Structure
Basic Information
MAC: 2.11
MAC-BAR: 3
ED₉₅: 2.97 2
MAC-Awake: 0.8
Metabolism %: 2 - 51
Vapor Pressure: 1601
Age related MAC Values1
| Age | MAC | MAC + 60%N₂O |
|---|---|---|
| < 1 mo | 3.3% | |
| 1 - < 6 mo | 3.0% | |
| 6 mo - 3 yr | 2.8% | 2.0% |
| 3 - 12 | 2.5% | |
| 25 | 2.6% | 1.4% |
| 40 | 2.1% | 1,1% |
| 60 | 1.7% | 0.9% |
| 80 | 1.4% | 0.7% |
Additional Info
- MH Trigger
- Inhalational anesthetic of choice for mask induction
- Sinoatrial node discharge rate is slowed and conduction in the His-Purkinje system is prolonged (prolonged QT interval
- ↑ RR, bronchodilation
- ↓ TV, MV
- Dose dependent depression of the ventilatory response to hypercarbia and hypoxia
- ↓ ciliary movement and altered mucus characteristics
- Dose dependent effect on skeletal muscle relaxation
- Potentiates the action of neuromuscular blockers (greatest with myasthenia gravis)
- In the presence of a dessicated CO₂ absorber exothermic reaction with volatile anesthetics can lead to fire and/or carbon monoxide formation.
- Sevoflurane breaks down in some CO₂ absorbers to Compound A. For these CO₂ absorbers the manufacturer recommends flow rates of 1-2 lpm for up to 2 MAC hours and 2 lpm thereafter.[^1] Compound A formed from this process has not been shown to be clinically significant. See Drägersorb Free for an example of an absorbent that does not form Compound A.
- Most highly metabolized modern inhalational anesthetic. Metabolized into flouride ions with can be nephrotoxic although it has not been shown to be clinically significant in patients without kidney disease.[^1]
- All MAC values can be decreased by co-administered agents (benzodiasepines, opioids, Alpha-2 agonists, etc.)
Cochrane Reviews
1.
Abu‐Amara M, Gurusamy K, Glantzounis G, Fuller B, Davidson B. Pharmacological interventions for ischaemia reperfusion injury in liver resection surgery performed under vascular control. Cochrane Database of Systematic Reviews. 2009;(4). doi:10.1002/14651858.CD008154
2.
Boonmak P, Boonmak S, Pattanittum P. High initial concentration versus low initial concentration sevoflurane for inhalational induction of anaesthesia. Cochrane Database of Systematic Reviews. 2016;(6). doi:10.1002/14651858.CD006837.pub3
3.
Chhabra A, Subramaniam R, Srivastava A, Prabhakar H, Kalaivani M, Paranjape S. Spectral entropy monitoring for adults and children undergoing general anaesthesia. Cochrane Database of Systematic Reviews. 2016;(3). doi:10.1002/14651858.CD010135.pub2
4.
Costi D, Cyna A, Ahmed S, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database of Systematic Reviews. 2014;(9). doi:10.1002/14651858.CD007084.pub2
5.
Herling S, Dreijer B, Wrist Lam G, Thomsen T, Møller A. Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery. Cochrane Database of Systematic Reviews. 2017;(4). doi:10.1002/14651858.CD011387.pub2
6.
Lewis S, Nicholson A, Reed S, Kenth J, Alderson P, Smith A. Anaesthetic and sedative agents used for electrical cardioversion. Cochrane Database of Systematic Reviews. 2015;(3). doi:10.1002/14651858.CD010824.pub2
7.
Miller D, Lewis S, Pritchard M, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non‐cardiac surgery. Cochrane Database of Systematic Reviews. 2018;(8). doi:10.1002/14651858.CD012317.pub2
8.
Módolo N, Módolo M, Marton M, et al. Intravenous versus inhalation anaesthesia for one‐lung ventilation. Cochrane Database of Systematic Reviews. 2013;(7). doi:10.1002/14651858.CD006313.pub3
9.
Ortiz A, Atallah Á, Matos D, da Silva E. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane Database of Systematic Reviews. 2014;(2). doi:10.1002/14651858.CD009015.pub2
10.
Prabhakar H, Singh G, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. Cochrane Database of Systematic Reviews. 2016;(9). doi:10.1002/14651858.CD010467.pub2
References
Takita K, Yamane M, Morimoto Y, Kemmotsu O. The ED(95) of end-tidal sevoflurane concentration for the smooth exchange of the tracheal tube for a laryngeal mask airway is 2.97%. Can J Anaesth. 2003 Feb;50(2):184-8. doi: 10.1007/BF03017854. PMID: 12560312. ↩︎