Isoflurane

FDA label

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Renal Undefined

Hepatic Contraindicated after prior halogenated-anesthetic hepatitis/unexplained hepatic dysfunction; use with caution in hepatic disease

Instructions

• Administer only by personnel trained in general anesthesia, via a vaporizer designed for isoflurane
• Individualize and titrate to effect by age and clinical status (MAC decreases with increasing age)
• Replace desiccated CO2 absorbent before use to avoid carbon monoxide formation
• Have airway, ventilation, oxygen, and circulatory resuscitation immediately available

Available strengths

• sol 99.9 %
• inhaler 1 mL/mL

Contraindications

• Patients in whom general anesthesia is contraindicated
• Known or suspected genetic susceptibility to malignant hyperthermia
• History of confirmed hepatitis or unexplained moderate-severe hepatic dysfunction after a halogenated inhalational anesthetic

Cautions

• Malignant hyperthermia — discontinue triggers, give IV dantrolene, supportive care
• Perioperative hyperkalemia — especially neuromuscular disease/Duchenne muscular dystrophy
• Hepatic reactions/sensitivity hepatitis with repeated exposure
• Hypersensitivity reactions, incl. anaphylaxis
• QT prolongation/torsade de pointes — monitor susceptible patients
• Carbon monoxide from desiccated CO2 absorbents
• Pediatric neurotoxicity with >3 h exposure in children <3 yr
• Dose-dependent hypotension/reduced systemic vascular resistance

Adverse reactions

• Agitation
• Cough, breath holding
• Laryngospasm
• Nausea, vomiting
• Chills/shivering
• Delirium
• Arrhythmias
• Hypotension

Pregnancy No adequate human studies; animal embryofetal toxicity; prolonged 3rd-trimester/early-life exposure raises neurotoxicity concern.

Lactation Insufficient data on excretion in human milk; weigh risks and benefits before use in nursing women.