Dosing and uses of Ultane (sevoflurane)
Adult dosage forms and strengths
liquid
- 100%
Anesthesia
12-25 years
- 2.6% in oxygen or 1.4% with 65% N2O/35% oxygen
25-40 years
- 2.1% in oxygen or 1.1% with 65% N2O/35% oxygen
40-60 years
- 1.7% in oxygen or 0.9% with 65% N2O/35% oxygen
60-80 years
- 1.4% in oxygen or 0.7% with 65% N2O/35% oxygen
Pediatric dosage forms and strengths
liquid
- 100%
Anesthesia
0-1 month full term neonate
- 3.3% in oxygen
1-6 months
- 3% in oxygen
6 months to <3 years
- 2.8% in oxygen or 2 % with 65% N2O/35% oxygen
3-12 years
- 2.5% in oxygen or 2.5 % with 65% N2O/35% oxygen
12-25 years
- 2.6% in oxygen or 1.4% with 65% N2O/35% oxygen
Ultane (sevoflurane) adverse (side) effects
Frequency not defined
Malignant hyperthermia
Dose-dependent hypotension
Bradycardia
Tachycardia
Hypotension
Hypertension
Nausea/vomiting
Cough
Agitation
Increased salivation
Airway obstruction
Laryngospasm
Apnea
Increased BUn
Increased ALt
Respiratory irritation
Nephrotoxicity
Glycosuria
Proteinuria
Postmarketing Reports
Seizures (majority of cases in children and young adults, most had no medical history of seizures)
Cardiac arrest
Cases of mild, moderate and severe post-operative hepatic dysfunction or hepatitis with or without jaundice
Malignant hyperthermia
Allergic reactions (eg, rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions)
Transient elevations in glucose, liver function tests, and WBC count
Warnings
Contraindications
Susceptibility to malignant hyperthermia
Hypersensitivity, lack of ventilatory support
Cautions
Volatile liquid; use appropriate vaporizer for inhalation
Agitation/delirium may occur
Postoperative hepatitis reported
Closely monitor patients with anemia, hepatic impairment, myxedema, renal impairment
Can induce malignant hyperthermia in genetically susceptible individuals
Reports of QT prolongation, associated with torsade de pointes (in exceptional cases, fatalities reported); exercise caution when administering to susceptible patients (eg, congenital long QT syndrome, coadministration with drugs that prolong QT interval)
Should not be used as a sole agent of induction in patients with ventricular dysfunction
Risk of perioperative hyperkalemia in pediatric patients reported (rare); some resulting in cardiac arrhythmia and death
Perioperative hyperkalemia
- Inhaled anesthetics associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients postoperatively
- Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable
- Concomitant use of succinylcholine has been associated with most, but not all, of these cases
- Elevated serum creatinine kinase levels and, in some cases, changes in urine consistent with myoglobinuria observed
- Despite similar presentation to malignant hyperthermia, none of affected patients exhibited signs or symptoms of muscle rigidity or hypermetabolic state
- Early and aggressive intervention to treat hyperkalemia and resistant arrhythmias recommended
- Evaluation for latent neuromuscular disease recomended
Pregnancy and lactation
Pregnancy category: B
Lactation: excreted in breast milk; no adverse effect on nursing infant
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Ultane (sevoflurane)
Mechanism of action
Volatile liquid general anesthetic; may alter activity of neuronal ion channels, especially the fast synaptic neurotransmitter receptors including nicotinic acetylcholine, GABA, and glutamate receptors.
Pharmacokinetics
Onset: 2-3 min
Duration: Depends on blood concentration
Metabolism: Liver (3-5%); CYP2E1
Excretion: Respiratory exhaled gases
Pharmacogenomics
Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)
