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Terrell (Isoflurane) - Summary

 
 



TERRELL SUMMARY


Isoflurane, USP, a nonflammable liquid administered by vaporizing, is a general inhalation anesthetic drug.

Terrell (ISOFLURANE) is indicated for the following:


Isoflurane may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.


See all Terrell indications & dosage >>

NEWS HIGHLIGHTS

Media Articles Related to Terrell (Isoflurane)

Study shows anesthesia-related deaths decline; improvement needed to reduce injuries
Source: Pain / Anesthetics News From Medical News Today [2014.10.17]
Although recent trends show a decline in anesthesia-related deaths, a study published today by the Journal of Healthcare Risk Management concludes that risks are evolving and both physicians and...

Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Source: MedicineNet Pregnancy Drug Dangers Specialty [2014.10.15]
Title: Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Category: Health News
Created: 10/14/2014 12:00:00 AM
Last Editorial Review: 10/15/2014 12:00:00 AM

Large study delivers message to expectant mothers: Epidural, spinal anesthesia safe choices for relieving pain
Source: Pain / Anesthetics News From Medical News Today [2014.10.14]
Women seeking pain relief during childbirth should be comforted to know that epidural and spinal anesthesia are extremely safe, suggests a study of more than 80,000 women that reviewed anesthesia...

Huge registry shows anesthesia complication rates dropped by more than half in four years
Source: Pain / Anesthetics News From Medical News Today [2014.10.12]
Anesthesia-related complications decreased by more than half in four years, according to the Anesthesia Quality Institute's (AQI) National Anesthesia Clinical Outcomes Registry (NACOR) of more than...

The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Source: MedicineNet Heart Attack and Atherosclerosis Prevention Specialty [2014.09.08]
Title: The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Category: Doctor's Views
Created: 9/8/2014 12:58:00 PM
Last Editorial Review: 9/8/2014 12:58:43 PM

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Published Studies Related to Terrell (Isoflurane)

Effect of a heat and moisture exchanger on heat loss in isoflurane-anesthetized dogs undergoing single-limb orthopedic procedures. [2011.12.15]
Objective-To determine whether a heat and moisture exchange device (HME) prevents a decrease in body temperature in isoflurane-anesthetized dogs undergoing orthopedic procedures...

Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol - a clinical trial. [2011.11.21]
BACKGROUND: Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown. We tested whether RIPC is associated with differential effects depending on background anesthesia. Specifically, we hypothesized that RIPC during isoflurane anesthesia attenuates myocardial injury in patients undergoing coronary artery bypass graft (CABG) surgery, and that effects may be different during propofol anesthesia... CONCLUSION: Thus, RIPC during isoflurane but not during propofol anesthesia decreased myocardial damage in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked by upper limb ischemia/reperfusion depend on background anesthesia, with combined RIPC/isoflurane exerting greater beneficial effects under conditions studied. (c) 2011 The Authors Acta Anaesthesiologica Scandinavica (c) 2011 The Acta Anaesthesiologica Scandinavica Foundation.

Increased lung clearance of isoflurane shortens emergence in obesity: a prospective randomized-controlled trial. [2011.09]
Background: There is a concern that obesity may play a role in prolonging emergence from fat-soluble inhalational anaesthetics. We hypothesized that increased pulmonary clearance of isoflurane will shorten immediate recovery from anaesthesia and post-anaesthesia care unit (PACU) stay in obese patients.

Respiratory resistance during anaesthesia with isoflurane, sevoflurane, and desflurane: a randomized clinical trial. [2011.09]
BACKGROUND: To investigate whether the effects of desflurane on inspiratory resistance are similar to those of isoflurane and sevoflurane during 30 min administration at 1 and 1.5 MAC in patients with healthy lungs... CONCLUSIONS: In healthy adults, neither sevoflurane nor isoflurane produced bronchodilation at 1 and 1.5 MAC. Desflurane did not affect respiratory resistance at 1 MAC, but at 1.5 MAC caused significant increase in both total and airway resistance with return to near baseline values after discontinuation of the agent.

Synergy of isoflurane preconditioning and propofol postconditioning reduces myocardial reperfusion injury in patients. [2011.07]
Either isoflurane preconditioning or high-dose propofol treatment has been shown to attenuate myocardial IRI (ischaemia/reperfusion injury) in patients undergoing CABG (coronary artery bypass graft) surgery. It is unknown whether isoflurane and propofol may synergistically attenuate myocardial injury in patients...

