Statement on the Use of Low Gas Flows for Sevoflurane MENUStandards and Practice ParametersBACKSTANDARDS AND PRACTICE PARAMETERSStandards and Practice ParametersASA Statements on COVID-19ASA Physical Status Classification SystemResources from ASA CommitteesASA Community Advocacy & ASAPACBACKADVOCACY & ASAPACAdvocacy & ASAPACASAPACAdvocacy TopicsJoin the Grassroots NetworkWashington and FDA and CommitteesRelated OrganizationsWork at ASANewsroomContact UsFOR PATIENTSSHOP ASAHOMESkip to main content STANDARDS AND PRACTICE PARAMETERSStatement on the Use of Low Gas Flows for SevofluraneDeveloped by: Committee on Equipment and FacilitiesOriginal Approval: October 18, 2023The U.S. Food and Drug Administration (FDA)-approved labeling by the manufacturer indicating a minimum fresh gas flow (FGF) for sevoflurane
Effect of total intravenous anesthesia versus sevoflurane anesthesia on intraoperative facial nerve monitoring: a randomized controlled trial Intraoperative facial nerve monitoring (IFNM) facilitates effective nerve preservation during ear and head and neck surgeries. Quantitative differences in the timely feasibility of IFNM during total intravenous anesthesia (TIVA) vs sevoflurane anesthesia have not been investigated. We conducted a randomized controlled trial in which 98 patients undergoing ear surgery were allocated to either the TIVA or sevoflurane group. We used quantitative neuromuscular monitoring of train-of-four (TOF) responses to assess achievements of IFNM-feasible conditions, and recorded the TOF count (TOFC) or TOF ratio of T4/T1 (TOFR). The primary outcome was the time
Short-term outcomes in infants following general anesthesia with low-dose sevoflurane/dexmedetomidine/remifentanil versus standard dose sevoflurane (The TREX trial). The TREX (Trial Remifentanil DEXmedetomidine) trial aimed to determine if, in children < 2 years old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia (LD-SEVO) is superior to standard dose sevoflurane (STD-SEVO ) in the LD-SEVO arm. Time from eye-opening to Post Anesthesia Care Unit (PACU) discharge was similar in both arms, as were morbidity and mortality. One patient in each arm suffered a life-threatening event but neither suffered long-term sequelae. These early postoperative results suggest that in children less than 2 years of age receiving greater than 2 hours of general anesthesia, the low-dose sevoflurane
Similarity and dissimilarity in alterations of the gene expression profile associated with inhalational anesthesia between sevoflurane and desflurane. Although sevoflurane is one of the most commonly used inhalational anesthetic agents, the popularity of desflurane is increasing to a level similar to that of sevoflurane. Inhalational anesthesia generally activates and represses the expression of genes related to xenobiotic metabolism and immune response, respectively. However, there has been no comprehensive comparison of the effects of sevoflurane and desflurane on the expression of these genes. Thus, we used a next-generation sequencing method to compare alterations in the global gene expression profiles in the livers of rats subjected to inhalational anesthesia by sevoflurane or desflurane
Effect of preoperative dexmedetomidine administration on the bispectral index in children during sevoflurane inhalation anesthesia: a randomized controlled trial. The available data on the effect of dexmedetomidine premedication on anesthesia depth in children during general anesthesia are limited. This study was designed to determine the effect of preoperative dexmedetomidine administration on the bispectral index (BIS) and sevoflurane requirements in children during sevoflurane anesthesia. 120 children aged 5 to 12 years undergoing concealed penis repair or hypospadias plastic surgery were randomized to receive preoperative administration of 0.25 µg kg dexmedetomidine, 0.5 µg kg dexmedetomidine, 0.75 µg kg dexmedetomidine, or the same volume of placebo. The primary outcome was the change in the BIS
Anesthetic Sevoflurane Induces Enlargement of Dendritic Spine Heads in Mouse Neurons via Tau-Dependent Mechanisms. Sevoflurane induces neuronal dysfunction and cognitive impairment. However, the underlying mechanism remains largely to be determined. Tau, cyclophilin D, and dendritic spine contribute to cognitive function. But whether changes in dendritic spines are involved in the effects of sevoflurane and the potential association with tau and cyclophilin D is not clear. We harvested hippocampal neurons from wild-type mice, tau knockout mice, and cyclophilin D knockout mice. We treated these neurons with sevoflurane at day in vitro 7 and measured the diameter of dendritic spine head and the number of dendritic spines. Moreover, we determined the effects of sevoflurane on the expression
