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Ethrane

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Indications:

May be used for induction and maintenance of general anesthesia. Enflurane may be used for analgesia in vaginal delivery. Enflurane may also be used for anesthesia during operative vaginal delivery or delivery by Caesarean section. However, as noted above, higher concentrations of enflurane may produce uterine bleeding.

Contraindications:

Seizure disorders,Known sensitivity to enflurane or other halogenated anesthetics.

Adverse reactions:

Motor activity exemplified by movement of various muscle groups and/or seizures may be encountered with deep levels of enflurane anesthesia. Hypotension, respiratory depression, arrhythmias, shivering, hyperthermia, nausea and vomiting have been reported. Elevation of the WBC count has been observed. It has not been determined whether this is related to enflurane or to surgical stress. Elevation of AST, LDH, alkaline phosphatase, and bilirubin, with or without frank jaundice, have been reported in the post-operative period following enflurane anesthesia in some patients. Hepatitis has been reported very rarely. Delirium, hallucinations and hiccup occur rarely.

Interactions:

The action of nondepolarizing relaxants is augmented by enflurane. 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 neuromuscular blockade will be longer in the presence of enflurane than when halothane or nitrous oxide with a balanced technique are used.

Warnings:

Bromsulfalein (BSP) retention is mildly elevated postoperatively in some cases. There is some elevation of glucose and WBC count intraoperatively. Glucose elevation should be considered in diabetic patients. In susceptible individuals, enflurane anesthesia may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia. The syndrome includes nonspecific features such as muscle rigidity, tachycardia, tachypnea, cyanosis, arrhythmias, and unstable blood pressure. (It should also be noted that many of these nonspecific signs may appear with light anesthesia, acute hypoxia, etc. The syndrome of malignant hyperthermia secondary to enflurane appears to be rare; by March 1980, 35 cases had been reported in North America for an approximate incidence of 1/725 000 enflurane anesthesias.) An increase in overall metabolism may be reflected in an elevated temperature (which may rise rapidly early or late in the case, but usually is not the first sign of augmented metabolism) and an increased usage of the CO2 absorption system (hot canister). PaO2 and pH may decrease, and hyperkalemia and a base deficit may appear. Treatment includes discontinuance of triggering agents (e.g. enflurane), administration of i.v. dantrolene sodium, and application of supportive therapy. Such therapy includes vigorous efforts to restore body temperature to normal, respiratory and circulatory support as indicated, and management of electrolyte-fluid-acid-base derangements. (Consult prescribing information for dantrolene sodium i.v. for additional information on patient management.) Renal failure may appear later, and urine flow should be sustained if possible.

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