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Clinical Trials Related to Terrell (Isoflurane)

Acceleration of Recovery From General Anesthesia - Efficacy of Isocapnic Hyperpnoea in Obese Patients Undergoing Isoflurane Anesthesia [Recruiting]
Faster recovery from anesthesia is important for obese patients because they are at high risk of respiratory complications following tracheal extubation. Isoflurane has several properties that make it a preferable agent for anesthesia in obese patients. Its main limitation is a longer recovery time due to slower elimination in comparison to other agents. Elimination of isoflurane from the lungs can be accelerated by increasing in patient's minute ventilation, which decreases the level of CO2 in blood (hypocapnia).Isocapnic Hyperpnoea (IH) is a method allowing increased ventilation and therefore enhancement of the elimination of inhalation agents while maintaining a normal blood CO2 level. The investigators will compare recovery time from isoflurane anesthesia in obese patients during standard anesthesia management protocol (control) to a group treated with IH.

The Effect of Sevoflurane Versus Isoflurane on Vasopressor Need [Recruiting]

Effects of Propofol and Isoflurane on Pulmonary Vascular Resistance [Recruiting]
The investigators hypothesize that there is no difference between the effects of isoflurane and propofol anaesthesia on pulmonary vascular resistance (PVR).

Closed Loop Isoflurane Administration With Bispectral Index in Open Heart Surgery [Recruiting]
With the advancement in microprocessor technology and better understanding of pharmacodynamics and pharmacokinetics of anaesthetic agents, computer facilitated closed loop control of anaesthesia using propofol has been shown to be accurate with better performance than manual control (3,4). Literature on computer controlled administration of inhalational anaesthetics is few (1), as it requires the computer to control the dial setting on the vapouriser. The investigators intend to compare the computer controlled closed loop administration of isoflurane by infusing it into the anaesthetic circuit with conventional vaporiser control in elective open heart surgery.

40 patients (ASA II-IV; 18- 65 years) undergoing elective cardiac surgery requiring cardiopulmonary bypass (CPB) will be randomly divided into manual or closed loop groups. Propofol will be used for induction of anaesthesia in both groups followed by isoflurane for maintenance. In the manual group, isoflurane will be administered through the Tech 7 vapouriser during pre and post CPB periods to target bispectral index (BIS) of 50. In closed loop group, isoflurane will be administered using infusion of liquid isoflurane into expiratory limb of the closed circuit. This rate of infusion though a conventional syringe pump will be controlled by algorithm termed 'Improvised Anaesthetic Agent Delivery System' (IAADS) to maintain BIS of 50. Patients in both groups will receive 500ml of 100 % oxygen as fresh gas flow. The % of time bispectral index (BIS) is within the 10% of set target BIS of 50 will be the primary outcome measure. The secondary outcome measures will be median performance error (MDPE)(2), median absolute performance error (MDAPE)(2), wobble(2), divergence(2), amount of isoflurane used and hemodynamic parameters will be secondary outcome measures.

Sevoflurane and Isoflurane - During Cardiopulmonary Bypass With the MECC System (Minimized Extracorporeal Circuit) [Recruiting]
The use of volatile anesthetics in cardiac anesthesia is very common, because of their cardioprotective effects and their ability to ensure a sufficient depth of anesthesia. In line with the development of fast track concepts in cardiac anesthesia, volatile anesthetics are widely used to avoid a delayed recovery from cardiac surgery and anesthesia. Volatile anesthetics are delivered from calibrated vaporizers in the anesthesia machine or the cardiopulmonary bypass machine (during extracorporeal circulation).

Isoflurane and Sevoflurane are the most commonly used volatile anesthetics in patients undergoing cardiopulmonary bypass (CPB). The vaporizer of the anesthetics is on the cardiopulmonary bypass machine and the volatile agent is blended with air and oxygen. Until now, the pharmacokinetics of halothane, enflurane, isoflurane and desflurane during CPB have been described.

Sevoflurane might be of advantage because of additional myocardial protective effects during cardiac anesthesia and cardiopulmonary bypass. However, the pharmacokinetics of sevoflurane during CPB have not been investigated so far, although its being used at many hospitals.

The investigators will conduct a randomized prospective study with either sevoflurane or isoflurane during cardiopulmonary bypass surgery. The study will help to answer the questions about the possible cardioprotective effects of the widely used volatile anesthetics and the hemodynamic stability during cardiopulmonary bypass. Knowing the pharmacokinetics of these drugs allows the anesthesiologist to titrate the volatile anesthetics more precise.

The investigators hypothesizes that the maximal postoperative increase in troponin T will be smaller in the sevoflurane group than in the isoflurane group. The investigators hypothesizes that the total amount of noradrenaline needed during the entire period of cardiopulmonary bypass will be smaller in the sevoflurane group than in the isoflurane group. The investigators hypothesizes that kinetics of washin and washout at the CPB will be faster in the sevoflurane group than in the isoflurane group. The investigators hypothesizes that the time to extubation, respectively the length of stay in intensive care unit and hospital is shorter in the sevoflurane group than in the isoflurane group.

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Page last updated: 2014-10-17

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