Sevoflurane Disease Interactions

The use of sevoflurane is contraindicated in patients with known or suspected susceptibility to malignant hyperthermia.

In a multicenter study to compare the safety of sevoflurane and isoflurane in patients with mild to moderate hepatic impairment, sevoflurane patients had prolonged terminal disposition of fluoride, as evidenced by longer inorganic fluoride half-life than patients with normal hepatic function. Results of evaluations of laboratory parameters (e.g., ALT, AST, alkaline phosphatase, and total bilirubin, etc.), as well as investigator-reported incidence of adverse events relating to liver function, demonstrate that sevoflurane can be administered to patients with normal or mild-to-moderately impaired hepatic function. The use of this agent in patients with severe hepatic dysfunction has not been investigated. Clinical judgment should be exercised when sevoflurane is used in patients with underlying hepatic conditions or under treatment with drugs known to cause hepatic dysfunction.

The use of inhaled anesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients during the postoperative period. Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable. Early and aggressive intervention to treat the hyperkalemia and resistant arrhythmias is recommended; as is subsequent evaluation for latent neuromuscular disease. Caution and close monitoring is recommended when using this agent in these patients.

Studies comparing sevoflurane to isoflurane for maintenance of anesthesia during neurosurgical procedures found no difference between sevoflurane and isoflurane with regard to recovery from anesthesia. In patients at risk for elevations of intracranial pressure (ICP), sevoflurane should be administered cautiously in conjunction with ICP-reducing maneuvers such as hyperventilation.

Limited data are available on the use of oral sevoflurane in patients with renal insufficiency. Sevoflurane may be associated with glycosuria and proteinuria when used for long procedures at low flow rates. Caution is advised when using sevoflurane in these patients as the safety has not been fully established.

The use of sevoflurane has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia. Caution and clinical judgment should be exercised when using sevoflurane in patients who may be at risk for seizures.