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Wednesday, January 09, 2008

Sevoflurane - Inhalational agents is the induction agent of choice in children

Question

020. Which of the following inhalational agents is the induction agent of choice in children?

1. Methyoxyflurane

2. Sevoflurane

3. Desflurane

4. Isoflurane

Answer

2. Sevoflurane.

Reference

KDTripathi 5th edition Page 341

Lee 12th Edition Page 509

Also seen in

PARAS - PARAS 4th Edition Page 40

Sure Sucess in PG Entrance 1st Edition Page 100

Quality

Spotter

Status

Repeat

QTDF

All books give this

Discussion

Sevoflurane is polyflurinated methyl isopropyl alcohol. Sevoflurane is indicated for the induction and maintenance of general anesthesia in adult and pediatric patients during inpatient or outpatient surgery. Often, sevoflurane is used with other medications to induce or supplement anesthesia. Sevoflurane has several effects that serve to lower blood pressure. It depresses cardiac function, decreases cardiac contractility, and decreases peripheral vascular resistance in a manner similar to that of isoflurane. Due to its lack of pungency, sevoflurane is widely used for induction of anesthesia in pediatric patients.

Explanation

1. Methoxyflurane is 2,2-Dichloro-1,1-difluoro-1-methoxyethane; Penthrane Pentran; Pentrane; 2,2-Dichloro-1,1-difluoroethyl methyl ether; Methflurane; Methoxflurane. Methoxyflurane (Metofane) is no longer being manufactured in the United States or Canada.

2. Sevoflurane is the agent of choice for Children, as it poses no problem in induction and absence of pungency makes it pleasant and administrable through mask

3. Desflurane is a fluorinated congener of Isoflurane

4. Isoflurane is fluorinated methyl ethyl ether and causes least alteration of cardiovascular status

Comments

· Sevoflurane is contraindicated in Closed circuit with Soda Lime or Baralyme since a toxic compound is produced. The toxic compound produced is Compund A - PIPE - Pentafluoroisopropenyl fluoro methyl ether

· Other agents contraindicated in closed circuit are

1. Trichloroethylene

2. Chloroform

3. Methoxyflurane

Tips

Enflurane is the anesthesia of choice in Pheochromocytoma

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