The Probability Distribution of Times to Awakening From Sevoflurane Anesthesia, Among a Homogeneous Group of Cases With the Same Age-Adjusted Minimum Alveolar Concentration Fraction. Human studies of awakening from general anesthesia inform understanding of neural mechanisms underlying recovery of consciousness. Probability distributions of times for emergence from anesthesia provide mechanistic of categories with ≥40 cases. We used Gas Man simulation to infer the probability distribution of volatile agent concentrations in the vessel-rich group (ie, brain). There were 48 cases among patients having oral surgery extractions by 1 surgeon, without anesthesia trainees, sevoflurane anesthesia with 0.3 MAC fraction at surgery end, without N2O, BIS monitor, or neuromuscular block reversal. Their extubation
Distinct effects of sevoflurane and propofol on vascular permeability in vitro and in a mouse model. General anesthetics may substantially influence endothelium function, potentially affecting outcomes of surgical patients, but their effects are unclear. Here, we studied a commonly used inhaled anesthetic, sevoflurane, and an intravenous anesthetic, propofol, on vascular endothelial permeability . Downstream targets were identified using RNA sequencing and confirmed by qRT-PCR and western blot. Sevoflurane at clinically relevant concentrations disrupted the endothelial monolayer formed by HUVECs and MPECs in transwell permeability models. Sevoflurane, but not propofol, induced 1.8-fold increase of AngioSense® dye accumulation in mouse lung than control, indicating pulmonary vascular leakage
The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial. In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific for elective surgery under general anesthesia supplemented with caudal analgesia had either sevoflurane anesthesia titrated to maintain a characteristic density spectral array pattern or based on a predefined end-tidal sevoflurane concentration of 2.3% (standard care group). The time interval between the discontinuation of sevoflurane and the moment when discharge criteria from the operating room were met
A Placebo-Controlled Randomized Trial Comparing Oral Midazolam, Dexmedetomidine, and Gabapentin on Prophylaxis of Emergence Agitation After Sevoflurane Anesthesia in Adenotonsillectomy. Sevoflurane causes emergence agitation (EA) in up to 80% of pediatric patients. Using midazolam, dexmedetomidine (DEX), and gabapentin, this work aimed to assess the prophylactic effect of oral premedication on EA incidence experienced by pediatric patients during recovery from sevoflurane anesthesia. Randomized controlled trial. Kafrelsheikh University, Kafrelsheikh, Egypt. This study was performed on 240 men and women aged 3 to 10 years who were scheduled for adenotonsillectomy. Patients were randomized into 4 equal-sized groups. Thirty minutes before general anesthesia, oral premedication was applied
Comparison of Effect Sevoflurane-Based Anesthesia and Propofol-Based Anesthesia on the Early Postoperative Renal Function of Living Kidney Transplant Donors: A Randomized Controlled Trial. Living kidney transplantation is a common treatment for end-stage renal disease. The impact of anaesthetics on postoperative biomarkers of renal injury in living kidney transplant donors is not well understood . 70 transplant donors who underwent kidney extraction were randomly assigned to following two groups: sevoflurane (S group) and propofol (P group). Urine and blood were collected before induction and 1, 2, 6 days after operation. Kidney injury marker-1 (KIM-1), interleukin-18 (IL-18) and tissue inhibitor of metalloproteinase-2 (TIMP-2) were measured by enzyme-linked immunosorbent assay. Record
BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial. In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia. The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age. Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45-60 during
Psychomotor Responses to Independent Visual, Auditory and Tactile Electrical stimuli during Sevoflurane sedation (PRIVATES). Patient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation. 15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol
Effect of remimazolam tosilate for injection (HR7056) versus sevoflurane on the incidence of postoperative delirium in older patients undergoing total hip arthroplasty: study protocol for a prospective, multicentre, two-arm, parallel-group, randomised co Postoperative delirium (POD) is a common postoperative complication and is associated with numerous adverse outcomes. Advanced age and hip surgery are high risk factors for POD. Both remimazolam tosilate for injection and sevoflurane can be used as sedatives for the maintenance of general anesthesia, but the comparison of their impacts on the incidence of POD has not been reported. This study aims to compare the effect of remimazolam tosilate vernus sevoflurane on the incidence of POD in older patients undergoing total hip arthroplasty
