Buy Sevorane liquid 250 ml
  • Buy Sevorane liquid 250 ml

Sevorane® [Sevoflurane]

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Clinical Pharmacology

Sevorane is a drug for inhalation anesthesia.

Pharmacodynamics
Inhalation use of the drug for induction anesthesia causes a rapid loss of consciousness, which is quickly restored after the cessation of anesthesia.
Introduction anesthesia is accompanied by minimal excitation and signs of irritation of the upper respiratory tract and does not cause excessive secretion in the tracheobronchial tree and stimulation of the central nervous system. Like other powerful agents for inhalation anesthesia, sevoflurane causes a dose-dependent suppression of the respiratory function and a decrease in blood pressure. In humans, the threshold level of sevoflurane, which determines the development of arrhythmias under the action of adrenaline, was comparable to that of isoflurane and exceeded the threshold level of halothane.
Sevoflurane has a minimal effect on intracranial pressure and does not reduce the response to CO2. Sevoflurane has no clinically significant effect on liver or kidney function and does not cause an increase in renal or hepatic failure. Sevoflurane does not affect the concentration function of the kidneys, even with prolonged anesthesia (approximately up to 9 h).

The minimum alveolar concentration (MAC) is the concentration at which 50% of patients do not move in response to a single irritation (skin incision). MAK sevoflurane in different age groups are listed in the section "Dosage and administration".
IAC of sevoflurane in oxygen is 2.05% in a 40-year-old adult. MAC sevoflurane, as well as other halogenated drugs, decreases with age and with the addition of nitric oxide.

Pharmacokinetics
Solubility
The low solubility of sevoflurane in the blood provides a rapid increase in alveolar concentration when injected into general anesthesia and a rapid decrease after stopping inhalation. The ratio of alveolar concentration and concentration in the inhaled mixture into the accumulation phase 30 minutes after inhalation of sevoflurane was 0.85. In the phase of elimination, the ratio of alveolar concentrations after 5 minutes was 0.15.

Distribution and metabolism
Rapid elimination of sevoflurane from the lungs minimizes drug metabolism. In humans, less than 5% of the absorbed dose of sevoflurane is metabolized by the action of cytochrome P450 (CYP 2E1) to hexafluoroisopropanol, releasing inorganic fluorine and carbon dioxide (or carbon dioxide). The resulting hexafluoroisopropanol is rapidly conjugated with glucuronic acid and excreted in the urine. Other metabolic pathways of sevoflurane have not been established. It is the only fluorinated volatile anesthetic that is not metabolized to trifluoroacetic acid.

The concentration of fluoride ions depends on the duration of general anesthesia, the concentration of injected sevoflurane and the composition of the mixture for anesthesia. Barbiturates do not cause defluorination of sevoflurane. Approximately 7% of adults in whom in clinical studies Abbott measured concentrations of inorganic fluorine, they exceeded 50 μM; no clinically significant changes in renal function were found in any of these patients.

Indications

Induction and supportive general anesthesia in adults and children during surgical operations in the hospital and outpatient settings.

Composition

1 bottle with liquid for inhalation contains:
active substance: sevoflurane 250 ml

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Sevorane® [Sevoflurane]

Dosage and Administration

Anesthesiologists should individually select the means for premedication.
General anesthesia during surgery
When performing general anesthesia, it is necessary to know the concentration of Sevoran, coming from the evaporator. To do this, you can use the evaporator, specially calibrated for sevoflurane.
Introduction to General Anesthesia
The dose is selected individually and titrated to achieve the desired effect, taking into account the age and condition of the patient. After inhalation of Sevoran, you can enter a short-acting barbiturate or another drug for intravenous general anesthesia. For introduction into general anesthesia, Sevoran can be used in oxygen or in a mixture of oxygen and nitrous oxide.
Before surgery adults and children Inhalation of Sevoraran in concentrations up to 8% usually provides an introduction to general anesthesia for less than 2 minutes
Supportive General Anesthesia
The required level of general anesthesia can be maintained by inhalation of sevoflurane at a concentration of 0.5–3% in combination with or without nitrogen oxide.
MAK values ​​for adults and children taking into account age

