Formulary
Sevoflurane: Indications, Dosing, Side Effects and Interactions
Sevoflurane clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Sevoflurane: Indications, Dosing, Side Effects and Interactions
Sevoflurane clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Induction of anaesthesia (in oxygen or nitrous oxide-oxygen)**
- **Adult** (By Inhalation): Initially 0.5-1 %, then increased to up to 8 %, increased gradually, according to response, to be administered using specifically calibrated vaporiser.
**Maintenance of anaesthesia (in oxygen or nitrous oxide-oxygen)**
- **Adult** (By Inhalation): 0.5-3 %, adjusted according to response, to be administered using specifically calibrated vaporiser.
**Induction of anaesthesia (in oxygen or nitrous oxide-oxygen) for sevoflurane**
- **Neonate** (By inhalation): Up to 4 %, adjusted according to response, to be administered using specifically calibrated vaporiser.
- **Child** (By inhalation): Initially 0.5-1 %, then increased to up to 8 %, increased gradually, according to response, to be administered using specifically calibrated vaporiser.
**Maintenance of anaesthesia (in oxygen or nitrous oxide-oxygen) for sevoflurane**
- **Neonate** (By inhalation): 0.5-2 %, adjusted according to response, to be administered using specifically calibrated vaporiser.
- **Child** (By inhalation): 0.5-3 %, adjusted according to response, to be administered using specifically calibrated vaporiser.
Cautions
For all volatile halogenated anaesthetics Can trigger malignant hyperthermia; raised intracranial pressure (can increase cerebrospinal pressure) Cautions For sevoflurane Susceptibility to QT-interval prolongation
Contraindications
For all volatile halogenated anaesthetics Susceptibility to malignant hyperthermia
Side effects
For all volatile halogenated anaesthetics Common or very common Agitation; apnoea; arrhythmias; chills; cough; dizziness; headache; hypersalivation; hypertension; hypotension; nausea; respiratory disorders; vomiting Uncommon Hypoxia Frequency not known Breath holding; cardiac arrest; haemorrhage; hepatic disorders; hyperkalaemia; malignant hyperthermia; QT interval prolongation; rhabdomyolysis; seizure Side-effects For sevoflurane Common or very common Drowsiness; fever; hypothermia Uncommon Asthma; atrioventricular block; confusion Frequency not known Dystonia; intracranial pressure increased; muscle rigidity; nephritis tubulointerstitial; oedema; pancreatitis
Interactions
**Severe interactions:**
- Inducers of CYP2E1 Medicinal products and compounds that increase the activity of cytochrome P450 isoenzyme CYP2E1, such as isoniazid and alcohol, may increase the metabolism of sevoflurane and lead...
- St John's Wort Severe hypotension and delayed emergence from anaesthesia with halogenated inhalational anaesthetics have been reported in patients treated long-term with St John's Wort.
**Other interactions (19):**
- Beta-sympathomimetic agents like isoprenaline and alpha- and beta- sympathomimetic agents like adrenaline and noradrenaline should be used with caution during Sevoflurane narcosis, due to a...
- Sevoflurane may lead to marked hypotension in patients treated with calcium antagonists, in particular dihydropyridine derivates.
- Sevoflurane has been shown to be safe and effective when administered concurrently with a wide variety of agents commonly encountered in surgical situations such as central nervous system agents,...
- Epinephrine/Adrenaline Sevoflurane is similar to isoflurane in the sensitisation of the myocardium to the arrhythmogenic effect of exogenously administered adrenaline.
- Indirect-acting Sympathomimetics There is a risk of acute hypertensive episode with the concomitant use of sevoflurane and indirect-acting sympathomimetics products (amphetamines, ephedrine).
- Beta blockers Sevoflurane may increase the negative inotropic, chronotropic and dromotropic effects of beta blockers (by blocking cardiovascular compensatory mechanisms).
Pregnancy
May depress neonatal respiration if used during delivery.
Breast feeding
Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
Renal impairment
Use with caution.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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