Sevoflurane

Sevoflurane (Ultane®)

Mildly increases CBF and ICP, and reduces CMRO2. Mild negative inotrope, cardiac output not as well maintained as with isoflurane or desflurane.

Sevoflurane is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset.


The general inhalation anesthetic sevoflurane can be used for the topical treatment of complicated wounds. It is applied in liquid form and may be used to irrigate the inside of cavities. Sevoflurane also exhibits in vitro antimicrobial activity. Therefore, sevoflurane may be used as an alternative to typical antibiotic or surgical treatment of complicated, localized infections.

Joys et al. from Chandigarh, used digital subtraction angiography to compare the effects of propofol and sevoflurane on the luminal diameter of cerebral vessels and on cerebral vascular mean transit time in patients with aneurysmal subarachnoid hemorrhage (aSAH).

This prospective preliminary study included adult patients with good-grade aSAH scheduled for endovascular coil embolization; patients were randomized to receive propofol or sevoflurane anesthesia during endovascular coiling. The primary outcome was the luminal diameter of 7 cerebral vessel segments measured on the diseased and nondiseased sides of the brain at 3-time points: awake, postinduction of anesthesia, and post coiling. Cerebral transit time was also measured as a surrogate for cerebral blood flow.

Eighteen patients were included in the analysis (9 per group). Baseline and intraoperative parameters were similar between the groups. Propofol increased the diameter of 1 vessel segment at postinduction and post coiling on the diseased side and in 1 segment at post coiling on the nondiseased side of the brain (P<0.05). Sevoflurane increased vessel diameter in 3 segments at postinduction and in 2 segments at post coiling on the diseased side, and in 4 segments at post coiling on the nondiseased side (P<0.05). Cerebral transit time did not change compared with baseline awake state in either group and was not different between the groups.

Sevoflurane has cerebral vasodilating properties compared with propofol in patients with good-grade aneurysmal subarachnoid hemorrhage (aSAH). However, sevoflurane affects cerebral vascular mean transit time comparably to propofol 1).

The case of a 61-year-old male patient who suffered a cranioencephalic trauma 18 years previously is presented. The patient underwent surgeries related to the trauma on numerous occasions. To date, he has suffered various recurrent epidural abscesses, which have been treated with surgical cleaning and antibiotic treatment. In the most recent episode, he presented a frontal epidural abscess 25 mm in diameter with fistulization of the skin. The patient gave written informed consent to be treated with sevoflurane irrigation, and the Pharmacy Service authorized the off-label use. Sevoflurane was applied via a catheter placed inside the cavity during weekly outpatient procedures. The procedures began 8 weeks after the clinically and radiologically verified recovery of the abscess. By avoiding surgery and the associated hospital admission, this novel alternative may prevent patient morbidity and, furthermore, may produce important economic savings.

The treatment of complicated wounds with liquid sevoflurane may be an effective and economically efficient clinical alternative for some patients 2).


1)

Joys S, Panda NB, Ahuja CK, Luthra A, Tripathi M, Mahajan S, Kaloria N, Jain C, Singh N, Regmi S, Jangra K, Chauhan R, Soni SL, Bhagat H. Comparison of Effects of Propofol and Sevoflurane on the Cerebral Vasculature Assessed by Digital Substraction Angiographic Parameters in Patients Treated for Ruptured Cerebral Aneurysm: A Preliminary Study. J Neurosurg Anesthesiol. 2022 Jan 28. doi: 10.1097/ANA.0000000000000833. Epub ahead of print. PMID: 35090162.
2)

Ferrara P, Domingo-Chiva E, Selva-Sevilla C, Campos-García J, Gerónimo-Pardo M. Irrigation with Liquid Sevoflurane and Healing of a Postoperative, Recurrent Epidural Infection: A Potential Cost-Saving Alternative. World Neurosurg. 2016 Jun;90:702.e1-5. doi: 10.1016/j.wneu.2016.02.079. Epub 2016 Feb 24. PubMed PMID: 26924116.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

WhatsApp WhatsApp us
%d bloggers like this: