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ISOFLURANE is a brand name for Isoflurane. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Isoflurane is general inhalation anaesthetic for use in induction and maintenance.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology MAC values for Isoflurane vary with age. The table below indicates average MAC values for different age groups. 60% Premedication: Premedication drugs should be selected according to the needs of the patient. The respiratory depressant effect of Isoflurane should be taken into account.
The use of anticholinergic drugs is a matter of choice, but may we advisable for inhalation induction in paediatrics.
Induction:
As Isoflurane has a mild pungency, inhalation should usually be preceded by the use of a short acting barbiturate, or other intravenous induction agent, to prevent coughing. Alternatively, Isoflurane with oxygen or with an oxygen/ nitrous oxide mixture may be administered.
5%. 0% usually produce surgical anaesthesia in 7-10 minutes. 4). 5% in an oxygen/nitrous oxide mixture. 0%) may be required when Isoflurane is given with oxygen alone. 75% isoflurane in a mixture of oxygen/nitrous oxide is suitable to maintain anaesthesia for this procedure.
Arterial pressure levels during maintenance tend to be inversely related to alveolar Isoflurane concentration in the absence of other complicating factors. Provided there are no other complicating factors this is probably due to peripheral vasodilation.
Excessive falls in blood pressure may be due to the depth of anaesthesia and, in such circumstances, can be corrected by reducing the inspired Isoflurane concentration.
Elderly:
As with other agents, lesser concentrations of isoflurane are normally required to maintain surgical anaesthesia in elderly patients. See above for MAC values related to age.
Method of Administration:
Vaporisers specially calibrated for Isoflurane should be used so that the concentration of anaesthetic can be accurately controlled. Isoflurane is not recommended as an induction agent in children.
a. Summary of the safety profile Adverse reactions encountered in the administration of Isoflurane are in general dose dependent extensions of pharmaco-physiological effects and include hypotension, respiratory depression and arrhythmias.
8). Shivering, nausea, vomiting, ileus, agitation and delirium have been observed in the post-operative period. Cardiac arrest, bradycardia and tachycardia have been observed with general inhalation anaesthetic drugs including isoflurane.
Reports of QT prolongation, associated with torsade de pointes (in exceptional cases, fatal) have been received. b. Tabulated summary of adverse reactions The following table displays adverse reactions reported in clinical trials and from post-marketing experience.
Frequency cannot be estimated from the available data, therefore it is "not known". 8(c). 4. 3In patients undergoing induced abortion. 4. 4May cause a slight decrease in intellectual function for 2-4 days after anaesthesia. 4. 5Small changes in moods and symptoms may persist for up to 6 days.
4. c. Description of selected adverse reactions Transient increases in blood bilirubin, blood glucose and serum creatinine with decrease in BUN, serum cholesterol and alkaline phosphatase have been observed. As with other general anaesthetics, transient elevations in white blood count have been observed even in the absence of surgical stress.
Rare reports of hypersensitivity (including dermatitis contact, rash, dyspnoea, wheezing, chest discomfort, swelling face, or anaphylactic reaction) have been received, especially in association with long-term occupational exposure to inhaled anaesthetic agents, including isoflurane.
, methacholine challenge). The etiology of anaphylactic reactions experienced during inhalational anaesthetic exposure is, however, unclear because of the exposure to multiple concomitant drugs, many of which are known to cause such reactions.
Vaporisers specially calibrated for isoflurane should be used so that the concentration of anaesthetic delivered can be accurately controlled. Hypotension and respiratory depression increase as anaesthesia is deepened. Reports of QT prolongation, associated with torsade de pointes (in exceptional cases, fatal), have been received.
Caution should be exercised when administering isoflurane to patients at risk for QT prolongation. Caution should be exercised in administering general anaesthesia, including isoflurane, to patients with mitochondrial disorders. Isoflurane, like other inhalational agents, has relaxant effects on the uterus with the potential risk for uterine bleeding.
Clinical judgement should be observed when using isoflurane during obstetric anaesthesia. 6). , desflurane, enflurane and isoflurane). No clinically significant concentrations of carbon monoxide are produced in the presence of normally hydrated absorbents.
