Isoflurane
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Questions & Answers
Side Effects & Adverse Reactions
Increasing depth of anesthesia with isoflurane, USP 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 human consumption.
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Manufacturer Warnings
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Uses
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History
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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.
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| Some physical constants are: | ||
| Molecular weight | 184.5 | |
| Boiling point at 760 mm Hg | 48.5°C | |
| 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 | |
| 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 dogs6.
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 Manufacturers
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Halocarbon Products Corp.
![Isoflurane Liquid [Halocarbon Products Corp.]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Isoflurane | Halocarbon Products Corp.
CautionOperating rooms should be provided with adequate ventilation to prevent the accumulation of anesthetic vapors.
PremedicationA premedication regimen, which may be employed depending upon the patient status, to avert excitement during induction, may include an anticholinergic, a tranquilizer, a muscle relaxant, and a short-acting barbiturate.
Inspired ConcentrationThe 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 then is diluted (e.g., Verni-trol® vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:
% isoflurane = 100PVFV 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 used (mL/min)Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.
Induction HorsesInspired 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.
DogsInspired concentrations of 2.0 to 3.0% 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 produce surgical anesthesia in 5 to 10 minutes.
MaintenanceThe concentration of vapor necessary to maintain anesthesia is much less than that required to induce it.
HorsesSurgical levels of anesthesia in the horse may be sustained with a 1.5 to 1.8% concentration of isoflurane in oxygen.
DogsSurgical 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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Patterson Veterinary
Isoflurane | Patterson Veterinary
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 then is diluted (e.g., Verni-trol® vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:
% isoflurane = 100PVFV 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 used (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 con be expected to produce 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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Piramal Critical Care Inc
Isoflurane | Piramal Critical Care Inc
Premedication
Premedication should be selected according to the need of the individual patient, taking into account that secretions are weakly stimulated by isoflurane, and the heart rate tends to be increased. The use of anticholinergic drugs is a matter of choice.
Inspired Concentration
The concentration of isoflurane being delivered from a vaporizer during anesthesia should be known.
This may be accomplished by using:
a. vaporizers calibrated specifically for isoflurane;
b. vaporizers from which delivered flows can be calculated, such as vaporizers delivering a saturated vapor which is then diluted. 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 agent alters calibration or operation of these vaporizers.
Induction
Induction with isoflurane in oxygen or in combination with oxygen-nitrous oxide mixtures may produce coughing, breath holding, or laryngospasm. These difficulties may be avoided by the use of a hypnotic dose of an ultra-short-acting barbiturate. Inspired concentrations of 1.5 to 3.0% isoflurane usually produce surgical anesthesia in 7 to 10 minutes.
Maintenance
Surgical levels of anesthesia may be sustained with a 1.0 to 2.5% concentration when nitrous oxide is used concomitantly. An additional 0.5 to 1.0% may be required when isoflurane is given using oxygen alone. If added relaxation is required, supplemental doses of muscle relaxants may be used.
The level of blood pressure during maintenance is an inverse function of isoflurane concentration in the absence of other complicating problems. Excessive decreases may be due to depth of anesthesia and in such instances may be corrected by lightening anesthesia.
![Isoflurane Liquid [Patterson Veterinary]](http://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=287211cb-23c3-4f58-a5a1-3bffc763d753&name=isoflurane-02.jpg)
![Isoflurane Liquid [Piramal Critical Care Inc]](http://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=13c9c37a-0c3d-450a-a61e-d2796818b18f&name=100-ml-label.jpg)
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