Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Sevofluranea. After inhalational induction.i. Consider switching to another volatile agent afterinduction as soon as the airway is secured.ii.Reduce fresh gas flows to a maximum of one litre perminute.b. For patients whose clinical condition or surgical procedurerequires preservation of systemic vascular resistance morethan can be achieved with other agents. (Sevoflurane maydepress SVR to a lesser degree than isoflurane ordesflurane.)c. For patients with ischaemic heart disease, in whomisoflurane at more than one MAC for ischaemicpreconditioning can produce coronary steal, hypotensionand reflex tachycardia.d. Where the patient’s clinical condition or surgical procedureindicates that postoperative recovery be as accelerated aspossible.i. During spontaneous ventilation only.ii.During IPPV, use desflurane or propofol TIVA ifaccelerated recovery is indicated.Acceptable use policy1. Every bottle of sevoflurane used will be signed out to anoperating theatre by the ODP.2. Theatre usage will be monitored and reported regularly to theDivisional Pharmacy Forum.3. An individual anaesthetist’s use of sevoflurane will not berestricted by this policy. However, all anaesthetists usingsevoflurane will be responsible for knowing about this policy andconsidering their usage of sevoflurane. Each use of sevoflurane172 Anaesthetists Handbook January 2010