alkaline phosphatase were observed.
In susceptible people, means for inhalation anesthesia, including isoflurane, can cause a state of skeletal muscle hypermetabolism, which leads to an increase in their oxygen demand and the development of a clinical syndrome known as malignant hyperthermia. The first sign of this syndrome is hypercapnia, and its clinical symptoms may include muscle stiffness, tachycardia, tachypnea, cyanosis, arrhythmias and / or unstable blood pressure. Some of these nonspecific symptoms may also occur with mild anesthesia, acute hypoxia, hypercapnia, and hypovolemia.
Treatment of malignant hyperthermia involves the abolition of drugs that caused its development, intravenous administration of dantrolene and maintenance of symptomatic therapy. Later, kidney failure may develop, so you should monitor and, if possible, maintain diuresis.
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 in particular can develop in patients with latent or evident neurological diseases, especially in patients with Duchenne's myodystrophy. In some cases, there was a connection with simultaneous use of succinylcholine. In these patients, there was also a significant increase in serum CK, change in the composition of urine and myoglobinuria. In contrast to malignant hyperthermia and some similarity in the manifestation of such patients, there was never a muscle rigidity or symptoms associated with muscle hypermetabolism. In case of the threat of development of such conditions, especially when a latent current neuromuscular disease is detected in a patient, immediate actions should be started to stop hyperkalemia and stable arrhythmia.
There are reports of individual cases of an increase in the level of carboxyhemoglobin using halogen containing anesthetics containing a group - CF 2 H, such as dezoflurane, enflurane and isoflurane. In the presence of normally moistened CO 2 sorbents, no increase in the concentration of carbon monoxide is observed.
Replacement of over-dried sorbents СО 2
When using isoflurane with over-dried CO 2 sorbents (especially those containing potassium hydroxide), rare cases of excessive overheating and / or spontaneous ignition in anesthesia apparatus are described.
If the anesthetist suspects that the sorbent CO 2 is over-dried, then it should be replaced before applying Foran. When drying the CO 2 sorbent, the color of the indicator does not always change. Consequently, the absence of color changes in the indicator can not be considered a confirmation of adequate hydration. Sorbents СО 2 must be regularly changed regardless of the color of the indicator.
Use in Pediatrics
Ieflurane can be used in newborns and children under 2 years of age with an acceptable level of benefit and risk for all other commonly used anesthetic agents.
In case of an overdose, discontinue foran administration, maintain airway patency, start assisted or controlled ventilation with oxygen and maintain adequate cardiovascular function .
Isoflurane significantly potentiates the action of all known muscle relaxants, and more of the non-depolarizing muscle relaxants.
Neostigmine eliminates the effects of nondepolarizing muscle relaxants, but does not affect the muscle relaxation caused by isoflurane itself.
All muscle relaxants are compatible with isoflurane.
With the simultaneous use of isoflurane with nitric oxide (N 2 O), a decrease in MAK was observed in adult patients.
The drug is dispensed on prescription for hospitals.
List B. The drug should be stored out of reach of children, at a temperature of no higher than 30 ° C. Shelf life - 5 years.
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