Age of the patientSevoflurane in oxygenSevoflurane in 65% N2O / 35% O2
0-1 months * 3.3%
1 - <6 months 3.0%
6 months - <3 years 2.8% 2.0%
3-12 years old 2.5%
25 years 2.6% 1.4%
40 years 2.1% 1.1%
60 years 1.7% 0.9%
80 years 1.4% 0.7%


* Full-term newborns. MAC in preterm infants was not determined.
With age, the MAC decreases. The average concentration of sevoflurane, which provides a patient with MAK at the age of 80 years, is approximately 50% of that of a patient at the age of 20 years.
Patients usually quickly come out of general anesthesia with Sevoran. In this regard, postoperative analgesia may be required earlier.

Adverse reactions

From the side of the central nervous system and peripheral nervous system: agitation, drowsiness after exiting from general anesthesia, dizziness.
In children who received Sevoran for induction anesthesia, there were cases of independently passing dystonic movements, the connection of which with the drug was not established. In isolated cases, after applying Sevoran, short-term convulsions were noted.
Although after stopping the feeding of Sevoran, consciousness usually recovers in a few minutes, however, the state of intellectual capabilities was not studied within 2-3 days after anesthesia. Within a few days after applying Sevoran (as well as other means for anesthesia), slight mood changes may occur.
On the part of the respiratory system: dose-dependent respiratory depression, increased cough, respiratory disorders (apnea after intubation, laryngospasm).
Since the cardiovascular system: dose-related inhibition of cardiac activity, decrease or increase in blood pressure, bradycardia, tachycardia.
From the digestive system: nausea, vomiting, increased salivation; in some cases, postoperative hepatitis (the connection with the use of Sevran has not been established), transient disturbances in liver function indicators.
Allergic reactions: in some cases, rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions.
From the laboratory indicators: transient increases in glucose and white blood cell count are possible. During and after anesthesia with Sevoran, a transient increase in serum concentration of inorganic fluorine is possible (with a maximum value within 2 hours after stopping Sevoran administration and returning within 48 hours to the level before surgery). In clinical studies, an increase in fluorine concentration was not accompanied by impaired renal function.
Other: chills, fever.
In susceptible patients, powerful agents for inhalation anesthesia, including Sevoran, can cause skeletal muscle hypermetabolism, leading 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 clinical symptoms may include muscle stiffness, tachycardia, tachypnea, cyanosis, arrhythmias, and / or blood pressure instability. Some of these nonspecific symptoms may also appear during mild anesthesia, acute hypoxia, hypercapnia, and hypovolemia. Later, kidney failure may develop (should be monitored and, if possible, maintained diuresis).
Most adverse reactions are mild or moderate and transient.

Contraindications

Confirmed or suspected genetic susceptibility to the development of malignant hyperthermia, increased sensitivity to sevoflurane or other halogenated drugs.
Carefully used in violation of renal function, with neurosurgical interventions.

Drug interactions

Safety and efficacy of Sevoran has been confirmed with simultaneous use with various drugs that are often used in surgical practice, including drugs that affect the functions of the central nervous system, the autonomic nervous system, muscle relaxants, antimicrobials (including aminoglycosides), hormones and their synthetic analogues, blood products and cardiovascular drugs, including epinephrine (adrenaline).
The ability of sevoflurane to displace drugs from the association with serum and tissue proteins has not been studied.
In clinical studies, no adverse events were observed when using sevoflurane in patients who took drugs that are actively binding to proteins and have a small Vd (for example, phenytoin).
Sevoran can be used with barbiturates as well as with benzodiazepines and opioid analgesics.

