Anaesthetic Ether/ 1901

anaesthesia. Ether also possesses analgesic and muscle 400 micrograms/kg). analgesics or berequired. The dose of etomidate should also be reduced in relaxant properties. Premedication with an antimuscarinic as premedication reduce myoclonic muscle movements; patients with hepatic cirrhosis. Caution may be appropriate such as atropine is necessary to reduce salivary and also reduce injection site pain. A neuromuscular in patients with pre-existing epilepsy. bronchial secretions. blocker is necessary if intubation is required. See also Adverse Effects and Precautions for General Solvent ether is described on p. 2212.3. Anaesthetics, p. 1896.3. Administration in children. Etomidate is used in children Adverse Effects for the induction of anaesthesia; for details of doses, Effects on the endocrine system. Etomidate used for seda­ which may be proportionately larger than in adults, see tion in an intensive care unit was implicated in an Ether has an irritant action on the mucous membrane of the Uses and Administration, above. US licensed product increase in mortality. 1 However, there is considerable con­ respiratory tract; it stimulates salivation and increases information does not recommend the use of etomidate troversy about the effects of etomidate on mortality in cri­ bronchial secretion. Laryngeal spasm may occur. Ether below 10 years of age. In the UK, etomidate emulsion is tically-ill patients (such as those with severe trauma or causes vasodilatation which may lead to a severe fall in licensed for use in those aged over 6 months, although it sepsis) when given as a single bolus dose for induction.2 blood pressure and it reduces blood flow to the kidneys; it may be given to younger patients in emergencies, and One systematic review' concluded that the use of etomi­ also increases capillary bleeding. The bleeding time is other formulations do not specify a minimum age; the date for rapid tracheal intubation in ctitically-ill patients unchanged but the prothrombin time may be prolonged. BNFC suggests all etomidate products may be used for was associated with an increased risk of mortality; how­ Ether may cause malignant hyperthermia in certain induction from I month of age. ever, another review" that included patients receiving rou­ individuals. Alterations in kidney and function have tine surgical anaesthesia found this effect to be statistically been reported. Convulsions occasionally occur. Hyperglyc­ Administration in theelderly. A study1 in elderly patients insignificant. aemia due to gluconeogenesis has been noted. has shown that although reducing the rate of intravenous The UK CSM agreed that etomidate could cause a Recovery is slow from prolonged ether anaesthesia and injection of etomidate reduces the speed of induction, the significant fall in circulating plasma-cortisol concentrations, postoperative vomiting is common. Acute overdosage of dosage required is also reduced. Giving etomidate 0.2% umesponsive to corticotropin stimulation.' Other regulators ether is characterised by respiratory failure and cardiac solution at a rate of !Omg/minute induced. anaesthesia in have taken similar views in restricting the use of etomidate, arrest. a mean of 89.6 seconds and required a mean dose of which is now not given by prolonged infusion, essentially Dependence on ether or ether vapour has been reported. II 0 micrograms/kg. Corresponding values for a rate of limiting its licensed use to induction of anaesthesia. Prolonged contact with ether spilt on any tissue produces 40 mg/minute were 47.7 seconds and 260micrograms/kg, Licensed product information advises that the postoperative necrosis. respectively. See also Adverse Effects of General Anaesthetics, rise in serum-cortisol concentration, which has been noted 1. Berthoud MC, et al. Comparison of infusion rates of three i.v. anaesthetic after thiopental induction, is delayed for about 3 to 6 hours p. 1896.3. agents for induction in elderly patients. Br J Anaesth 1993; 70: 423-7. when etomidate is used for induction, A study comparing the effects of etomidate with those of Anaesthesia. Etomidate might be useful for induction if Precautions on the adrenocortical function of neonates rapid tracheal intubation is required with a competitive Ether anaesthesia is contra-indicated in patients with borne by mothers who received these agents for induction neuromuscular