Sevorane anesthesia for children. Consequences, doctors' reviews, instructions, side effects, contraindications

The beginning of the use of Sevoran as anesthesia in children became a progressive step in anesthesiology. This led to a significant reduction in the number and severity of complications. His predecessors have consequences general anesthesia could be fatal.

The high safety of this drug, its good tolerance by children, and the minimum effect on organs and systems determine the widespread use of the drug in surgical practice.

According to patients' reviews, when coming out of anesthesia, the child may be lethargic and drowsy, some vomiting. However, the use of this agent makes it possible to treat inflammation of the inner tissue of the tooth and caries in children who are difficult to tolerate dental procedures.

Therapy is necessary even if milk teeth are damaged, so the infectious process in the oral cavity can spread to other organs, in addition, there is a pronounced pain syndrome. There is also an increased risk of pulpitis affecting the rudiments of permanent teeth.

Forms of release, packaging, composition

Sevoran - anesthesia for children (the consequences of parental reviews are most often described as insignificant), which is used in inhalation form. It is a transparent, colorless liquid with a high degree of volatility, that is, it easily changes from a liquid to a gaseous state.

The drug is produced in dark bottles made of polyethylene naphthalate - a polymer that has high chemical resistance. The secondary packaging is a cardboard box. The vials can have a capacity of 100 and 250 ml.

The main and only component of the drug is sevoflurane. According to its chemical structure, it is an ether subjected to halogenation, in which the hydrogen atom is replaced by fluorine.

It has low blood solubility, does not have a specific pungent odor and is characterized by a rapid increase in alveolar concentration, at which half of the patients of the test group, there is no response to the incision made on the skin (there is no reflex motor reaction associated with the transmission of nervous signal).

In Russia, the drug is sold by the representative office of the American biopharmaceutical company ABBVIE. The medicinal product does not contain any additives or additional stabilizers.

The main active ingredient has the following characteristics:

• practically does not decompose under the influence of acids and heat;
• chemically inert, does not corrode materials;
• does not cause corrosion of metals and alloys in contact with them (including stainless steel, copper, aluminum, nickel, chrome coatings);
• mixes well with ethyl alcohol, other volatile liquids, chloroform, hydrocarbons (in particular, with benzene); poorly soluble in water;
• may decompose when interacting with carbon dioxide in an anesthesia machine, as well as when using dry absorbers containing potassium hydroxide;
• remains stable under normal room lighting;
• the liquid is not flammable and flammable, which complies with the rules of explosion and fire safety;
• when the temperature rises in the presence of carbon dioxide, decomposition increases;
• the substance is destroyed by the action of alkalis, with the formation of pentofluoroisopropylfluoromethyl ether or hexafluoroisopropanol and formaldehyde;
• since the saturated vapor pressure is low, it is possible to use standard evaporators.

Clinical and pharmacological group

There are more than 1200 clinical and pharmacological groups in pharmaceuticals. This drug belongs to the group of drugs for inhalation anesthesia.

These include volatile substances such as ethers, halothane mixed with air or oxygen, trichlorethylene (the most powerful narcotic compound), isoflurane (precursor of sevoflurane), gases - nitrous oxide, cyclopropane, xenon and others. They are quickly absorbed through the respiratory tract, so this type of anesthesia can be easily controlled by the anesthesiologist.

Pharmaco-therapeutic group

According to the pharmacotherapeutic group (the main pharmacological effect), this agent is classified as anesthetic inhalation agents.

When using them, the following processes are observed:

• inhibition of the activity of the central nervous system with the shutdown of consciousness, which is reversible;
• decreased pain sensitivity and reflexes;
• decrease in muscle tone.

