Sevoflurane (Ultane) is the most recently introduced inhalation anesthetic. It has low tissue and blood solubility, which allows for rapid induction and emergence and makes it useful for outpatient and ambulatory procedures. It has the advantage of not being pungent, a characteristic that permits a smooth inhalation induction, and is particularly useful in pediatric anesthesia.
Hypotension is produced by sevoflurane as systemic vasodilation occurs and cardiac output decreases. Since it does not directly produce tachycardia, it is a useful alternative to consider in patients with myocardial ischemia. However, a concern for reflex-induced tachycardia remains.
Sevoflurane undergoes hepatic biotransformation (about 3% of the inhaled dose), and it is somewhat degraded by conventional CO2 absorbents. The degradation product from the absorbent has been reported to be nephrotoxic, although the report is controversial and not substantiated by more recent studies. Sevoflurane's actions on skeletal muscle and on vascular regulation within the CNS are similar to those described for the other halogenated hydrocarbon anesthetics.
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