The concentration of sevoflurane being delivered from a vaporizer during anesthesia should be known. This may be accomplished by using a vaporizer calibrated specifically for sevoflurane. The administration of general anesthesia must be individualized based on the patient's response.
Replacement of Desiccated CO2 Absorbents:
When a clinician suspects that the CO2 absorbent may be desiccated, it should be replaced. The exothermic reaction that occurs with sevoflurane and CO2 absorbents is increased when the CO2 absorbents become desiccated, such as after an extended period of dry gas flow through the CO2 absorbent canisters (see PRECAUTIONS).
Pre-anesthetic Medication:
No specific pre-medication is either indicated or contraindicated with sevoflurane. The decision as to whether or not to premedicate and the choice of pre-medication is left to the discretion of the anesthesiologist.
Induction:
Sevoflurane has a non-pungent odor and does not cause respiratory irritability; it is suitable for mask induction in pediatrics and adults.
Maintenance:
Surgical levels of anesthesia can usually be achieved with concentrations of 0.5 - 3 % sevoflurane with or without the concomitant use of nitrous oxide. Sevoflurane can be administered with any type of anesthesia circuit.
Table 9: MAC Values for Adults and Pediatric Patients According to Age
Age of Patient
(years)
Sevoflurane
in Oxygen
Sevoflurane
In 65% N2O/35% O2
0 – 1 months #
3.3%
1 - <6 months
3.0%
6 months- <3 years
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%
# Neonates are full-term gestational age. MAC in premature infants has not been determined.
@ In 1 - <3 year old pediatric patients, 60%N2O/40%O2 was used.