In this case, 4 stages of anesthesia are conventionally distinguished:

1. Anesthesia stage.
2. Stage of arousal.
3. Surgical anesthesia.
4. Exit from anesthesia.

This scheme is common for all drugs in this group.

pharmachologic effect

The drug has the following pharmacological action:

• Rapid onset of anesthesia without a pronounced stage of arousal.
• Sufficient depth of anesthesia for painless medical procedures. Good controllability - changing the degree of anesthesia by varying the concentration of volatile vapor in the inhaled mixture.
• The drug has a wide range between the dose giving a pronounced anesthetic effect and the amount active substance, in which toxic damage to the brain, respiratory and vasomotor center. This determines the safety of the drug.
• Dose-dependent suppression of the activity of the respiratory center and a decrease in blood pressure.

Sevoran - anesthesia for children (the consequences of reviews in most cases characterize as insignificant), which affects vital systems:

• The cardiovascular system:

1. blood pressure and general peripheral vascular resistance, but to a lesser extent than with isoflurane;
2. automatism, excitability and contractility of the heart muscle change slightly;
3. violation of blood circulation in the myocardium was not revealed.

• Respiratory system:

1. breathing becomes slower and more depressed;
2. tidal volume decreases;
3. attacks of bronchospasm are stopped.

• Central and peripheral nervous system:

1. increased cerebral blood flow;
2. violation of autoregulation does not occur;
3. intracranial pressure slightly increases;
4. the brain's need for oxygen decreases;
5. no convulsions;
6. there is a relaxation of muscle tissue, including sufficient for the introduction of an endotracheal tube in children.

• Urinary system:

1. renal blood flow decreases slightly;
2. in the process of metabolism of the active substance, fluoride is formed, which inhibits the function of the renal tubules, through which water is absorbed;
3. the ability of the kidneys to concentrate urine is slightly impaired.

• Hepatobiliary tract:

1. reduced blood flow in the portal vein, which collects blood in the liver;
2. in the hepatic artery, blood flow increases;
3. overall blood flow and oxygen supply to the liver remain at an acceptable level.

Pharmacokinetics

The features of pharmacokinetics are:

• Since the drug has a low blood solubility, the concentration of the active compound rapidly increases when it enters the respiratory system.
• The ratio of concentration on inhalation and exhalation half an hour after the start of administration is 0.85.
• The lowest required alveolar concentration in oxygen is 2.05% (this figure is set for adult patients aged 40 years). The onset of anesthesia for children is on average 2 minutes.
• At the end of anesthesia, the above ratio reaches only 0.15. The duration of recovery from anesthesia after stopping the drug delivery is 5 minutes.
• Since the drug is quickly excreted, its metabolism in the human body is minimal.
• The drug that has entered the systemic circulation (less than 5%) is metabolized in the liver by complex iron-containing proteins to hexafluoroisopropanol with the release of fluorine and carbon dioxide. This process can be enhanced by the preliminary introduction of ethyl alcohol or barbiturates. The metabolite has no biological activity, quickly binds to glucuronic acid.
• The excretion of the metabolic product occurs through the kidneys. At the same time, no significant changes in kidney function were detected even with prolonged anesthesia up to 9 hours.

Advantages of Sevoran anesthesia

The benefits of the drug include the following:

• rapid entry of the active substance into the arterial blood, the absence of the stage of arousal;
• technical ease of use;
• biological and fire safety;
• minimum negative effect on the body, no impairment of autoregulation in the brain, a slight decrease myocardial functions and heart rate, no arrhythmogenic effect and redistribution of blood flow from ischemic zones;
• the ability to quickly increase or decrease the depth of anesthesia;
• no increase in epileptic activity;
• minimal irritation to the respiratory tract;
• good tolerance in children who do not respond well to the installation of infusion systems (intravenous systemic administration of drugs), the possibility of using in the absence of venous access;
• a more favorable process of restoring cardiac activity during the period of recovery from anesthesia, which significantly reduces the risk of heart failure;
• lack of additives in the drug;
• the possibility of using it as an emergency anesthesia;
• a decrease in the level of systemic inflammatory reaction, a protective effect on the myocardium.

Flaws

The disadvantages include the following:

• impossibility of mask inhalation with injuries in the face area;
• the presence of side effects (including hyperthermia, increased intracranial pressure);
• the need to hold a certain period of time after the onset of anesthesia, since a sleeping patient can react to a pain factor;
• high price.

