Therapeutic indications

Sevoflurane is indicated for induction and maintenance of general anaesthesia in adult and paediatric patients for inpatient and outpatient surgery.

 

Posology and method of administration

Premedication should be selected according to the need of the individual patient, and at the discretion of the anaesthetist.

Surgical Anaesthesia:

Sevoflurane should be delivered via a vaporiser specifically calibrated for use with sevoflurane so that the concentration delivered can be accurately controlled. MAC (minimum alveolar concentration) values for sevoflurane decrease with age and with the addition of nitrous oxide. The table below indicates average MAC values for different age groups.

Table 1: MAC values for Adults and Paediatric patients according to age

Age of Patient (years) Sevoflurane in Oxygen Sevoflurane in *5% N2O/*5% O2

0 1 months* 3.3% 2.0%**

1 - < 6 months 3.0%

6 months - < 3 years 2.8%

3 - *2 2.5%

*5 2.6% 1.4%

*0 2.1% 1.1%

*0 1.7% 0.9%

*0 1.4% 0.7%

* Neonates are full term gestational age. MAC in premature infants has not been determined.

** In 1 <3 year old paediatric patients, *0% N2O/*0% O2 was used.

Induction:

Dosage should be individualised and titrated to the desired effect according to the patient's age and clinical status. A short acting barbiturate or other intravenous induction agent may be administered followed by inhalation of sevoflurane. Induction with sevoflurane may be achieved in oxygen or in combination with oxygen-nitrous oxide mixtures. In adults inspired concentrations of up to 5% sevoflurane usually produce surgical anaesthesia in less than 2 minutes. In children, inspired concentrations of up to 7% sevoflurane usually produce surgical anaesthesia in less than 2 minutes. Alternatively, for induction of anaesthesia in unpremedicated patients, inspired concentrations of up to 8% sevoflurane may be used.

Maintenance:

Surgical levels of anaesthesia may be sustained with concentrations of 0.5 - 3% sevoflurane with or without the concomitant use of nitrous oxide.

Emergence:

Emergence times are generally short following sevoflurane anaesthesia. Therefore, patients may require early post-operative pain relief.

Older people:

MAC decreases with increasing age. The average concentration of sevoflurane to achieve MAC in an *0 year old is approximately *0% of that required in a *0 year old.

Paediatric population:

Refer to Table 1 for MAC values for paediatric patients according to age.

 

Contraindications

Sevoflurane should not be used in patients with known or suspected sensitivity to sevoflurane or other halogenated anaesthetics (e.g. history of liver function disorder, fever or leucocytosis of unknown cause after anaesthesia with one of these agents).

Sevoflurane is also contraindicated in patients with known or suspected genetic susceptibility to malignant hyperthermia.

Sevoflurane is contraindicated in patients in whom general anaesthesia is contraindicated.