SEVOFLURANE

• Chemically fluorinated isopropyl methyl ether.
  • Enflurane, desflurane & isoflurane – Ethyl-methyl ether.
• Agent of choice in induction for pediatric age group & elderly.
  • Note: usually iv agents used for induction.
• Non-pungent
• Fast onset of action.
• Safe in children
• Unstable when exposed to soda lime (CO2 absorbent) & toxic metabolites (Compound A) –> Nephrotoxicity
• Should not be used in closed circuit.
• Minimum Alveolar Concentration (MAC) – 2%  
  • Higher than isoflurane.
• Blood gas coefficient is higher than desflurane.
• Rapid & smooth induction & recovery.

ACTIONS:

• Does not increase heart rate.
• Anaesthetic without epileptogenic potential.
• Potent cardio depressant than isoflurane
• Increases intracranial pressure (ICP)
• Increases plasma & urinary fluoride ions.
  • Cause renal & hepatic injury.

USES:

• Elective urology surgery in pediatrics.
• Patent ductus arteriosus (PDA). 
• Child with intestinal obstruction with deranged liver function test

CONTRAINDICATIONS:

• Malignant hyperthermia.
• Not used in closed circuits because of toxic product (olefin) production.

ADVERSE EFFECT:

• Raised intracranial tension
• Respiratory depression.
• Nephrotoxicity.
• Activation of EEG & seizure activity positive (lesser than enflurane).