blocker as it has been shown to reduce the diabetes mellitus, impaired kidney function, raised CSF of anaesthesia before caesarean section indicated that there time to onset of block with vecuronium.l.2 Indeed, etomi­ pressure, and severe liver disease. Its use is not advisable in was no evidence to preclude the use of etomidate in such date has been suggested2•3 by some to be the agent of hot and humid conditions in patients with fever, as patients. However, regardless of which anaesthetic agent choice for rapid sequence induction of anaesthesia in convulsions are liable to occur, particularly in children and was used, early feeding was recommended to avoid emergency settings; advantages include rapid onset and in patients who have been given atropine. neonatal hypoglycaemia. short duration of action, predictable clinical effect, and 6 See also Precautions for General Anaesthetics, p. 1897.3. The inhibitory effect of etomidate on adrenocortical haemodynarnic stability. However, there is considerable function has been used to control episodes of hypercorti­ controversy about its use in critically-ill patients, see Interactions solaemia; for details, see Cushing's Syndrome, above. Effects on the Endocrine System, below. Ether enhances the action of competitive neuromuscular 1. Ledingham Watt I. Influence of sedation on mortality in critically ill 1. Gill RS, Scott RPF. Etomidate shortens the onset time of neuromuscular 1M. multiple trauma patients. Lancet 1983; i: 1270. blockers to a greater degree than most other anaesthetics. block. Br J Anaesth 1992; 69: 444-6. 2. Kulstad EB, et al. Etomidate as an induction agent in septic patients: red 2. Bergen JM, Smith DC. A review of etomidate for rapid sequence However, it does not potentiate the arrhythmogenic effect flags or false alarms? West J Emera Med2010 ; 11: 161-72. intubation in the emergency department. J of sympathomimetics, including adrenaline, as much as Bmero Med 1997; 15: 221-30. 3. Albert SG, et al. The effect of etomidate on adrenal function in critical 3. Nestor NB, Burton JH. ED use of etomidate for rapid sequence induction. other inhalational anaesthetics. illness: a systematic review. Intensive Care Med 2011; 37: 901-10. Am J Emero Med 2008; 26: 946-50. See also Interactions of General Anaesthetics, p. 1897.3. 4. Hohl CM, et al. The effect of a bolus dose of etomidate on cortisol levels, mortality, and health services utilization: a systematic review. Ann Emero Cushing's syndrome. There have been reports1·4 of benefit Med 2010; 56: 105-13.e5. P.��P.�������� . with the use of etomidate for acute control of hypercorti­ 5. Goldberg A. Etomidate. Lancet 1983; ii: 60. . - - ...... 6. Crozier TA, et al. Effects of etomidate on the adrenocortical and (details are given in Volume B) solaemia associated with Cushing's syndrome (p. 2559.1), ProprielaryPreparations metabolic adaptation of the neonate. Br J Anaesth 1993; 70: 47-53. particularly if the oral route is not available. Single-ingredient Preparations.S.Afr. : Hoffmans Druppels. I. Greening JE, et a!. Efficient short-term control of hypercortisolaemia by Fr. : Ger.: Hypersensitivity. Reactions involving innnediate wide­ Homoeopathic Preparations. Strophantus Compose; low-dose etomidate in severe paediatric Cushing's disease. Horm Res Angioton H; Angioton St; Corselect N; Crataegus comp; Dia­ 2005; 64: 140-3. spread cutaneous flushing or urticaria attributed to etomi­ date have been described.' There have also been reports2•3 card. 2. Johnson TN, Canada TW.Etomidate use for Cushing's syndrome caused by an ectopic adrenocorticotropic hormone-producing tumor. Ann of anaphylactic reactions after injection of etomidate. Pharmacother 2007; 41: 350-3. 1. Watkins J. Etomidate: an 'immunologically safe' anaesthetic agent. 3. Dabbagh A, et al. Etomidate infusion in the critical care setting for Anaesthesia 1983; 38 (suppl): 34-8. suppressing the acute phase of Cushing's syndrome. Anesth Anala 2009; Etomidate tBAN, usAN, rtNNJ 2. Krumholz W, et al. Ein fall von anaphylaktoider reaktion nach gabe von 108: 238-9. etomidat. Anaesthesist 1984; 33: 161-2. 4. Mettauer N, Brierley J. A novel use of etomidate for intentional adrenal 3. Sold M, Rothhammer A. Lebensbedrohliche anaphylaktoide reaktion suppression to control severe hypercortisolemia in childhood. Pediatr Crit nach etomidat. Anaesthesist 1985; 34: 208-10. Care Med 2009; 10: e37-e40.

