Isoflurane

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 decom pose in the presence of soda lime (at normal operating temperatures) and does not attack aluminum, tin, brass, iron or copper.

CLINICAL PHARMACOLOGY

Isoflurane (isoflurane, USP) is an inhalation anesthetic. Induction and recovery from anesthesia with isoflurane are rapid. ^2,5The level of anesthesia may be changed rapidly with isoflurane. Isoflurane is a profound respiratory depressant. RESPIRATION MUST BE MONITORED CLOSELY IN THE HORSE AND DOG AND SUPPORTED WHEN NECESSARY. As anesthetic dose is increased, both tidal volume and respiratory rate decrease. ^3,6This depression is partially reversed by surgical stimulation, even at deeper levels of anesthesia.

Blood pressure decreases with induction of anesthesia but returns toward normal with surgical stimulation. Progressive increases in depth of anesthesia produce corresponding decreases in blood pressure; however, heart rhythm is stable and cardiac output is maintained with controlled ventilation and normal PaCO ₂despite increasing depth of anesthesia. The hypercapnia which attends spontaneous ventilation during isoflurane anesthesia increases heart rate and raises cardiac output above levels observed with controlled ventilation. ³Isoflurane does not sensitize the myocardium to exogenously administered epinephrine in the dog.

Muscle relaxation may be adequate for intra-abdominal operations at normal levels of anesthesia. However, if muscle relaxants are used to achieve greater relaxation, it should be noted that: ALL COMMONLY USED MUSCLE RELAXANTS ARE MARKEDLY POTENTIATED WITH ISOFLURANE, THE EFFECT BEING MOST PROFOUND WITH THE NONDEPOLARIZING TYPE. Neostigmine reverses the effect of nondepolarizing muscle relaxants in the presence of isoflurane but does not reverse the direct neuromuscular depression of isoflurane.

INDICATIONS

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

ISOFLURANE CONTRAINDICATIONS

Isoflurane (isoflurane, USP) is contraindicated in horses and dogs with known sensitivity to isoflurane or to other halogenated agents.

WARNINGS

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

WARNING: Not for use in horses intended for food.

PRECAUTIONS

Isoflurane like some other inhalational anesthetics, can react with desiccated carbon dioxide (C0 ₂) absorbents to produce carbon monoxide which may result in elevated carboxyhemoglobin levels in some patients. Case reports suggest that barium hydroxide lime and soda lime become desiccated when fresh gases are passed through the CO ₂absorber canister at high flow rates over many hours or days. When a clinician suspects that CO ₂absorbent may be desiccated, it should be replaced before the administration of Isoflurane (isoflurane, USP).

Usage in Pregnancy: Reproduction studies have been performed in mice and rats with no evidence of fetal malformation attributable to Isoflurane (isoflurane, USP). Adequate data concerning the safe use of isoflurane in pregnant and breeding horses and dogs have not been obtained.

ISOFLURANE ADVERSE REACTIONS

Hypotension, respiratory depression and arrhythmias have been reported. For customer service, adverse effects reporting, and/or a copy of the material safety data sheet, call (888) 694-8381.

OVERDOSAGE

In the event of overdosage, or what may appear to be overdosage, the following action should be taken:

Stop drug administration, establish that the airway is clear and initiate assisted or controlled ventilation with pure oxygen as circumstances dictate.

ISOFLURANE DOSAGE AND ADMINISTRATION

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. Verni-trol® vaporizer) also may be used. The delivered concentration from such a vaporizer may be calculated using the formula: