Der Anaesthesist
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Due to its low solubility and the high maximum concentration delivered by the vaporizer sevoflurane is especially suitable for the performance of low flow anaesthetic techniques. High flow phases for wash-in or wash-out of anaesthetic gases can be kept short, the difference between the volatile's concentration in the fresh gas and within the breathing system is comparatively small, and the time constants are short even during low flow anaesthesia. The monitoring, required to sufficiently ensure the safety of the patients, corresponds to the current obliging technical safety standards. ⋯ Thoroughly the use of sevoflurane with dry soda lime must be avoided, as this volatile in an extreme exothermic reaction is absorbed nearly totally and degraded to a considerable degree by dry carbon dioxide absorbent. The gaseous degradation products are pungent and possibly may be harmful to the patients. Only by low flow anaesthesia the use of sevoflurane will gain an economically and ecologically acceptable range of efficiency.
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Sevoflurane is a viable alternative to propofol and desflurane for both induction and maintenance of general anaesthesia in the ambulatory setting. As a result of sevoflurane's lack of respiratory irritant properties, it provides for a smooth induction and prompt emergence from outpatient anaesthesia. In addition, the relatively low incidence of post-operative nausea and vomiting facilitates "fast-tracking" after ambulatory surgery. Although no single anaesthetic agent is ideal, when sevoflurane is combined with other adjunctive drugs it can produce excellent surgical conditions for a wide variety of ambulatory surgical and diagnostic procedures.
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There are a number of assays available to study genetic toxicity of inhalation anaesthetics. Those discussed in this review are the Ames Salmonella mutagenesis test and assays for structural chromosome aberrations, micronuclei (MN) and sister chromatid exchanges (SCEs). None of these assays showed abnormalities induced by volatile inhalation anaesthetics. ⋯ Under these conditions occupational exposure is low even when using laryngeal mask airways and uncuffed tracheal tubes. Sevoflurane is a halocarbon, but is only partially halogenated and the only halogen it contains is fluorine. Sevoflurane, therefore, appears to have an insignificant effect on ozone depletion and its contribution to the greenhouse effect is negligible.
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In common with other halogenated volatile anaesthetics, sevoflurane causes a dose-related cardiovascular depression and therefore the affection of blood flow of different organ systems is suggested. So far known, sevoflurane is not different compared to isoflurane in affecting liver and splanchnic blood flow. Concluded from former published studies there was no case of hepatic toxicity of sevoflurane been published so that this substance can be used in patients with reduced hepatic function. ⋯ However, barbiturates as well as phenytoin do not influence the metabolism of sevoflurane because these agents do not induce the major hepatic defluorinating enzyme cytochrome P450 2E1. Obesity, untreated diabetes mellitus and alcohol abuse increase the hepatic content and activity of cytochrome P450 2E1 and therefore enhanced anaesthetic defluorination is to be suspected. Until now, there are no studies about sevoflurane anaesthesia in patients after liver transplantation but the extremely low hepatotoxic potential as compared to isoflurane provides no argument to avoid this substance for anesthesia in liver transplanted patients.