Status epilepticus. General anaesthesia may be used to Interactions control refractory tonic-clonic status epilepticus (p. 510.2). A reduced dose of etomidate may be necessary in patients A short-acting such as thiopental is usually who have received , , or opioids. The used, but other anaesthetics including etomidate have also effect of etomidate has been potentiated by other been tried1 for intractable convulsive status epilepticus. drugs. However, like several other anaesthetics there have been See also Interactions of General Anaesthetics, p. 1897.3. reports of seizures associated with its use in anaesthesia, 23 NOTE. Do not confuse with edetate; see Inappropriate especially in patients with epilepsy. Administration under Sodium Edetate, p. 155!.2. Calcium-channel blockers. Prolonged anaesthesia and 1. Yeoman P, et al. Etomidate infusions for the control of refractory status Cheyne-Stokes respiration after etomidate injection has Pharmacopoeias. In Chin., Bur. (see p. vii) and US. epilepticus. Intensive Care Med 1989; 15: 255-9. been reported in 2 patients also given verapami/.1 Ph. Eur. 8: (Etomidate). A white or almost white powder. 2. Nicoll K, Callender J. Etomidate-induced convulsion prior to electro­ convulsive therapy. Br J Psychiatry 2000; 177: 373. I. Moore CA. et al. Potentiation of etomidate anesthesia by verapamil: a M.p. about 68 degrees. Very slightly soluble in water; freely 3. Sen H, et al. Epileptic seizure during anaesthesia induction with report of two cases. Hosp Pharm 1989; 24: 24-5. soluble in and in .. Protect from etomidate. Middle East J Anesthesiol 2010; 20: 723-5. light. General anaesthetics. For a report of synergy between USP 36: (Etomidate). A white or almost white powder. Very Adverse Effectsand Precautions propofo / and etomidate, see p. 1912.2. slightly soluble in water; freely soluble in alcohol and in Excitatory phenomena (especially involuntary myoclonic dichloromethane. Protect from light. muscle movements, which are sometimes severe) are common after injection of etomidate, but may be reduced After injection, etomidate is rapidly redistributed from the Uses and Administration by giving an opioid analgesic or a short-acting benzodia­ CNS to other body tissues, and undergoes rapid metabolism Etomidate is an intravenous anaesthetic used for the zepine beforehand. Pain on injection may be reduced by in the liver and plasma. Pharmacokinetics are complex and induction of general anaesthesia (p. 1896.1). Anaesthesia is giving etomidate into a large vein in the arm rather than have been described by both 2- and 3-compartment models. rapidly induced and may last for 6 to 10 minutes with a into the hand, or, again, by premedication with an opioid Etomidate is about 76% bound to plasma proteins. It is single usual dose. Recovery is usually rapid without analgesic. Convulsions may occur -rarely, as may mainly excreted in the urine, but some is excreted in the hangover effect. Etomidate has no analgesic activity. laryngospasm and cardiac arrhythmias. Hypersensitivity bile. It may cross the placenta and is distributed into breast For the induction of anaesthesia, etomidate is available reactions including anaphylaxis have been reported. milk. as a conventional or an emulsion injection formulation. The Etomidate is associated with less hypotension than other usual dose is 300 micrograms/kg of etomidate given slowly, drugs commonly used for induction. References. preferably into a large vein in the arm, although a lower Because etomidate inhibits adrenocortical function 1. Levron JC, Assoune P. Pharmacoctnetique de l'etomidate. Ann Fr Anesth Reanim 1990; 9: 123-6. dose of ISO micrograms/kg of the emulsion formulation during maintenance anaesthesia (see below) its use is 2. Sfez M, et al. Comparaison de Ia pharmacocinetique de retomidate chez may be sufficient. An initial dose of !50 to 200 micr­ limited to induction of anaesthesia. Supplementary I' enfant et chez l'adulte. Ann Fr Anesth Reanim 1990; 9: 127-31. ograms/kg is recommended in the elderly, subsequently corticosteroid therapy should be considered in at-risk 3. Esener Z, et al. Thiopentone and etomidate concentrations in maternal and umbilical plasma, and in colostrum. J adjusted according to effects (see also below). Dosage should patients, particularly those with adrenocortical dysfunction. Br Anaesth 1992; 69: 586-8. 4. Kaneda K, et al. Population pharmacokinetics and pharmacodynamics of also be reduced in hepatic cirrhosis. Children may require Etomidate should be used with care in the elderly, who brief etomidate infusion in healthy volunteers. J Clin Pharmacol201 1; up to 30% more than the usual adult dose (i.e. up to may be more prone to cardiac depression; lower doses may 51: 482-9 1.