Mechanism of action, principle of work with anesthesia in pediatric dentistry

Sevoran is an anesthesia for children, during 1 session of which doctors can painlessly cure a large number of teeth. General anesthesia usually results in increased sleepiness. According to reviews, the child returns to normal on the same day.

The basic principles of using this drug for anesthesia in pediatric dentistry are as follows:

• Before planning treatment, it is necessary to carry out preliminary diagnostics to identify possible diseases of the heart, lungs and other organs (ECG, clinical blood test, general urine analysis, consultations specialists).
• The use of anesthesia and manipulations are also not carried out during the period of acute respiratory infections, acute respiratory viral infections and other acute conditions. The child must have been healthy for the past 2 weeks, and vaccinations should be postponed or done in advance.
• The duration of anesthesia is determined by the attending physician and depends on the volume of medical intervention.
• Before the actual procedure, you cannot feed the child for 4 hours and drink for 3 hours.
• If surgery is scheduled for the afternoon, it is recommended that you take a walk or recreational activity to distract your child from eating.
• To reduce the risk of complications and medical errors, it is necessary to choose a clinic that has permits for anesthesia and resuscitation measures, and doctors have experience working with children.
• In the dentist's office, the child is laid on a chair and an inhalation mask is put on him under the pretext of playing. To create a more comfortable environment, the child can fall asleep under anesthesia in the hands of the parents.
• A tube is then inserted into the throat of the children, into which gas is supplied to maintain anesthesia.
• At the end of the treatment, the child is transferred to an adjacent “wake-up room”.
• After coming out of anesthesia, if the child does not have nausea, you can offer him sweet tea or yogurt, it is also recommended to distract him with cartoons.
• The child should still be under the supervision of a doctor for about 1 hour.
• After 1.5 hours, you can offer him food. Food should not be heavy on the stomach.
• After treatment, your doctor may recommend taking antipyretics and pain relievers, such as Nurofen.

Usually, on the same day, the child becomes as active as before the application of anesthesia. Dental care in young children is often a psycho-traumatic procedure with long-term consequences.

Therefore, the use of general sedation is an urgent problem in outpatient dentistry. Clinical studies of this drug show its high efficacy and safety in the treatment of caries and pulpitis at a young age.

Indications for use

Sevoran - anesthesia for children (the consequences of the reviews describe without complications), which has the following main indication: introductory (in the period from the beginning of general anesthesia to surgical stage of anesthesia) or maintenance (duration of the surgical stage) anesthesia in adults and children during surgical interventions in inpatient and outpatient setting.

Contraindications

Contraindications for the appointment of this drug include:

• a decrease in the total amount of circulating blood in severe severity;
• the risk of malignant hyperthermia, clinically confirmed (in the patient's history) or genetically determined;
• severe hypotension;
• increased intracranial pressure;
• individual sensitivity to the drug;
• breast-feeding.

It is also used with caution in the following cases:

• renal or hepatic impairment;
• neurological diseases in which muscle tissue is involved;
• ischemic heart disease and other pathologies of this organ (constant monitoring of hemodynamics is necessary);
• hereditary diseases leading to defects in the functioning of mitochondria;
• predisposition to seizures.

Security measures

When prescribing a medicine, the following safety measures must be taken into account:

• joint use with beta-sympathomimetics can lead to the development of arrhythmias (especially with genetic deficiency of alpha-glucosidase);
• the fresh gas jet velocity must be at least 2 l / min. to prevent the formation of a nephrotoxic metabolite when reacting with alkalis (carbon dioxide absorbers);
• the drug can only be used by specialists who have completed a special training course on general anesthesia;
• since when prescribing narcotic painkillers as premedication, deterioration of functions is possible breathing, then constant medical monitoring of the patient's condition is required (ECG, blood pressure and other indicators);
• when using overdried carbon dioxide scavengers, spontaneous ignition of anesthesia machines can occur, which contributes to a delay in the delivery of the drug, as a result, its highest level is reached for a longer time (in this case, replacement is necessary sorbent);
• with a deep degree of anesthesia, a significant drop in blood pressure can occur; to correct this condition, it is necessary to reduce the concentration of the drug in the inhalation mixture;
• since recovery from anesthesia occurs quickly, additional anesthesia may be required during the recovery period.

