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Terrell (Isoflurane) - Indications and Dosage

 
 



INDICATIONS & USAGE

Isoflurane may be used forinduction and maintenance of general anesthesia. Adequate data have notbeen developed to establish its application in obstetrical anesthesia.

DOSAGE & ADMINISTRATION

Premedication

Premedication shouldbe selected according to the need of the individual patient, taking intoaccount that secretions are weakly stimulated by isoflurane, and the heart ratetends to be increased. The use of anticholinergic drugs is a matter of choice.


InspiredConcentration

The concentration ofisoflurane being delivered from a vaporizer during anesthesia should be known.

This may beaccomplished by using:

a) vaporizerscalibrated specifically for isoflurane;

b) vaporizers fromwhich delivered flows can be calculated, such as vaporizers delivering asaturated vapor which is then diluted. The delivered concentration from such avaporizer may be calculated using the formula:


% Isoflurane =  100 PVFV

                        FT (PA– PV)


where:


PA =Pressure of atmosphere

PV = Vaporpressure of isoflurane

FV = Flowof gas through vaporizer (mL/min)

FT = Totalgas flow (mL/min)


Isoflurane containsno stabilizer. Nothing in the agent alters calibration or operation of these vaporizers.


Induction

Induction withisoflurane in oxygen or in combination with oxygen-nitrous oxide mixtures mayproduce coughing, breath holding, or laryngospasm. These difficulties may beavoided by the use of a hypnotic dose of an ultra-short-acting barbiturate.Inspired concentrations of 1.5 to 3.0% isoflurane usually produce surgicalanesthesia in 7 to 10 minutes.


Maintenance

Surgical levels ofanesthesia may be sustained with a 1.0 to 2.5% concentration when nitrous oxideis used concomitantly. An additional 0.5 to 1.0% may be required whenisoflurane is given using oxygen alone. If added relaxation is required,supplemental doses of muscle relaxants may be used.


The level of blood pressure during maintenance is an inverse function ofisoflurane concentration in the absence of other complicating problems.Excessive decreases may be due to depth of anesthesia and in such instances maybe corrected by lightening anesthesia.

HOW SUPPLIED

Isoflurane, USP ispackaged in 100 mL and 250 mL amber-colored bottles.

100 ML - NDC66794-011-10

250 ML - NDC 66794-011-25

Safety and Handling

Occupational Caution

There is no specificwork exposure limit established for Isoflurane. However, the National Institutefor Occupational Safety and Health Administration (NIOSH) recommends that noworker should be exposed at ceiling concentrations greater than 2ppm of anyhalogenated anesthetic agent over a sampling period not to exceed one hour.


The predicted effects of acute overexposure by inhalation of Isofluraneinclude headache, dizziness or (in extreme cases) unconsciousness. There are nodocumented adverse effects of chronic exposure to halogenated anesthetic vapors(W aste A nesthetic G ases or WAGs) in the workplace.Although results of some epidemiological studies suggest a link betweenexposure to halogenated anesthetics and increased health problems (particularlyspontaneous abortion), the relationship is not conclusive. Since exposure toWAGs is one possible factor in the findings for these studies, operating roompersonnel, and pregnant women in particular, should minimize exposure.Precautions include adequate general ventilation in the operating room, the useof a well-designed and well-maintained scavenging system, work practices tominimize leaks and spills while the anesthetic agent is in use, and routineequipment maintenance to minimize leaks.

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