The low solubility of sevoflurane in blood and other tissues provides for rapid induction of anesthesia, rapid changes in anesthetic depth following changes in delivered concentration, and rapid emergence following discontinuation of administration (Table 13-1).
Approximately 3% of absorbed sevoflurane is biotransformed by hepatic CYP2E1, the predominant product being hexafluoroisopropanol; metabolism of sevoflurane also produces inorganic fluoride. Interaction of sevoflurane with soda lime (CO2 absorbent) produces decomposition products, one of which, compound A (pentafluoroisopropenyl fluoromethyl ether), may have toxicity (see Side Effects: Kidney, Liver, and Gastrointestinal Tract below).
CLINICAL USE Sevoflurane is widely used, particularly for outpatient anesthesia, because of its rapid recovery profile. It is well-suited for inhalation induction of anesthesia (particularly in children) because it is not irritating to the airway. Induction of anesthesia is rapidly achieved using inhaled concentrations of 2-4%.
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