Sevoflurane

How it works

It produces general anaesthesia through actions on central nervous system ligand-gated ion channels, including potentiation of GABA-A receptor activity, leading to loss of consciousness.

Prescribing in practice

• It is a recognised trigger of malignant hyperthermia in susceptible individuals, so a personal or family history must be sought and dantrolene and an emergency protocol must be available.
• Its low pungency and rapid onset and offset make it well suited to inhalational (gas) induction, particularly in paediatric anaesthesia.
• It causes dose-dependent respiratory and cardiovascular depression and must be delivered through a calibrated vaporiser with anaesthetic gas scavenging.

Monitoring

Monitor end-tidal anaesthetic concentration, oxygenation, ventilation, haemodynamics and temperature throughout administration.

Counselling the patient

• This anaesthetic gas is delivered by an anaesthetist with full monitoring.
• Tell the team about any personal or family history of serious reactions to anaesthesia.

Evidence & guidelines

Its use in induction and maintenance of anaesthesia, including paediatric gas induction, is standard practice supported by the SPC and anaesthetic guidance.