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Pharmacology Exam I > Sevoflurane > Flashcards

Sevoflurane Flashcards

1
Q

What is another name for sevoflurane?

A

Ultane

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2
Q

When was sevo synthesized and by whom?

A

late 1960s/early 1970s by Richard Wallin at Travenol Laboratory (Baxter)

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3
Q

When was it approved for use in US?

A

1995, was delayed and reconsidered in 1980s with increased outpatient surgery.

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4
Q

What are some characteristics of sevoflurane?

A

clear, colorless, sweet smelling (kind of), highly fluorinated, stable at room temp, no additives or stabilizers

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5
Q

What is the MW of Sevo?

A

200.05g

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6
Q

What is the boiling point of sevo?

A

58.6C

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7
Q

What is the vapor pressure of sevo?

A

157 mmHg

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8
Q

How many F ions are in Sevoflurane?

A

7…sevo=seven

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9
Q

What gases are methyl ethyl ethers?

A

des and iso

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10
Q

What gas is a methyl isopropyl ether?

A

sevo

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11
Q

What is the MAC of sevo?

A

2.0 (1.7-2.2)

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12
Q

What is the blood:gas of sevo?

A

0.63, low

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13
Q

What is the oil:gas of sevo?

A

53.4

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14
Q

How is sevo stored?

A

amber bottles

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15
Q

What is formed when degradation occurs with CO2 absorbents?

A

Compound A (pentafluoroisopropenyl fluoromethyl ether) Theoretically can cause nephrotoxicity but no reports in humans

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16
Q

How does Compound A occur?

A

When sevo interacts with sodalime or baralyme, a degradation product (not metabolite) forms. Increased formation with low fresh gas flows and high temperatures.

17
Q

How can you prevent Compound A from occuring?

A

make sure sodalime doesn’t dry out, maintain temperature, use higher fresh gas flows

18
Q

What does the packaging label say to do to avoid exposure to compound A?

A

sevo should not exceed 2 MAC hours at flow rates of 1-2L/min, fresh gas flow rates <1 are not recommended. We just keep flow rates at 2L/min or higher if long case.

19
Q

True/False: Sevo reacts with desiccated dioxide absorbents and flammable compounds can be produced.

A

True, at high temps spontaneous combustion can occur.

20
Q

Can you do inhalation induction with sevo?

A

yes, 4-8% sevo in 50% mixture of N2O and oxygen takes 1-3 min for induction.

21
Q

True/False: Emergence is slow with sevo.

A

False: quick emergence mostly eliminated through lungs, sometimes too quick causing emergence delirium.

22
Q

Who does emergence delirium most impact?

A

children 1-5 incidence 12-13%, but can be all ages, successfully treated with 1-2 mcg/kg of fentanyl. May be blunted by switching gases for maintenance or pre-treatment with benzos.

23
Q

How is sevo metabolized?

A

95% by lungs, other 5% in the liver to form hexafluoroisopropanol (HFIP) and inorganic Fluoride. HFIP is conjugated with gluconronic acid and excreted in the urine.

24
Q

What effects does sevo have on the cardiovascular system?

A

mild decrease in contractility, less decrease in SVR and ABP compared to others, no coronary steal, not associated with tachycardia at <2 MAC, CO not as well maintained as with other gases, no arrhythmias. (some peds get brady but not 1st consideration)

25
Q

What effects does sevo have on the respiratory system?

A

non-irritating to upper resp tract, doesn’t induce cough reflex, lowest resp changes of all agents.

26
Q

What effect does sevo have on the renal system?

A

slight increase in renal blood flow, inorganic fluoride concerns

27
Q

What effect does sevo have on the hepatic system?

A

decreased portal blood flow, increased hepatic artery flow, maintains total hepatic blood flow, low hepatotoxicity.

28
Q

What effects on the nervous system does sevo have?

A

slight increase in CBF and ICP, >1.5 MAC may impair auto-regulation of CBF, decreases CMRO2, linked to seizure activity with higher MAC, cognitive function recovered twice as fast in geriatrics compared to iso. we use less in neuro and increased ICP patients.

29
Q

What musculoskeletal effects does sevo have?

A

potentiates NMBD, profound muscle relaxation, provides adequate muscle relaxation in kids for intubation.

30
Q

What types of patients is sevo good for?

A

myasthenia gravis, outpatient procedures, inhalation induction, kids

31
Q

Describe a one breath sevo induction.

A

prime circuit with 8% sevo with high (8LPM) fresh gas flows, patient exhales completely, huge breath into mask, LOC within 1 min. Need compliant patient with good lungs.

32
Q

What drug interactions are there with sevo?

A

works will with N2O–decreased MAC by 50% in adults or 25% in kids when used together; decreased with benzos, opioids, propofol; can potentiate NMBD

33
Q

When should you use caution with sevo?

A

severely hypovolemic patients (can decrease CO), intracranial hypertension (can increase CBF)

Pharmacology Exam I (11 decks)

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