Sevorane Special Precautions

General: During maintenance of anesthesia, increasing the concentration of sevoflurane produces dose-dependent decreases in blood pressure. Excessive decrease in blood pressure may be related to depth of anesthesia and in such instances may be corrected by decreasing the inspired concentration of sevoflurane.
As with all anesthetics, maintenance of hemodynamic stability is important to the avoidance of myocardial ischemia in patients with coronary artery disease.
The recovery from general anesthesia should be assessed carefully before patients are discharged from the post-anesthesia care unit.
Renal Impairment: Because of the small number of patients with renal insufficiency (baseline serum creatinine >1.5 mg/dL) studies, the safety of sevoflurane administration in this group has not yet been fully established. Therefore, sevoflurane should be used with caution in patients with renal insufficiency.
Neurosurgery: In patients at risk for elevations of ICP, sevoflurane should be administered cautiously in conjunction with ICP-reducing maneuvers eg, hyperventilation.
Information to Patients: Although recovery of consciousness following sevoflurane administration generally occurs within minutes, the impact on intellectual function for 2 or 3 days following anesthesia has not been studied. As with other anesthetics, small changes in moods may persist for several days following administration.
Effects on the Ability to Drive or Operate Machinery: Patients should be advised that performance of activities requiring mental alertness eg, operating a motor vehicle or hazardous machinery, may be impaired for some time after general anesthesia.
Carcinogenicity: Studies on carcinogenesis have not been performed. No mutagenic effect was noted in the Ames test and no chromosomal aberrations were induced in cultured mammalian cells.
Use in pregnancy: Pregnancy Category B: Reproduction studies in rats and rabbits at doses up to 1 MAC have revealed no evidence of impaired fertility or harm to the fetus due to sevoflurane. There are no adequate and well-controlled studies in pregnant women, therefore, sevoflurane should be used during pregnancy only if clearly needed.
Labor and Delivery: In a clinical trial, the safety of sevoflurane was demonstrated for mothers and infants when used for anesthesia during cesarian section. The safety of sevoflurane in labor and vaginal delivery has not been demonstrated.
Use in lactation: It is not known whether sevoflurane is excreted in human milk. Caution should be exercised when sevoflurane is administered to nursing women.
Use in the elderly: MAC decreases with increasing age. The average concentration of sevoflurane to achieve MAC in an 80-year old is approximately 50% of that required in a 20-year old.