Anaesthetists Handbook - MEDICAL EDUCATION at University ...

SevofluraneSevoflurane[Dr Mark Porter, October 2005; appraised by Dr John Elton, January 2008]Sevoflurane is twenty-one times more expensive than isoflurane.Think before using it and use it on low flow – less than 500 mL perminute. (Desflurane costs twenty-five times as much as isofluraneand should be used with similar attention to economy.)Clinical pharmacologyThe advantage of sevoflurane may be lost if using opiates ormidazolam, as these and other agents may cause postoperativesedation. Using a good regional block for analgesia instead ofsedative drugs will enable faster recovery.Where the duration of anaesthesia will exceed two hours, sevofluranewill not give a different recovery profile to isoflurane.While rapidity of recovery can be proven when comparingsevoflurane with isoflurane in shorter cases, it rarely has anysignificant effect on clinical outcomes, length of stay or list turnover.Do you really have to use it?Sevoflurane inhalational induction is about the same cost as anampoule of propofol, especially where nitrous oxide is used toincrease potency, and cardiorespiratory parameters may be bettermaintained. However, consider whether inhalational induction isnecessary in each case.Clinical indicationsAnaesthetists should consider the clinical indications for usingsevoflurane in every case. Where a specific indication is notapparent, anaesthetists should use isoflurane or another agent.1. Inhalational induction of anaesthesia.2. Maintenance of anaesthesia.Anaesthetists Handbook January 2010 171