enflurane (Discontinued)

Brand and Other Names:Ethrane, Compound 347
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

volatile liquid for inhalation

  • 250mL per bottle (99.9%)
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Anesthesia

Surgical anesthesia

  • Induction: 2-4.5% inspired concentrations produce surgical anesthesia within 7-10 min; administer with oxygen or combination of oxygen/nitrous oxide mixture
  • Maintenance: 0.5-3% inspired concentrations maintain surgical anesthesia; if added relaxation is required, supplemental with muscle relaxants; ventilate to maintain carbon dioxide tension in arterial blood between 35-45 mmHg

Cesarean Section

  • 0.5-1% as supplement to other general anesthetics

Analgesia

Vaginal delivery: 0.25-1% provides analgesia equivalent to that produced by 30-60% nitrous oxide

Safety and efficacy not established

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Interactions

Interaction Checker

and enflurane

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    No Interactions Found
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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            Frequency Not Defined

            Malignant hyperthermia

            Motor activity/seizures (with deep anesthesia or light anesthesia accompanied by hypocapnia)

            Hypotension

            Respiratory depression

            Hypoxia

            Arrhythmias

            Shivering

            Nausea

            Vomiting

            Increased WBCs

            Liver impairment, including hepatic failure (rare)

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            Warnings

            Contraindications

            Hypersensitivity

            Seizure disorders

            Known or suspected genetic susceptibility to malignant hyperthermia

            Cautions

            Avoid hyperventilation to minimize possible CNS excitation

            Continuous blood pressure monitoring required; lighten administration if excessive BP decrease occurs (unless hypovolemic)

            Renal dysfunction is associated with serum fluoride levels >50 micromol/L

            Postoperative hepatitis reported

            Increased intracranial pressure may occur

            May trigger skeletal muscle hypermetabolic state leading to high oxygen demand and malignant hyperthermia

            Caution in patients considered more susceptible to cortical stimulation

            Decrease dose of neuromuscular blocker if coadministered (longer recovery when coadministered with enflurane compared with halothane or nitrous oxide)

            May decrease hepatic, renal, hepatic, and splenic blood flow

            Should not be used as a sole agent of induction in patients with ventricular dysfunction

            Perioperative Hyperkalemia

            • Inhaled anesthetics associated with rare increases in serum potassium levels that have resulted in cardiac arrhythmias and death in pediatric patients postoperatively
            • Patients with latent as well as overt neuromuscular disease, particularly Duchenne muscular dystrophy, appear to be most vulnerable
            • Concomitant use of succinylcholine has been associated with most, but not all, of these cases
            • Elevated serum creatinine kinase levels and, in some cases, changes in urine consistent with myoglobinuria observed
            • Despite similar presentation to malignant hyperthermia, none of affected patients exhibited signs or symptoms of muscle rigidity or hypermetabolic state
            • Early and aggressive intervention to treat hyperkalemia and resistant arrhythmias recommended
            • Evaluation for latent neuromuscular disease recomended
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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Unknown whether distributed in breast milk, caution advised

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhalation anesthetic

            Pharmacokinetics

            Onset of action: 7-10 minutes

            Peak Plasma Concentration: Biotransformation results in low serum fluoride levels (average 15 micromol/L); can exceed 50 micromol/L if anesthesia >2 MAC hr

            Metabolism: Liver

            Excretion: Respiratory exhaled gases

            Pharmacogenomics

            Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)

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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.