Anaes SAQs · Volatile & inhalational agents
Sevoflurane: pharmacology, MAC and adverse effects
Final — sevoflurane (fluorinated methyl isopropyl ether; BP 58 degrees C; non-pungent sweet odour; blood-gas 0.65, oil-gas 47; about 3 to 5 percent metabolised by CYP2E1; compound A in desiccated soda lime, CO in desiccated baralyme). MAC defined as the alveolar concentration at 1 atmosphere preventing movement to surgical stimulus in 50 percent of subjects; sevoflurane MAC about 2 percent adults; lowered by age, hypothermia, pregnancy, opioids, benzodiazepines, alpha-2 agonists, N2O; raised by infancy, hyperthermia, chronic alcohol, hypernatraemia, MAOIs. Adverse effects: emergence agitation in children 1 to 5 years, PONV, epileptiform EEG at high MAC, compound A nephrotoxicity (rat, unproven in humans), CO from desiccated absorbent, MH trigger.
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Outline the physical chemistry and pharmacokinetics of sevoflurane. Define minimum alveolar concentration (MAC) and state the factors that modify it. Discuss the adverse effects of sevoflurane and the measures used to reduce them.
References4ShowHide
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