Care should be taken to follow manufacturer's instructions for CO2 absorbents. Isoflurane has been reported to interact with dry carbon dioxide absorbents during closed circuit anaesthesia, to form carbon monoxide. In order to minimize the risk of formation of carbon monoxide in rebreathing circuits and the possibility of elevated carboxyhaemoglobin levels, carbon dioxide adsorbents should not be allowed to dry out.
g. Baralyme). When a clinician suspects that the CO2 absorbent may be desiccated, it should be replaced before administration of isoflurane. The colour indicator of most CO2 absorbents does not necessarily change as a result of desiccation.
Therefore, the lack of significant colour change should not be taken as an assurance of adequate hydration. CO2 absorbents should be replaced routinely regardless of the state of the colour indicator. General Because levels of anaesthesia can be altered easily and quickly with Isoflurane, only vaporisers which produce a predictable concentration with a good degree of accuracy or techniques during which inspired or expired concentrations can be monitored, should be used.
Isoflurane is contraindicated in patients with known sensitivity to Isoflurane or to other halogenated anaesthetics. It is also contraindicated in patients with known or suspected genetic susceptibility to malignant hyperthermia.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Minimally raised levels of serum inorganic fluoride occur during and after isoflurane anaesthesia, due to biodegradation of the agent. 4 μmol/l in one study) could cause renal toxicity, as these are well below the proposed threshold levels for kidney toxicity.
d. Paediatric population Use of inhaled anaesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in paediatric patients during the post-operative period.
) During the induction of anaesthesia, saliva flow and tracheobronchial secretion can increase and can be the cause of laryngospasm. ) e.
Other special populations Neuromuscular disease:
Use of inhaled anaesthetic agents has been associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in paediatric patients during the post-operative period. Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable.
4).
Elderly:
Lesser concentrations of isoflurane are normally required to maintain surgical anaesthesia in elderly patients. ) Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.
It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
The degree of hypotension and respiratory depression may provide some indication of anaesthetic depth. As with any potent general anaesthetic, isoflurane should only be administered in an adequately equipped anaesthetising environment by those who are familiar with the pharmacology of the drug and qualified by training and experience to manage the anaesthetised patient.
Reports demonstrate that Isoflurane can produce hepatic injury ranging from mild transient increases of liver enzymes to fatal hepatic necrosis in very rare instances. It has been reported that previous exposure to halogenated hydrocarbon anaesthetics, especially if the interval is less than 3 months, may increase the potential for hepatic injury.
Cirrhosis, viral hepatitis or other pre-existing liver disease can be a reason to select an anaesthetic other than a halogenated anaesthetic. Regardless of the anaesthetics employed, maintenance of normal haemodynamics is important to the avoidance of myocardial ischaemia in patients with coronary artery disease.
Isoflurane markedly increases cerebral blood flow at deeper levels of anaesthesia. There may be a transient rise in cerebral spinal fluid pressure which is fully reversible with hyperventilation. Isoflurane must be used with caution in patients with increased intracranial pressure.
In such cases hyperventilation may be necessary. Use of isoflurane in hypovolaemic, hypotensive and debilitated patients has not been extensively investigated. A lower concentration of isoflurane is recommended for use in these patients.
All commonly used muscle relaxants are markedly potentiated by isoflurane, the effect being most profound with non-depolarising agents. Isoflurane may cause a slight decrease in intellectual function for 2-4 days following anaesthesia.
Small changes in moods and symptoms may persist for up to 6 days after administration. 7). A potentiation of neuromuscular fatigue can be seen in patients with neuromuscular diseases, such as myasthenia gravis. Isoflurane should be used with caution in these patients.
8). Isoflurane may cause respiratory depression which may be augmented by narcotic premedication or other agents causing respiratory depression. 8). 8). Paediatric Population Children under two years of age Caution should be exercised when Isoflurane is used in small children due to limited experience with this patient group.
During the induction of anaesthesia, saliva flow and tracheobronchial secretion can increase and can be the cause of laryngospasm, particularly in children. Malignant Hyperthermia In susceptible individuals, isoflurane anaesthesia may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia.
The syndrome includes nonspecific features such as […]