Adult clinical experience with sevoflurane and pharmaco-economic aspects.

This article has reviewed the physical-chemical properties and performance characteristics of sevoflurane. Both drugs provide a greater degree of control of anesthetic depth and a more rapid immediate recovery from anesthesia than is currently available with other inhaled agents because of their decreased solubility. Sevoflurane is currently in widespread clinical use in Japan and parts of Europe and the Americas. Compared to desflurane, sevoflurane has the additional advantage of being non-irritating to the airway; inhalation induction of anesthesia with sevoflurane is achieved rapidly and easily. The instability of sevoflurane with carbon dioxide absorbents and its in vivo biotransformation produce potentially toxic by-products. These by-products, including Compound A and fluoride have been extensively studied and although the possibility for iatrogenic sequella from sevoflurane exists, the likelihood of long-term toxicity appears quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane: 1) to renally impaired patients, and 2) to any patient with fresh gas flows less than 2 liters per minute. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anesthesia.