SUPRANE
Clinical safety rating: caution
Comprehensive 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SUPRANE (SUPRANE).
| Breastfeeding | Sevoflurane is rapidly eliminated; trace amounts may be excreted into breast milk. The M/P ratio is not established. Due to rapid clearance, the risk to the infant is low. The manufacturer recommends discontinuing breastfeeding for 24 hours after anesthesia to minimize exposure. |
| 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. |
■ 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 hyperthermia","Known hypersensitivity to desflurane or other halogenated anesthetics","Induction of anesthesia in pediatric patients","Patients with a history of hepatitis or unexplained jaundice after previous halogenated anesthetic use"]
| 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"] |
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| 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. |