Isoflurane Inhalant

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Isoflurane Inhalant Recall

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Side Effects & Adverse Reactions

Increasing depth of anesthesia with isoflurane may increase hypotension and respiratory depression. The electroencephalographic pattern associated with deep anesthesia is characterized by burst suppression, spiking, and isoelectric periods.4

Since levels of anesthesia may be altered easily and rapidly, only vaporizers producing predictable percentage concentrations of isoflurane should be used. (see DOSAGE AND ADMINISTRATION)
The action of nondepolarizing relaxants is augmented by isoflurane. Less than the usual amounts of these drugs should be used. If the usual amounts of non-depolarizing relaxants are given, the time for recovery from myoneural blockade will be longer in the presence of isoflurane than in the presence of other commonly used anesthetics.

Not for use in horses intended for food.

Keep out of reach of children.

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Legal Issues

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FDA Safety Alerts

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Manufacturer Warnings

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FDA Labeling Changes

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Uses

Attane (isoflurane, USP) is used for induction and maintenance of general anesthesia in horses and dogs.

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History

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Other Information

Isoflurane, USP, a nonflammable liquid administered by vaporizing, is a general inhalation anesthetic drug. It is l-chloro-2,2,2-trifluoroethyl difluoromethyl ether, and its structural formula is:

Each mL contains 99.9% isoflurane.

Some physical constants are:

Molecular weight 184.5

Boiling point at 760 mm Hg 48.5°C (uncorr.)

Refractive index n20D 1.2990-1.3005

Specific gravity 25° /25° C 1.496

Vapor pressure in mm Hg** 20° C 238

25° C 295

30° C 367

                                                35° C         450

**Equation for vapor pressure calculation:
                                                   A = 8.056
log10Pvap = A + B                    B = -1664.58
                             T                    T = oC + 273.16

Partition coefficients at 37°C:

Water/gas 0.61

Blood/gas 1.43

Oil/gas 90.8

Partition coefficients at 25°C - rubber and plastic

Conductive rubber/gas 62.0

Butyl rubber/gas 75.0

Polyvinyl chloride/gas 110.0

Polyethylene/gas ~2.0

Polyurethane/gas ~1.4

Polyolefin/gas ~1.1

Butyl acetate/gas ~2.5

Purity by gas chromatography >99.9%

Lower limit of flammability in oxygen or None

nitrous oxide at 9 joules/sec. and 23° C

Lower limit of flammability in oxygen or Greater than useful

nitrous oxide at 900 joules/sec. and 23° C concentration in anesthesia.

MAC (Minimum Alveolar Concentration) is 1.31% in horses1 and 1.28% in dogs.6

Isoflurane is a clear, colorless, stable liquid containing no additives or chemical stabilizers. Isoflurane has a mildly pungent, musty, ethereal odor. Samples stored in indirect sunlight in clear, colorless glass for five years, as well as samples directly exposed for 30 hours to a 2-amp, 115-volt, 60-cycle long wave U.V. light were unchanged in composition as determined by gas chromatography. Isoflurane in one normal sodium methoxide-methanol solution, a strong base, for over six months consumed essentially no alkali, indicative of strong base stability. Isoflurane does not decompose in the presence of soda lime, (at normal operating temperatures) and does not attack aluminum, tin, brass, iron or copper.

Sources

Isoflurane Inhalant Manufacturers

Piramal Critical Care Inc.

Isoflurane Inhalant | Piramal Critical Care Inc

Caution: Operating rooms should be provided with adequate ventilation to prevent the accumulation of anesthetic vapors.

Premedication: A premedication regimen, which may be employed depending upon the patient status, to avert excitement during induction, might include an anticholinergic, a tranquilizer, a muscle relaxant, and a short-acting barbiturate.

Inspired Concentration: The delivered concentration of isoflurane should be known. Isoflurane may be vaporized using a flow-through vaporizer specifically calibrated for isoflurane. Vaporizers delivering a saturated vapor which then is diluted. (eg, Verni-trol(R) vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:

                                             100 PVFV

% isoflurane                        -------------

                                                FT ( PA-FV)

where: PA = Pressure of atmosphere

            PV = Vapor pressure of isoflurane

            FV = Flow of gas through vaporizer (mL/min)

            FT = Total gas flow (mL/min)

Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.

Induction:
Horses: Inspired concentrations of 3.0% to 5.0% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the horse.

Dogs: Inspired concentrations of 2.0% to 2.5% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the dog.

These concentrations can be expected to produce surgical anesthesia in 5 to 10 minutes.

Maintenance: The concentration of vapor necessary to maintain anesthesia is much less than that required to induce it.

Horses: Surgical levels of anesthesia in the horse may be sustained with a 1.5% to 1.8%

concentration of isoflurane in oxygen.

Dogs: Surgical levels of anesthesia in the dog may be sustained with a 1.5% to 1.8%

concentration of isoflurane in oxygen.

The level of blood pressure during maintenance is an inverse function of isoflurane

concentration in the absence of other complicating problems. Excessive decreases, unless

related to hypovolemia, may be due to depth of anesthesia and in such instances may be

corrected by lightening the level of anesthesia.

Recovery from isoflurane anesthesia is typically uneventful.2

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Mwi Veterinary Supply Co

Isoflurane Inhalant | Mwi Veterinary Supply Co

Caution: Operating rooms should be provided with adequate ventilation to prevent the accumulation of anesthetic vapors.