Striatal neurones expressing D1 dopamine receptors modulate consciousness in sevoflurane but not propofol anaesthesia in mice. Sevoflurane and propofol are the most widely used inhaled and i.v. general anaesthetics, respectively. The mechanisms by which sevoflurane and propofol induce loss of consciousness (LOC) remain unclear. Recent studies implicate the brain dopaminergic circuit in anaesthetic-induced LOC and the cortical-striatal-thalamic-cortical loop in decoding consciousness. We investigated the contribution of the dorsal striatum, which is a critical interface between the dopaminergic circuit and the cortical-striatal-thalamic-cortical loop, in sevoflurane and propofol anaesthesia. Electroencephalography and electromyography recordings and righting reflex tests were used
Sevoflurane-induction via the Flow-i ventilator in the pediatric intensive care unit for the treatment of status asthmaticus: a case report and literature review. Status asthmaticus is a severe asthma exacerbation commonly associated with hypercarbia, hypoxia, and respiratory acidosis that can be unresponsive to conventional therapies. Non-invasive positive pressure ventilation is utilized with sevoflurane, and mechanically ventilated with the Flow-i ventilator. Status asthmaticus is described as severe asthma that is refractory to repeated administration of beta-agonists, while near-fatal asthma is described as exacerbations requiring intubation and mechanical ventilation. When mechanical ventilation and conventional therapies are inadequate, inhalational anesthetics and extracorporeal membrane
Somatostatin-expressing neurons in the medial prefrontal cortex promote sevoflurane anesthesia in mice. The medial prefrontal cortex plays a crucial role in regulating consciousness. However, the specific functions of its excitatory and inhibitory networks during anesthesia remain uncertain. Here we explored the hypothesis that somatostatin interneurons in the medial prefrontal cortex enhance the effects of sevoflurane anesthesia by increasing GABA transmission to pyramidal neurons. EEG was utilized to reflect the depth of anesthesia. Immunostaining and fiber photometry were employed to assess neuronal activities and GABA delivery. The regulation of neuronal activity was achieved by chemogenetics and optogenetics. The expression of c-Fos was increased in somatostatin neurons of the medial
Impaired macroscopic CSF flow by sevoflurane in humans - both during and after anesthesia. According to the model of the glymphatic system, the directed flow of cerebrospinal fluid (CSF) is a driver of waste clearance from the brain. In sleep, glymphatic transport is enhanced, but it is unclear how it is affected by anesthesia. Animal research indicates partially opposing effects of distinct anesthetics but corresponding results in humans are lacking. Thus, this study aims to investigate the effect of sevoflurane anesthesia on CSF flow in humans, both during and after anesthesia. Using data from a functional magnetic resonance imaging (fMRI) experiment in 16 healthy human subjects before, during, and 45 minutes after sevoflurane mono-anesthesia of 2vol%, we related grey matter blood-oxygenation
Recurrence-free survival after hepatectomy using propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: a randomised controlled study. While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma. Adult patients scheduled for elective hepatectomy for hepatocellular carcinoma were assigned randomly (1:1) to either propofol-based total intravenous anaesthesia or sevoflurane-based inhalational anaesthesia. For recurrence-free survival
Ac-YVAD-cmk ameliorated sevoflurane-induced cognitive dysfunction and revised mitophagy impairment. It is common for elderly patients to develop postoperative cognitive dysfunction (POCD), but the pathophysiological mechanisms have not yet been fully explored. NLRP3 inflammasome activation and mitophagy impairment was involved in neurodegenerative disease. This study investigated the interaction of NLRP3 inflammasome and mitophagy in sevoflurane-induced cognitive dysfunction. We found that sevoflurane induced cleaved caspase-1 level, IL-1β and IL-18 maturation, and activated NLRP3 inflammasome in aged mice and the primary hippocampus neuron. The cleaved caspase-1 was demonstrated in microglia of hippocampus. Ac-YVAD-cmk, a selected caspase-1 inhibitor, reduced the expression of cleaved caspase-1