SUPRANE
Clinical safety rating
cautionComprehensive clinical and safety monograph for SUPRANE (SUPRANE).
Suprane (desflurane) is a volatile general anesthetic that potentiates GABA-A receptor activity and inhibits NMDA receptor function, leading to neuronal hyperpolarization and depression of central nervous system activity.
| Metabolism | Minimal hepatic metabolism (less than 0.02%) via CYP2E1; primarily eliminated unchanged by the lungs. |
| Excretion | Primarily eliminated by the lungs with minimal metabolism (<5%). Less than 0.2% of the absorbed dose is excreted renally as unchanged drug. |
| Half-life | Context-sensitive half-life: 2-5 minutes after brief administration; prolonged to 20-40 minutes after prolonged administration due to slow release from fat stores. |
| Protein binding | ~60% bound to serum proteins, primarily albumin and lipoproteins. |
| Volume of Distribution | Vd: 0.6-0.8 L/kg at steady state; large distribution into lipid-rich tissues. |
| Bioavailability | Inhalation: ~100% due to complete absorption from the lungs; no oral bioavailability is clinically relevant. |
| Onset of Action | Inhalation: Loss of consciousness in 1-2 minutes with high induction concentrations (4-8%); dose-dependent. |
| Duration of Action | Recovery from anesthesia: emergence in 5-15 minutes after short procedures; prolonged with longer exposure due to accumulation in adipose tissue. |
| Molecular Weight | 200.06 |
Induction: 0.5-3% inspired concentration in oxygen or oxygen/nitrous oxide mixture; Maintenance: 0.5-2% inspired concentration. Administered via inhalation using a calibrated vaporizer.
| Dosage form | LIQUID |
| Renal impairment | No dose adjustment required for renal impairment; Suprane is minimally metabolized and renally excreted. |
| Liver impairment | No specific dose adjustment for Child-Pugh class A or B; caution in severe hepatic impairment (Child-Pugh C) due to potential decreased clearance, consider reduced maintenance concentrations. |
| Pediatric use | Induction: 3% inspired concentration in oxygen (or oxygen/nitrous oxide) for unpremedicated children, titrated to effect; Maintenance: 1-2% inspired concentration. Adjust based on age and response. |
| Geriatric use | Elderly patients (≥65 years): Reduce induction and maintenance concentrations by 20-50% due to increased sensitivity and slower recovery; typical maintenance 0.5-1.5% inspired. |
| 1st trimester | Insufficient human data; animal studies show no evidence of teratogenicity at clinically relevant doses. Use only if clearly needed. |
| 2nd trimester | Limited human data; no known fetal harm from brief exposure. May cause transient maternal hypotension affecting placental perfusion. |
| 3rd trimester | Use with caution near term; may cause neonatal respiratory depression and hypotonia. Avoid for elective cesarean section due to uterine relaxation and increased blood loss. |
Clinical note
Comprehensive clinical and safety monograph for SUPRANE (SUPRANE).
| Placental transfer | Sevoflurane crosses the placenta rapidly; fetal concentrations reach approximately 50-70% of maternal levels within minutes. Transfer is facilitated by its low molecular weight and high lipid solubility. |
| Breastfeeding | Sevoflurane is rapidly eliminated via exhalation; negligible amounts enter milk. The half-life is short (<2 minutes), so breastfeeding can resume after full recovery from anesthesia (approximately 2-4 hours post-procedure). No adverse effects in infants have been reported. |
| Lactation Rating | Safe |
| Teratogenic Risk | Sevoflurane (Suprane) is classified as FDA Pregnancy Category B. Animal studies have not demonstrated teratogenic effects, but there are no adequate and well-controlled studies in pregnant women. Use in the first trimester should be avoided unless essential. In the second and third trimesters, it is used for general anesthesia; however, it may produce uterine relaxation and fetal depression. Prolonged or repeated exposure should be avoided due to potential neurotoxicity in the developing fetus. |
| Fetal Monitoring | Monitor maternal blood pressure, heart rate, oxygen saturation, and end-tidal sevoflurane concentration. For fetal monitoring, use continuous fetal heart rate monitoring during labor and delivery. Assess uterine tone and bleeding postoperatively. Monitor for signs of malignant hyperthermia in susceptible individuals. |
| Fertility Effects | Sevoflurane has not been shown to adversely affect human fertility. Animal studies did not demonstrate impaired fertility at clinically relevant doses. However, general anesthesia may transiently affect reproductive hormone levels and sperm parameters, but these effects are reversible. |
■ FDA Black Box Warning
Suprane is contraindicated for induction of anesthesia in pediatric patients due to a high incidence of laryngospasm, coughing, breath-holding, and hypoxia.
| Serious Effects |
Known or suspected susceptibility to malignant hyperthermiaKnown hypersensitivity to sevoflurane or other halogenated agentsSevere hepatic dysfunction (e.g., acute hepatitis, jaundice, or unexplained elevated liver enzymes)Use for induction in patients with known or suspected increased intracranial pressure (unless controlled ventilation is ensured)
| Precautions | Risk of malignant hyperthermia, Risk of perioperative hypersensitivity reactions including anaphylaxis, Risk of QT prolongation and torsades de pointes, Risk of hepatotoxicity in patients with previous exposure to halogenated anesthetics, May cause dose-dependent respiratory depression, Use caution in patients with increased intracranial pressure, May cause hypotension and bradycardia |
| Food/Dietary | No direct food interactions; fasting is required before anesthesia (typically NPO for 6-8 hours for solids, 2 hours for clear liquids) to reduce aspiration risk during induction. |
| Clinical Pearls | Suprane (desflurane) has a low blood-gas partition coefficient (0.42) enabling rapid induction and emergence. It is a potent bronchodilator but can cause airway irritation and coughing during induction; avoid in pediatric mask inductions. Contraindicated in patients with known or suspected malignant hyperthermia susceptibility. Requires a calibrated vaporizer due to high vapor pressure (near-ambient). Can produce dose-dependent hypotension and respiratory depression. |
| Patient Advice | You will be given this anesthetic gas through a mask or breathing tube to keep you asleep during surgery. · You may experience a temporary sore throat or cough after waking up. · Common side effects include nausea, vomiting, and shivering as you recover. · You should not drive or operate machinery for at least 24 hours after anesthesia. · Inform your doctor if you have any personal or family history of malignant hyperthermia. |
Loading safety data…