Isoflurane Piramal Critical Care (Isoflurane)

• Isoflurane is a volatile anesthetic used in the general anesthesia pathway.
• Induction of general anesthesia: rapid onset of unconsciousness for surgical procedures.
• Maintenance of general anesthesia: sustained depth of anesthesia throughout operations.
• Adjunct in cardiopulmonary bypass: helps maintain anesthesia during bypass procedures.
• Procedural sedation: provides controlled sedation for short, minimally invasive interventions.

• Isoflurane acts by potentiating the inhibitory GABA_A receptor and simultaneously inhibiting excitatory NMDA receptors in the central nervous system. This dual action reduces neuronal firing, leading to loss of consciousness, analgesia, and muscle relaxation, thereby facilitating controlled depth of anesthesia during surgical procedures.

Isoflurane may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Hypotension: reduced blood pressure during induction.
• Respiratory depression: decreased respiratory drive.
• Nausea and vomiting: post‑operative gastrointestinal upset.
• Tachycardia: elevated heart rate.
• Increased airway resistance: bronchospasm in susceptible patients.
• Dry mouth: mucosal dryness during recovery.

Serious or Rare Side Effects

• Malignant hyperthermia: life‑threatening hypermetabolic reaction.
• Severe hypotension: profound circulatory collapse.
• Cardiac arrhythmias: abnormal heart rhythms.
• Hepatotoxicity: rare liver injury.
• Seizures: occasional convulsive activity.
• Anaphylaxis: severe allergic reaction.

• Isoflurane requires careful monitoring and specific safety measures to minimize risks.
• Cardiovascular monitoring: continuously observe blood pressure and heart rate.
• Avoid in malignant hyperthermia‑susceptible patients: contraindicated due to risk of severe reaction.
• Caution in hepatic impairment: reduced metabolism may increase exposure.
• Ensure adequate ventilation: maintain oxygenation and CO₂ elimination.
• Limit prolonged exposure: avoid extended use beyond recommended surgical duration.
• Store at ambient temperature: keep container sealed, protect from light and moisture.

Isoflurane can interact with other drugs, affecting its safety and efficacy.

Major Interactions (Avoid)

• Potent CYP2E1 inhibitors: may increase isoflurane plasma levels.
• Concurrent volatile anesthetics: additive central nervous system depression.
• Neuromuscular blocking agents: potentiation of muscle relaxation.

Moderate Interactions (Monitor Closely)

• Drugs affecting hepatic metabolism (e.g., halothane): may alter clearance.
• Medications that lower blood pressure (e.g., beta‑blockers): enhanced hypotensive effect.
• Agents increasing intracranial pressure: potential for elevated cerebral pressure.