In the next 2-3 days, some patients may have minor changes in mood, and in children in ¼ cases of motor restlessness and deterioration of social interaction with others.

Instructions for use, doses

Sevoran - anesthesia for children (the consequences of the reviews are characterized by a high level of safety), must have the required concentration level of the active substance, indicated in the table below. It is selected based on the patient's age.

Patient age	Delivery of anesthesia in combination with oxygen,%	Delivery of anesthesia in combination with dinitrogen oxide,%
Up to 1 month	3,3	—
1-6 months	3,0	—
6 months to 3 years	2,8	2
From 3 to 12 years old	2,5	1,8
13-25 years old	2,6	1,4
26-40 years old	2,1	1,1
41-60 years old	1,7	0,9
60-80 years old	1,4	0,7

Adverse reactions and possible consequences

As side reactions, the following may occur:

• arrhythmia as a result of an increase in the concentration of potassium in the blood serum (the risk of this complication increases with neuromuscular diseases);
• hypermetabolism of skeletal muscles with the transition to multiple organ failure (malignant hyperthermia, also most often occurs in neuromuscular diseases);
• increased excretion of protein and glucose in the urine (impaired renal function), which develops in most cases with prolonged anesthesia; retention of urine;
• nausea, cough, vomiting (in case of violation of the recommendations for preparation for anesthesia), increased salivation;
• apnea, shortness of breath, respiratory depression, pulmonary edema, chest discomfort;
• pancreatitis, deterioration of the liver, the development of hepatitis (in rare cases); the risk of these disorders increases when halogenated hydrocarbons are used as inhalation anesthesia;
• increased intracranial pressure;
• convulsions;
• bradycardia, extrasystole, atrial fibrillation and hypotension (observed in children with Down syndrome);
• the most frequent negative consequences are increased drowsiness, dizziness, headache, impaired consciousness; in children - transient excitement;
• chills, fever;
• allergic reactions, up to anaphylactic shock with individual intolerance.

Overdose

In case of an overdose, it is necessary to stop the administration of anesthesia and carry out ventilation of the lungs with the use of oxygen. Also, measures should be taken to maintain the work of the cardiovascular system.

Drug interactions

The combined use of other drugs can lead to the following phenomena:

• sympathomimetics - the development of arrhythmia and hypertensive crisis;
• monoamine oxidase inhibitors - the risk of a hypertensive crisis (treatment with these drugs should be discontinued at least 14 days before surgery);
• calcium antagonists - lowering blood pressure;
• beta blockers - enhancing their action;
• verapamil - decrease in atrioventricular conduction;
• barbiturates, narcotic pain relievers, substances that enhance the activity of cytochrome P450, nitrous oxide - enhance the effect of anesthesia;
• opioids - lowering blood pressure, heart rate and respiration;
• muscle relaxants - strengthening and increasing the duration of neuromuscular blockade, inadequate relaxation;
• drugs containing St. John's wort (with prolonged use) - a significant decrease in pressure.

Terms of sale and storage

Features of storage conditions are:

• keep away from children;
• keep in its original packaging, tightly sealed;
• optimal storage temperature + 15 °... + 30 ° С;
• total storage time - 3 g.

The drug belongs to the prescription category and is marketed for clinics.

Price

The average price for this drug in pharmacy chains is 8500 rubles.

Sevoran - anesthesia for children, which opened a new milestone in inhalation anesthesia. It has become the gold standard for inhaled anesthetics. When using it, there are no such serious consequences as acute heart failure and death. According to the parents' reviews, the exit of children from anesthesia occurs quickly and without consequences.

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