The symbol t denotes a preparation no longer actively marketed 1902 Genera l Anaesthetics

�r�p?r?lic:>n.� Incompatibility. In the presence of moisture, with injected adrenaline is lower with halothane than iso­ _ ...... reacts with many metals. Rubber and some plastics dete­ flurane or . (details are given in Volume B) ProprietaryPreparations riorate when in contact with halothane vapour or liquid. Arrhythmias are considered to be very common in children anaesthetised with halothane and in the UK it is Single-ingredient Preparations. Austria: Hypnomidate; Belg.: Hypnomidate; Braz. : Hypnomidate; China: Pu Er Li (;f�;J\5fV); Stability, Halothane contains 0.01% wlw of as a recommended that it should not be used for dental Cz. : Hypnomidate; Fr.: Hypnomidate; Ger.: Hypnomidate; Gr.: stabiliser; some commercial preparations may also contain procedures outside hospital in those under 18 years old. Hypnomidate; Mex. : Hypnomidate; Neth.: Hypnomidate; Pol.: up to 0.00025% wlw of ammonia. Thymol does not volati­ A review1 of the mechanisms involved suggested that at Hypnomidate; Port.: Hypnomidato; S.Afr. : Hypnomidate; lise with balothane and therefore accumulates in the physiologically relevant concentrations, halogenated anaes­ Spain: Hypnomidate; Turk. : Hypnomidate; UK: Hypnomidate; vaporiser. It may give a yellow colour to any remaining thetics interact mainly with the repolarising potassium USA: Amidate. liquid; halothane that has discoloured should be dis- channels hERG and IKs, as well as with calcium and sodium carded. channels at slightly higher concentrations. Inhibition of Pharmacopoeial Preporafions these produces proarrhythrnic changes such as slowing of USP 36: Etomidate Injection. repolarisation and conduction. Other mechanisms, in dud­ Uses and Administration ing. alteration of catecholamine-induced signal transduction Halothane is a volatile halogenated anaesthetic given by and possibly effects on neuronal pathways may also Fospropofol Sodium (riNNM! inhalation. It has a minimum alveolar concentration (MAC) contribute to arrhythmogencsis. value (see Uses of General Anaesthetics, p. 1896.1) ranging l. Fbspropofol Himmel HM. Mechanisms involved in cardiac sensitization by volatile Fo.spropofo! o•sodfurn (USANl: s6dico.;F()spro­ from 0.64% in the elderly to 1.08% in infants. It is : general applicability to halogenated hydrocarbons? Grit Rev Sodiq on . . . oxygen at normal atmospheric pressure. It is not irritant to ·. . . . . [2,6�Bis(1-methyi(O\hyl).phenoxjt]meihyl. . . · disodiurn Effects on the kidneys. Renal failure has been reported .. · ..• the skin and mucous membranes and does not produce · phos: phat�. necrosis when spilt on tissues. It suppresses salivary, after halothane anaesthesia, 1.2 sometimes with concurrent liver failure.2 C3M,9Na70,Pco3322 bronchial, and gastric secretions and dilates the bronchioles. .-'· 2585 1"(H!/�9 (fospropofol However, its use has diminished due to the risk of 1. Cotton JR, et al. Acute renal failure following halothane anesthesia. Arch CAS 2SBSi6-89, 1 (fospropofoi); Pathol Lab l\:Ied 1976; 100: 628-9. sodium), hepatotoxicity; in the UK, it is only available on a named­ 2. Gelman ML, Lichtenstein NS. Halothane-induced nephrotoxicity. patient basis and in other countries, such as the USA, it has Urology 1981; 17: 323-7. UN!/ - 30868AYOf,": been withdrawn frmn Lhe rnarket. Halothane is used for the induction and maintenance of Effects on the liver, Liver damage has been recognised as Profile general anaesthesia (p. 1896.1) and is given using a an adverse effect of halothane for many years1·3 and con­ calibrated vaporiser to provide close control over the tinues to be reported.4 It may be severe, and associated Fospropofol is a of (p. I 909.3) that is given concentration of inhaled vapour. with a high mortality. intravenously as the sodium salt for sedation (p. 1032.2) in Anaesthesia may be induced initially with 0.5% v/v of Two types of hepatotoxicity are recognised; in type I adult patients undergoing diagnostic or therapeutic halothane in oxygen or mixtures of and there is a minor disturbance in liver function shown by procedures. In those aged under 65 years, and who are oxygen, and increased gradually, according to response, to a increases in liver enzyme values; this may occur in up to healthy or have mild systemic disease, an initial bolus concentration of 2 to 4% v/v. It takes up to about 5 minutes 30% of patients given halothane,5 or more if activity is injection of 6. 