Premedication: A premedication regimen, which may be employed depending upon the patient status, to avert excitement during induction, might include an anticholinergic, a tranquilizer, a muscle relaxant, and a short-acting barbiturate.
Inspired Concentration: The delivered concentration of Isoflurane (Isoflurane, USP) should be known. Isoflurane may be vaporized using a flow-through vaporizer specifically calibrated for Isoflurane. Vaporizers delivering a saturated vapor which then is diluted (e.g., Vernitrol® Vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:

Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.

Induction:

Horses: Inspired concentrations of 3.0 to 5.0% Isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia
in the horse.

Dogs: Inspired concentrations of 2.0 to 2.5% Isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the dog.

These concentrations can be expected to produce surgical anesthesia in 5 to 10 minutes.

Maintenance: The concentration of vapor necessary to maintain anesthesia is much less than that required to induce it.

Horses: Surgical levels of anesthesia in the horse may be sustained with a 1.5 to 1.8% concentration of Isoflurane in oxygen.

Dogs: Surgical levels of anesthesia in the dog may be sustained with a 1.5 to 1.8% concentration of Isoflurane in oxygen.

The level of blood pressure during maintenance is an inverse function of Isoflurane concentration in the absence of other complicating problems. Excessive decreases, unless related to hypovolemia, may be due to depth of anesthesia and in such instances may be corrected by lightening the level of anesthesia. Recovery from Isoflurane anesthesia is typically uneventful.2

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Mwi

Isoflurane Inhalant | Mwi

Caution: Operating rooms should be provided with adequate ventilation to prevent the accumulation of anesthetic vapors.

Premedication: A premedication regimen, which may be employed depending upon the patient status, to avert excitement during induction, might include an anticholinergic, a tranquilizer, a muscle relaxant and a short-acting barbiturate.

Inspired Concentration: The delivered concentration of Fluriso™(isoflurane, USP) should be known. Isoflurane may be vaporized using a flow-through vaporizer specifically calibrated for isoflurane. Vaporizers delivering a saturated vapor which then is diluted (e.g. Verni-trol® vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula:

% isoflurane = 100 PVFV / FT(PA-PV)

Where:     PA = Pressure of atmosphere
                PV = Vapor pressure of isoflurane
                FV = Flow of gas through vaporizer (mL/min)
                FT = Total gas flow used (mL/min)

Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.

Induction:

Horses: Inspired concentrations of 3.0 to 5.0% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the horse.

Dogs: Inspired concentrations of 2.0 to 2.5% isoflurane alone with oxygen following a barbiturate anesthetic induction are usually employed to induce surgical anesthesia in the dog.

These concentrations can be expected to produce surgical anesthesia in 5 to 10 minutes.

Maintenance: The concentration of vapor necessary to maintain anesthesia is much less than that required to induce it.

Horses: Surgical levels of anesthesia in the horse may be sustained with a 1.5 to 1.8% concentration of isoflurane in oxygen.

Dogs: Surgical levels of anesthesia in the dog may be sustained with a 1.5 to 1.8% concentration of isoflurane in oxygen.

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

Recovery from isoflurane anesthesia is typically uneventful.2

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Piramal Critical Care Inc

Isoflurane Inhalant | Piramal Critical Care Inc

PremedicationPremedication should be selected according to the need of the individual patient, taking into account that secretions are weakly stimulated by Isoflurane, USP, and the heart rate tends to be increased. The use of anticholinergic drugs is a matter of choice.Inspired ConcentrationThe concentration of isoflurane being delivered from a vaporizer during anesthesia should be known. This may be accomplished by using:a.Vaporizers calibrated specifically for isoflurane;b.Vaporizers from which delivered flows can be calculated, such as vaporizers delivering a saturated vapor, which is then diluted. The delivered concentration from such a vaporizer may be calculated using the formula:

% Isoflurane = 100 PVFV

FT (PA – PV)

where: PA = Pressure of atmosphere

PV = Vapor pressure of isoflurane

FV = Flow of gas through vaporizer (mL/min)

FT = Total gas flow (mL/min)

Isoflurane contains no stabilizer. Nothing in the drug product alters calibration or operation of these vaporizers.

InductionInduction with isoflurane in oxygen or in combination with oxygen-nitrous oxide mixtures may produce coughing, breath holding, or laryngospasm. These difficulties may be avoided by the use of a hypnotic dose of an ultra-short-acting barbiturate. Inspired concentrations of 1.5 to 3.0% isoflurane usually produce surgical anesthesia in 7 to 10 minutes.MaintenanceSurgical levels of anesthesia may be sustained with a 1.0 to 2.5% concentration when nitrous oxide is used concomitantly. An additional 0.5 to 1.0% may be required when isoflurane 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 of isoflurane concentration in the absence of other complicating problems. Excessive decreases may be due to depth of anesthesia and in such instances may be corrected by lightening anesthesia.

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Clipper Distributing Company Llc

Isoflurane Inhalant | Clinigen Healthcare Ltd.

CAUTION—DO NOT ADMINISTER FOSCAVIR BY RAPID OR BOLUS INTRAVENOUS INJECTION. THE TOXICITY OF FOSCAVIR MAY BE INCREASED AS A RESULT OF EXCESSIVE PLASMA LEVELS. CARE SHOULD BE TAKEN TO AVOID UNINTENTIONAL OVERDOSE BY CAREFULLY CONTROLLING THE RATE OF INFUSION. THEREFORE, AN INFUSION PUMP MUST BE USED. IN SPITE OF THE USE OF AN INFUSION PUMP, OVERDOSES HAVE OCCURRED.

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