Benzodiazepines and opioid analgesics are supposed to decrease sevoflurane MAC.
MAC sevoflurane decreases with simultaneous use of nitric oxide.
Equivalent MAC is reduced by about 50% in adults and about 25% in children.
Sevoflurane has an effect on the intensity and duration of the neuromuscular blockade caused by non-depolarizing muscle relaxants. With the introduction of Sevoran as an adjunct to anesthesia with Alfentanil / N2O he enhances the effects of pancuronium, vecuronium and atracuria. When prescribing these muscle relaxants in combination with sevoflurane, their dose should be adjusted in the same way as in the case of isoflurane. The effect of sevoflurane on the effect of succinylcholine and the duration of action of depolarizing muscle relaxants has not been studied.

Since an increase in the action of muscle relaxants is observed a few minutes after the start of inhalation of sevoflurane, a decrease in the dose of muscle relaxants during induction of anesthesia may lead to a delay in tracheal intubation or inadequate muscle relaxation.
Among non-depolarizing drugs, interaction with vecuronium, pancuronium and atracurium was studied. Although there are no special recommendations for their use, however, with endotracheal intubation, doses of non-depolarizing muscle relaxants should not be reduced; while maintaining anesthesia, the doses of non-depolarizing muscle relaxants should probably be lower than with anesthesia N2O / opioid analgesics. Additional doses of muscle relaxants are given based on the response to nerve stimulation.
Data on pharmaceutical incompatibility with other drugs Sevoran missing.

Pregnancy and Lactation

Category B. Adequate and strictly controlled studies of the safety of the drug during pregnancy was not conducted. Use of Sevoran during pregnancy is possible only in cases of extreme necessity.
A clinical study demonstrated the safety of Sevoran for mother and newborn when used for anesthesia with caesarean section. The safety of Sevoran during labor and during childbirth by natural means has not been established.
It is not known whether sevoflurane is excreted in breast milk.Use with caution during lactation (breastfeeding).

Special instructions

Sevoran can be used only by doctors who have experience with general anesthesia. It is necessary to have ready equipment for the restoration of airway, artificial lung ventilation, oxygen therapy and resuscitation.
The safety of using Sevoran in patients with impaired renal function has not been established. In this regard, the drug should be used with caution in patients with renal insufficiency.
For neurosurgical interventions, if the patient is at risk of increasing intracranial pressure, sevoflurane should be used with caution in conjunction with measures aimed at reducing intracranial pressure, such as hyperventilation.

The level of general anesthesia can change quickly and easily, so only specially calibrated evaporators should be used to deliver Sevoran. With the deepening of general anesthesia, an increase in arterial hypotension and suppression of the respiratory function is noted.
With supportive anesthesia, an increase in Sevran concentration causes a dose-dependent decrease in blood pressure. An excessive drop in blood pressure may be associated with a deep general anesthesia; in such cases, it can be increased by reducing the concentration of the supplied Sevoran.
As with the use of any means for general anesthesia in patients with IHD, it is necessary to maintain stable hemodynamics in order to avoid myocardial ischemia.
Patients emerging from general anesthesia should be carefully monitored before transport to the ward.
In the treatment of malignant hyperthermia, the abolition of drugs that caused its development, intravenous administration of sodium dantrolen and supportive symptomatic therapy is indicated.
Data on the development of dependence on Sevoran are not available.

Influence on ability to drive motor transport and control mechanisms
Patients should be informed that for some time after anesthesia, the ability to perform work that requires a quick reaction, such as driving a car or using potentially dangerous mechanisms, may deteriorate.
Replacing the dried CO sorbents2
Exothermic reaction that occurs during the interaction of sevoflurane and CO sorbents2, increases if the sorbent dries, for example, with prolonged exposure to dry gas. When using Sevoran with dry CO sorbents2 Rare cases of excessive overheating and / or spontaneous ignition in anesthesia machines are described. When overheating tanks with CO sorbent2 there may be an unusual delay in the increase or an unexpected decrease in the inhaled concentration of Sevoran (compared with the evaporator settings).

