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SevofluraneEdit

Sevoflurane is a widely used volatile anesthetic agent of the fluorinated ether class, employed for induction and maintenance of general anesthesia across diverse patient populations. Its favorable pharmacokinetic profile—principally its relatively low blood–gas partition coefficient—facilitates rapid and smooth emergence from anesthesia, with particular utility for pediatric patients due to its relatively non-irritating odor. First marketed in the early 1990s by a major pharmaceutical company under the brand Ultane, sevoflurane has since become a standard option in many operating suites worldwide. It is delivered through a calibrated vaporizer within an anesthesia machine, typically administered in combination with other agents to provide analgesia, amnesia, and muscle relaxation as part of a comprehensive anesthetic plan. General anesthesia Inhalation anesthesia Volatile anesthetic

Overview

History and classification

Sevoflurane was developed as a contemporary alternative to earlier volatile anesthetics, with the goal of combining rapid onset and recovery with a tolerable hemodynamic profile. It belongs to the broader category of volatile anesthetic agents, which are inhaled medications that produce immobility and unconsciousness when administered at sufficient concentrations. Its commercial availability and broad adoption reflect a balance between clinical performance, safety, and cost considerations that shape practice in many health systems. GABA_A receptor Halogenated ether

Chemical nature and mechanism

Sevoflurane is a fluorinated ether that exerts its anesthetic effect largely through modulation of neuronal ion channels, including potentiation of GABA_A receptor activity, along with effects on other targets that contribute to loss of consciousness and amnesia. The exact mechanism is complex and is a topic of ongoing research, but the net result is reduced neuronal excitability and a controlled, reversible state of anesthesia. Inhalation anesthesia General anesthesia

Pharmacokinetics

Administered as a vapor, sevoflurane enters the bloodstream via the lungs and rapidly equilibrates with brain tissue, yielding swift induction and recovery in many cases. Its relatively low blood–gas partition coefficient means it has faster onset and offset than some older agents. A small fraction is metabolized by the liver, producing fluoride ions and other metabolites such as hexafluoroisopropanol, but clinically significant hepatic injury is uncommon with modern practice. The majority of the drug is exhaled unchanged. This pharmacokinetic profile supports use in scenarios that require rapid neurological recovery, as well as stable maintenance during longer procedures. Liver metabolism HFIP Compound A

Medical use and administration

Indications and general approach

Sevoflurane is used for the induction and maintenance of general anesthesia in a wide range of surgical procedures. It is often chosen for pediatric anesthesia because of its pleasant odor and minimal airway irritation compared with some other volatile anesthetics, contributing to smoother induction. In practice, it is used as part of a multimodal anesthesia plan that may include intravenous agents, opioids, neuromuscular blockers, and local/regional techniques. The anesthetic plan is tailored to the patient’s age, comorbidities, and the specifics of the procedure. Pediatric anesthesia Multimodal anesthesia

Administration and monitoring

Administration occurs via a precise vaporizer that delivers a controllable concentration in the inspired gas mixture, typically adjusted to achieve the desired end-tidal concentration and depth of anesthesia. Anesthesia providers monitor hemodynamics, respiratory status, and depth of anesthesia continuously, adjusting the volatile concentration as needed. Modern practice emphasizes closed-system gas delivery with scavenging to minimize occupational exposure and environmental release. Anesthesia machine Ventilation Scavenging system

Special populations and cautions

Sevoflurane crosses the placenta and can affect the fetus, so obstetric anesthesia requires careful consideration of maternal and fetal status. It is used with caution in patients with significant hepatic disease or those with known susceptibility to malignant hyperthermia, a rare but serious reaction to some anesthetic agents. In most patients, however, it provides a favorable safety profile when administered by experienced clinicians within a monitored setting. Obstetric anesthesia Malignant hyperthermia Hepatic impairment

Metabolism, safety, and adverse effects

Metabolism and byproducts

A small portion of sevoflurane is metabolized by the liver, producing fluoride ions and other metabolites such as hexafluoroisopropanol. While this metabolic pathway can raise concerns about fluoride exposure and potential kidney effects under certain conditions, modern anesthesia practices minimize risk, and clinically meaningful nephrotoxicity is not a common outcome in typical use. The vast majority of sevoflurane is eliminated via the lungs. Fluoride exposure Nephrotoxicity HFIP

Adverse effects

Common effects include predictable cardiovascular and respiratory changes such as mild hypotension due to vasodilation and transient changes in heart rate, with emergence phenomena and postoperative nausea and vomiting possible in some patients. Rare complications align with those seen with other general anesthetics and are managed within standard perioperative protocols. Awareness of malignant hyperthermia in susceptible individuals remains a critical safety consideration, though the incidence is low. Postoperative nausea and vomiting Hypotension Malignant hyperthermia

Environmental impact and occupational safety

Volatile anesthetics, including sevoflurane, contribute to atmospheric greenhouse gas loads. In clinical practice, minimizing waste through low-flow anesthesia techniques, efficient scavenging, and avoidance of unnecessary leaks helps address environmental concerns while maintaining patient safety. Ongoing discussion in public and professional spheres weighs environmental stewardship against the imperative of delivering high-quality anesthesia. Global warming potential Anesthetic gas waste Environmental impact of pharmaceuticals

Controversies and debates (from a market- and safety-focused perspective)

  • Environmental and policy considerations: Critics argue that anesthetic gases contribute to greenhouse gas emissions, prompting calls for tighter controls or substitutes. Proponents contend that patient safety and access to effective anesthesia must not be compromised, and that emissions can be mitigated through best practices, scavenging, and technology without sacrificing care. The practical stance often emphasizes incremental improvements (e.g., low-flow anesthesia, absorbent technology) rather than broad, prohibitive regulations. Global warming potential Anesthetic gas waste Soda lime
  • Cost and accessibility: Sevoflurane’s price relative to other agents can influence formularies and hospital purchasing decisions. In many settings, the availability of affordable, effective options is a key factor in maintaining broad access to safe anesthesia across patient populations. The conservative approach tends to favor evidence-based choices that maximize safety, efficiency, and value. Cost of healthcare Pharmaceutical procurement
  • Clinical guidelines and autonomy: While guidelines aim to optimize patient outcomes, clinicians value autonomy to tailor anesthetic plans to individual patients. In this view, rigid mandates on agent selection can be less desirable than transparent, evidence-based frameworks that respect clinician judgment and patient-specific risk factors. Clinical guidelines Autonomy in medicine
  • Addressing criticisms: Some critics frame environmental concerns as disproportionately prioritizing climate issues over patient care. from a pragmatic, market-oriented perspective, defenders argue that responsible stewardship and patient safety can be aligned with technological and procedural innovations that reduce waste without compromising outcomes. When critics rely on sweeping or vague claims, proponents say the science supports measured, practical steps rather than alarmism. Climate change Welfare of patients

See also