5 mglkg (minimum; 385 mg, maximum: to attain surgical anaesthesia and halothane produces little measured by glutathione-S-transferase rather than serum 577.5 mg) may be followed by supplemental doses of or no excitement in the induction period. The more usual aminotransferase. 6 Subsequent re-exposure to halothane is 1.6mglkg (minimum; 105mg, maximum: 140 mg) given no practice is to induce anaesthesia with an intravenous agent. not necessarily associated with liver damage.2•7 more frequently than every 4 minutes. Patients aged 65 Anaesthesia is maintained with concentrations of 0.5 to 2% Type II hepatotoxicity, which is rarer, involves massive years and older, or those with severe systemic disease, vlv depending on the flow rate used; the lower liver cell necrosis; reported incidences2 range from I in 2500 should be given 7 5% of the usual initial (minimum: concentration is usually suitable for the elderly. to 1 in 36 000. Type II liver toxicity is characterised by 297.5 mg, maximum: 437.5 mg) and supplemental (mini­ Adequate muscle relaxation is only achieved with deep several clinical features: non -specific gastrointestinal upset, mum: 70mg, maximum: 105mg) doses. anaesthesia so a neuromuscular blocker is given to increase delayed pyrexia, jaundice, eosinophilia, serum autoanti­ References. muscular relaxation if necessary. bodies, rash, and arthralgia. u Biochemical tests of liver l. Fechner J, et al. Pharmacokinetics and pharmacodynamics of GPI 15715 function show changes typical of hepatocellular damage; or fospropofol (Aquavan injection): a water-soluble propofol prodrug. Administration in children. Halothane has been used for histological features are typified by centrilobular necrosis. 3 In: SchUttler J, Schwilden H, eds. Handb Exp Pharmacal: Modem Anesthetics. Berlin: Springer-Verlag, 2008; 182 (III): 253-66. the induction and maintenance of general anaesthesia in Several risk factors for development of serious toxicity 2. Levitzky BE, Vargo JJ. Fospropofol disodium injection for the sedation of children; however, in the UK, it is now mainly used by have become apparent;1•3 they include repeated exposure, patients undergoing colonoscopy. Ther Clin Risk Manag 2008; 4: 733-8. specialist anaesthetists to manage difficult airways. Doses previous adverse reactions to halothane (jaundice, pyrexia), 3. Silvestri GA, et a!. A phase 3, randomized, double-blind study to assess are as for adults (see Uses and Administration, above). female gender, obesity, middle age, genetic predisposition, the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest 2009; 135: enzyme induction, and a history of drug allergy. 41-7. Status osthmaticus. Inhalational anaestbetics such as The causes of halothane hepatotoxicity have been 4. Garnock-Junes KP, Scott LJ. Fospropofol. Drugs 2010; 70: 469-77. halothane, , and , have occasionally debated. Type I reactions may result from toxic products of 5. Gan TJ, et al. Safety evaluation of fospropofol for sedation during minor been used in the management of life-threatening acute halothane metabolism, possibly influenced by genetic surgical procedures . .J Clin Anesth 2010; 22: 260-7. 6. Pergolizzi JV, et al. Perspectives on the role of fospropofol in the severe asthma (p. 1195.2) unresponsive to standard mea­ factors or from an imbalance between hepatic oxygen monitored anesthesia care setting. Anesthesia! Res Pract 2011; 2011: sures. supply and demand. Changes in cellular calcium homo­ 458920. eostasis may also be involved. Type II reactions are most References. 7. Bengalorkar GM, et al. Fospropofol: clinical pharmacology. J Anaesthesia! likely immune-mediated2·3 It has been suggested' that Clin Pharmacal 201 1; 27: 79-83. l. Restrepo RD, et a!. Halothane, an effective infrequently used drug, in the treatment of pediatric status asthmaticus: a case report. J Asthma 2005; metabolism of halothane produces a reactive metabolite 42: 649-5 1. which binds covalently to proteins in the endoplasmic � li 2. Shankar V, et al. Isoflurane therapy for severe refractory status reticulum of hepatocytes. In susceptible patients it is r�p?r?_ c:>n.� asthmaticus in children. Intensive Care Med 2006; 32: 927-33. - . " believed that these metabolite-modified proteins provoke Proprietary Preparations (details are given in Volume B) 3. Thomson H, et al. Use of the AnaConDa anaesthetic delivery system to treat life-threatening asthma. Anaesthesia 2007; 62: 295-6. an immune response which is responsible for the liver Single-ingredient Preparations, USA: Lusedrat. 