Sevoflurane

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Sevoflurane
Sevoflurane.svg
Sevoflurane-3D-balls.png
Systematic (IUPAC) name
1,1,1,3,3,3-hexafluoro-2-(fluoromethoxy)propane
Clinical data
Trade names Sojourn, Ultane, Sevorane
AHFS/Drugs.com Consumer Drug Information
Legal status
Routes inhaled
Identifiers
CAS number 28523-86-6 YesY
ATC code N01AB08
PubChem CID 5206
DrugBank DB01236
ChemSpider 5017 YesY
UNII 38LVP0K73A YesY
KEGG D00547 YesY
ChEBI CHEBI:9130 YesY
ChEMBL CHEMBL1200694 N
Chemical data
Formula C4H3F7O 
Mol. mass 200.055 g/mol
 N (what is this?)  (verify)

Sevoflurane (1,1,1,3,3,3-hexafluoro-2-(fluoromethoxy)propane; synonym, fluoromethyl hexafluoroisopropyl ether), is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used for induction and maintenance of general anesthesia. The anesthetic is a gas at room temperature and is therefore an inhalational anaesthetic. Sevoflurane's name derives from having its from having seven fluorine atoms in its substituents, alongside a standard suffix for such agents.[citation needed]

It is one of the most commonly used volatile anesthetic agents, particularly for outpatient anesthesia,[1] and including in anesthesia of children and infants, and in veterinary medicine.[citation needed] Together with desflurane, sevoflurane is replacing isoflurane and halothane in modern anesthesiology.[citation needed] It is often administered in a mixture of nitrous oxide and oxygen.[citation needed]

After desflurane, it is the volatile anesthetic with the fastest onset and offset.[2] Though desflurane has the lowest blood–gas partition coefficient of the currently used volatile anesthetics, sevoflurane is the preferred agent for mask induction due to its lesser irritation to mucous membranes.[citation needed]

Sevoflurane "has an excellent safety record",[1] but is under review for potential neurotoxicity, especially relevant to administration in infants and children, and rare case reports akin to halothane hepatotoxicity, have made clear that low frequency liver injury may occur.[1]

Sevoflurane was discovered by Ross Terrell.[3] First reports on the use of sevoflurane appeared in the literature in 1971;[citation needed] it was introduced into clinical practice initially in Japan in 1990.[citation needed] The rights for sevoflurane in the US and other countries were held by Abbott Laboratories; it is now available as a generic drug.[when?][citation needed]

Medical uses[edit]

Sevoflurane is an inhaled anaesthetic that is often used to put children asleep for surgery.[4] During the process of waking up from the medication, it has been known to cause agitation and delirium.[4] It is not clear if this can be prevented.[4]

Adverse effects[edit]

Sevoflurane raises intracranial pressure and can cause respiratory depression.[5]

Studies examining a current significant health concern, anesthetic-induced neurotoxicity (including with sevoflurane, and especially with children and infants) are "fraught with confounders, and many are underpowered statistically", and so are argued to need "further data... to either support or refute the potential connection".[6]

Concern regarding the safety of anaesthesia is especially acute with regard to children and infants, where preclinical evidence from relevant animal models suggest that common clinically important agents, including sevoflurane, may be neurotoxic to the developing brain, and so cause neurobehavioural abnormalities in the long term; two large-scale clinical studies (PANDA and GAS) were ongoing as of 2010, in hope of supplying "significant [further] information" on neurodevelopmental effects of general anaesthesia in infants and young children, including where sevoflurane is used.[7]

Physical properties[edit]

Boiling point: 58.6 °C (at 101.325 kPa)
Density: 1.517–1.522 g/cm³ (at 20 °C)
MAC : 2.1 vol %
Molecular weight: 200 u
Vapor pressure: 157 mmHg (22.9 kPa) (at 20 °C)
197 mmHg (26.3 kPa) (at 25 °C)
317 mmHg (42.3 kPa) (at 36 °C)
Blood:Gas partition coefficient: 0.68
Oil:Gas partition coefficient: 47

Bispectral index[edit]

Sevoflurane has lower values of controversial bispectral index than desflurane.[8][9]

References[edit]

  1. ^ a b c Livertox: Clinical and Research Information on Drug-Induced Liver Injury (2014) "Drug Record: Sevoflurane", U.S. National Library of Medicine, 2 July 2014 update, see [1], accessed 15 August 2014.
  2. ^ Sakai EM, Connolly LA, Klauck JA (December 2005). "Inhalation anesthesiology and volatile liquid anesthetics: focus on isoflurane, desflurane, and sevoflurane". Pharmacotherapy 25 (12): 1773–88. doi:10.1592/phco.2005.25.12.1773. PMID 16305297. 
  3. ^ Burns, William; Edmond I Eger II (August 2011). "Ross C. Terrell, PhD, an Anesthetic Pioneer". Anesth. Analg. 2 113 (113): 387–9. doi:10.1213/ane.0b013e3182222b8a. 
  4. ^ a b c Costi, D; Cyna, AM; Ahmed, S; Stephens, K; Strickland, P; Ellwood, J; Larsson, JN; Chooi, C; Burgoyne, LL; Middleton, P (Sep 12, 2014). "Effects of sevoflurane versus other general anaesthesia on emergence agitation in children.". The Cochrane database of systematic reviews 9: CD007084. PMID 25212274. 
  5. ^ "Sevoflurane". 
  6. ^ P. Vlisides P & Z. Xie (2012) Neurotoxicity of general anesthetics: an update., Curr Pharm Design, 18(38):6232-40, see [2], accessed 15 August 2015.
  7. ^ L. Sun (2010) Early childhood general anaesthesia exposure and neurocognitive development, Br J Anaesth. 105 Suppl 1:i61-8, DOI 10.1093/bja/aeq302, see [3], accessed 15 August 2015.
  8. ^ Kim JK (Feb 2014). "Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia.". J Int Med Res 42 (1): 130–7. doi:10.1177/0300060513505525. PMID 24366495. 
  9. ^ Kreuer S (Oct 2009). "Comparative pharmacodynamic modeling of desflurane, sevoflurane and isoflurane.". J Clin Monit Comput. 23 (8). doi:10.1007/s10877-009-9196-6. PMID 19711188. 

Further reading[edit]

External links[edit]