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Questions & Answers
Side Effects & Adverse Reactions
Increasing depth of anesthesia with isoflurane may increase hypotension and respiratory depression. The electroencephalographic pattern associated with deep anesthesia is characterized by burst suppression, spiking, and isoelectric periods.4
Since levels of anesthesia may be altered easily and rapidly, only vaporizers producing predictable percentage concentrations of isoflurane should be used. (See DOSAGE AND ADMINISTRATION).
The action of nondepolarizing relaxants is augmented by isoflurane. Less than the usual amounts of these drugs should be used. If the usual amounts of nondepolarizing relaxants are given, the time for recovery from myoneural blockade will be longer in the presence of isoflurane than in the presence of other commonly used anesthetics.
Not for use in horses intended for food.
Keep out of reach of children.
Legal Issues
There is currently no legal information available for this drug.
FDA Safety Alerts
There are currently no FDA safety alerts available for this drug.
Manufacturer Warnings
There is currently no manufacturer warning information available for this drug.
FDA Labeling Changes
There are currently no FDA labeling changes available for this drug.
Uses
Isoflurane, USP is used for induction and maintenance of general anesthesia in horses and dogs.
History
There is currently no drug history available for this drug.
Other Information
Isoflurane, USP is a nonflammable, nonexplosive general inhalation anesthetic agent. Its chemical name is 1-chloro-2,2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:
Each mL contains 99.9% isoflurane.
Some physical constants are:
Molecular weight 184.5
Boiling point at 760 mm Hg 48.5° C (uncorr.)
Refractive index 1.2990-1.3005
Specific gravity 25°/25° C 1.496
Vapor pressure in mm Hg** 20°C 238
25°C 295
30°C 367
35°C 450
**Equation for vapor pressure calculation:
log10Pvap = A + B/T
where:
A = 8.056
B = -1664.58
T = °C + 273.16 (Kelvin)
Partition coefficients at 37° C:
Water/gas 0.61
Blood/gas 1.43
Oil/gas 90.8
Partition coefficients at 25° C - rubber and plastic
Conductive rubber/gas 62.0
Butyl rubber/gas 75.0
Polyvinyl chloride/gas 110.0
Polyethylene/gas ~2.0
Polyurethane/gas ~1.4
Polyolefin/gas ~1.1
Butyl acetate/gas ~2.5
Purity by gas chromatography - >99.9%
Lower limit of flammability in oxygen or nitrous oxide at 9 joules/sec. and 23° C - None
Lower limit of flammability in oxygen or nitrous oxide at 900 joules/sec. and 23° C - Greater than useful concentration in anesthesia.
MAC (Minimum Alveolar Concentration) is 1.31% in horses1 and 1.28% in dogs.6
Isoflurane is a clear, colorless, stable liquid containing no additives or chemical stabilizers. Isoflurane has a mildly pungent, musty, ethereal odor. Samples stored in indirect sunlight in clear, colorless glass for five years, as well as samples directly exposed for 30 hours to a 2 amp, 115 volt, 60 cycle long wave U.V. light were unchanged in composition as determined by gas chromatography. Isoflurane in one normal sodium methoxide-methanol solution, a strong base, for over six months consumed essentially no alkali, indicative of strong base stability. Isoflurane does not decompose in the presence of soda lime (at normal operating temperatures), and does not attack aluminum, tin, brass, iron or copper.
Sources
Isoflurane Usp Manufacturers
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Rxelite Holdings Inc.
Isoflurane Usp | Piramal Critical Care Inc
Caution: Operating rooms should be provided with adequate ventilation to prevent the accumulation of anesthetic vapors.
Premedication: A premedication regimen, which may be employed depending upon the patient status, to avert excitement during induction, might include an anticholinergic, a tranquilizer, a muscle relaxant, and a short-acting barbiturate.
Inspired Concentration: The delivered concentration of Isoflurane, USP should be known. Isoflurane may be vaporized using a flow-through vaporizer specifically calibrated for isoflurane. Vaporizers delivering a saturated vapor which is then diluted (e.g. Vernitrol® vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:
% Isoflurane = 100 PVFV
FT (PA – PV)
where: PA = Pressure of atmosphere
PV = Vapor pressure of isoflurane
FV = Flow of gas through vaporizer (mL/min)
FT = Total gas flow (mL/min)
Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.
Induction:
Horses: Inspired concentrations of 3.0% to 5.0% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the horse.
Dogs: Inspired concentrations of 2.0% to 2.5% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the dog.
These concentrations can be expected to product surgical anesthesia in 5 to 10 minutes.
Maintenance: The concentration of vapor necessary to maintain anesthesia is much less than that required to induce it.
Horses: Surgical levels of anesthesia in the horse may be sustained with a 1.5% to 1.8% concentration of isoflurane in oxygen.
Dogs: Surgical levels of anesthesia in the dog may be sustained with a 1.5% to 1.8% concentration of isoflurane in oxygen.
The level of blood pressure during maintenance is an inverse function of isoflurane concentration in the absence of other complicating problems. Excessive decreases, unless related to hypovolemia, may be due to depth of anesthesia and in such instances may be corrected by lightening the level of anesthesia. Recovery from isoflurane anesthesia is typically uneventful.2
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