4. Burburan SM, et a!. Anaesthetic management in asthma. Minerva damage. Findings8•9 have implicated the cytochrome P450 Anestesiol 2007; 73: 357-65. isoenzyme CYP2El as having a major role in the metabolism 5. Watanabe K, etal. Prolonged sevoflurane inhalation therapy for status asthmaticus in an infant. Pediatr Anesth 2008; 18: 543-5. of halothane and patients with high levels of this isoenzyme 6. Vaschetto R, et a!. Inhalational anesthetics in acute severe asthma. Curr may be predisposed to developing immune-medicated liver Halothane !BAN, rJNN! Targets 2009; 10: 826-32. da1nage after halothane exposure. 7. JD. Inhalational anesthesia; basic pharmacology, end organ Alotano; The UK CSM, 10 after receiving 84 further reports of Ha!.ota<. Intensive Care Med 2009; 24: 361-71. hepatotoxicity between 1978 and 1985, issued the following Pht�cir<_:>thaflurn; guidelines on precautions to be taken before using (R5l72-Bromo--2-chloro-1. , l ,.1-triftuoroethane.. CHBrCI.(F3:.197.4 halothane: Adverse Effects a careful anaesthetic history should be taken to • C45 - i 51.:07-7. - As with other halogenated anaesthetics, halothane has a determine previous exposure and previous reactions to N01A801, depressant action on the cardiovascular system and reduces halothane Ve.t _, QNO lllBOI. repeated exposure to halothane within a period of at blood pressure; signs of overdosage are bradycardia and • UNII ,.- UQT9G450 JP. profound hypotension. It is also a respiratory depressant and least 3 months should be avoided unless there are Pharmacopoeias. In Chin., Eur. (see p. vii), Int., Jpn, and US. can cause cardiacarrhythmias; there have been instances of overriding clinical circumstances. An opinion has been expressed that the 3-month interval between exposures Ph, Eur. 8: (Halothane). A clear, colourless, mobile, dense, cardiac arrest. The sensitivity of the heart to sympathomi- metic amines is increased. would be unlikely to prevent hepatotoxicity' non-flammable liquid. Distillation range 49 degrees to 51 1 Adverse effects on the liver have limited its use in recent a history of unexplained jaundice or pyrexia in a patient degrees. Slightly soluble in water; miscible with dehydrated • years (see below); these effects range from liver dysfunction following exposure to halothane is an absolute alcohol and with . Halothane contains to fatal hepatitis and necrosis and are more frequent contra-indication to its future use in that patient 0.01% wlw of thymoL Store at a temperature not greater These guidelines were reiterated in 1997 after the CSM was than 25 degrees in airtight containers. Protect from light. following repeated use. Halothane can produce nausea, vomiting, and shivering. notified of a further 15 cases of acute liver failure all USP 36: (Halothane). A colourless, mobile, non-flammable, Malignant hyperthermia has been reported. requiring transp1antation.11 heavy liquid having a characteristic odour resembling that See also Adverse Effects of General Anaesthetics, The problem of patients sensitised to halothane who of . It contains not less than 0.008% and not p. 1896.3. require subsequent anaesthesia with a volatile anaes­ more than 0.012% of thymol, by weight, as a stabiliser. It Review. thetic has been cliscussed -' Although the incidence of should contain not more than 0.03% of water. Distillation I. Kharasch ED. Adverse dntg reactions with halogenated anesthetics. Clin hepatotoxicity produced by enfluraneappears to be less than range 49 degrees to 51 degrees. Pharmacal Ther 2008; 84: 158-62. with halothane, it is of a similar nature and there have been Slightly soluble in water; misdble with alcohol, with reports of several patients who apparently had cross­ chloroform, with ether, and with fixed oils. Store in airtight Effects on the cardiovascular system, The incidence of sensitivity to both. Hepatotoxicity with isofluraneappears to containers at a temperature not greater than 40 degrees. carcliac arrhythmias is higher with halothane than with be rare and it was suggested that for the majority of patients Protect from light. Dispense only in the original container. enflurane or isoflurane; also the arrhythmogenic threshold sensitised to halothane, isoflurane would be likely to be free

All cross-references refer to entries in Volume A