If the anesthesiologist suspects that the CO sorbent2 overdried, it should be replaced before applying Sevoran. When drying sorbent WITH2 the color of the indicator does not always change. Consequently, the absence of changes in the color of the indicator can not be considered confirmation of adequate hydration. CO sorbents2 must be changed regularly regardless of the color of the indicator.

Overdosage

Symptoms: strengthening the inhibitory effect on the respiratory system and heart activity.
Treatment: you should stop administering Sevoran, ensure that the airway is maintained, initiate auxiliary or controlled ventilation of the lungs with the introduction of oxygen, and maintain adequate function of the cardiovascular system.

  • Brand name: Sevorane
  • Active ingredient: Sevoflurane
  • Dosage form: Liquid for inhalation
  • Manufacturer: Abbott
  • Country of Origin: USA

Studies and clinical trials of Sevoflurane (Click to expand)
  1. Separation and absolute configuration of the enantiomers of a degradation product of the new inhalation anesthetic sevoflurane (Dedicated to Professor Nakanishi on the occasion of his 75th birthday)
  2. The Effect of Sevoflurane Inhalation on Gabaergic Neurons Activation: Observation on the GAD67-GFP Knock-In Mouse
  3. The determination of a new inhalational anaesthetic, sevoflurane, using an internal standard, xenon, by gas chromatography/mass spectrometry/selected ion monitoring
  4. ChemInform Abstract: The Fluoromethyl Ether Sevoflurane as a Fluoride Source in Halogen-Exchange Reactions.
  5. ChemInform Abstract: An Efficient and Environmentally Friendly Synthesis of the Inhalation Anesthetic Sevoflurane.
  6. ChemInform Abstract: A Safe and Efficient Process for the Synthesis of the Inhalation Anesthetic Sevoflurane.
  7. ChemInform Abstract: Diisopropylethylamine Mono(hydrogen fluoride) for Nucleophilic Fluorination of Sensitive Substrates: Synthesis of Sevoflurane.
  8. Absolute configuration and conformational analysis of a degradation product of inhalation anesthetic Sevoflurane: A vibrational circular dichroism study
  9. Spatial nonuniformity of the resting CBF and BOLD responses to sevoflurane: In vivo study of normal human subjects with magnetic resonance imaging
  10. Ulcerative colitis after anesthesia with desflurane and sevoflurane
  11. Ab initio calculation of structures and properties of halogenated general anesthetics: halothane and sevoflurane
  12. Synthesis of fluoro-dideutero-methyl 1,1,1,3,3,3-hexafluoro-2-propyl ether (deuterated sevoflurane)
  13. Histamine release associated with intravenous delivery of a fluorocarbon-based sevoflurane emulsion in canines
  14. Development and validation of a direct headspace GC-FID method for the determination of sevoflurane, desflurane and other volatile compounds of forensic interest in biological fluids: Application on clinical and post-mortem samples
  15. Fluoro-dideutero-methyl 1,1,1,3,3,3-hexafluoroisopropyl ether (D2-sevoflurane) reactions on soda lime: deuterium content of deuterated sevoflurane and its volatile degradation products
  16. Analysis of sevoflurane degradation products in vapor phase samples
  17. Simple assay of plasma sevoflurane and its metabolite hexafluoroisopropanol by headspace GC–MS
  18. Cyclic voltammetry study of the electrocatalytic reduction of sevoflurane by a cobalt(III) Schiff base complex in the presence of oxygen
  19. Multinuclear NMR studies of gaseous and liquid sevoflurane
  20. A new detection method of sevoflurane utilizing cataluminescence of activated with
  21. Sevoflurane during cardiopulmonary resuscitation improves early post-resuscitation myocardial dysfunction in the rat
  22. Active 433 MHz-W UHF RF-powered chip integrated with a nanocomposite m-MWCNT/polypyrrole sensor for wireless monitoring of volatile anesthetic agent sevoflurane
  23. Atropine increases sevoflurane potency in cortical but not spinal networks during cholinergic overstimulation

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