Sevoflurane

Sevoflurane is a volatile inhalational anesthetic agent used for the induction and maintenance of general anesthesia in both adults and children. It is a fluorinated ether on the market under various brand names, including Ultane in many regions. Sevoflurane is valued for its non-pungent odor, which facilitates smooth inhalational induction, particularly in pediatric patients, and for providing rapid adjustment of anesthetic depth.

Administration and pharmacokinetics: Sevoflurane is delivered through a breathing circuit with oxygen or air, often in combination with other anesthetic agents. It has a relatively low blood–gas partition coefficient, typically around 0.6 to 0.7, which enables rapid onset and offset of anesthesia and swift recovery after discontinuation. The agent is mostly exhaled unchanged.

Metabolism and excretion: About 2–5% of sevoflurane is metabolized in the liver by esterases to inorganic fluoride and hexafluoroisopropanol; the majority is eliminated via exhalation. Fluoride exposure is usually minimal and not associated with significant clinical toxicity in routine practice.

Adverse effects and safety: Common effects include dose-dependent cardiovascular depression and respiratory suppression. Emergence phenomena, such as agitation, may occur, especially in children. Like all volatile anesthetics, sevoflurane carries a risk of triggering malignant hyperthermia in susceptible individuals. A historical consideration with very low fresh gas flow and desiccated CO2 absorbents is the production of Compound A, a nephrotoxic agent in animal studies; with modern practice and hydrated absorbents, this risk is considered minimal.

Special considerations: Sevoflurane is generally avoided in patients with known sensitivity to halogenated anesthetics or significant renal impairment without specialist guidance. Its use requires appropriate monitoring and equipment for general anesthesia, alongside standard perioperative care.