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Wilmington, North Carolina once had a thriving Black middle class and an elected interracial government. In 1898 white supremacists used violence to overthrow that government, kill Black residents and drive many others from the city.
MORE →Reflects the personal views, recollections, and perspective of the author, Mike Davis.
This is a personal recollection on the Move fire on May 13, 1985
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| Clinical data | |
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| Trade names | Sevorane, Ultane, others |
| AHFS/Drugs.com | Micromedex Detailed Consumer Information |
| Pregnancy category |
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| Routes of administration | Inhalation |
| Drug class | Anesthetic |
| ATC code | |
| Legal status | |
| Legal status | |
| Pharmacokinetic data | |
| Metabolism | Liver by CYP2E1 |
| Metabolites | Hexafluoroisopropanol |
| Elimination half-life | 15–23 hours |
| Excretion | Kidney |
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| CAS Number | |
| PubChem CID | |
| IUPHAR/BPS | |
| DrugBank | |
| ChemSpider | |
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| KEGG | |
| ChEBI | |
| ChEMBL | |
| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.171.146 |
| Chemical and physical data | |
| Formula | C4H3F7O |
| Molar mass | 200.056 g·mol−1 |
| 3D model (JSmol) | |
| Density | 1.53 g/cm3 |
| Boiling point | 58.5 °C (137.3 °F) |
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Sevoflurane, sold under the brand name Sevorane, among others, and informally known as sevo, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset.[8] While its offset may be faster than agents other than desflurane in a few circumstances, its offset is more often similar to that of the much older agent isoflurane. While sevoflurane is only half as soluble as isoflurane in blood, the tissue blood partition coefficients of isoflurane and sevoflurane are quite similar. For example, in the muscle group: isoflurane 2.62 vs. sevoflurane 2.57. In the fat group: isoflurane 52 vs. sevoflurane 50. As a result, the longer the case, the more similar will be the emergence times for sevoflurane and isoflurane.[9][10][11]
It is on the World Health Organization's List of Essential Medicines.[12]
It is one of the most commonly used volatile anesthetic agents, particularly for outpatient anesthesia,[13] across all ages, but particularly in pediatric anesthesia, as well as in veterinary medicine. Together with desflurane, sevoflurane is replacing isoflurane and halothane in modern anesthesia practice. It is often administered in a mixture of nitrous oxide and oxygen.
Sevoflurane is a potent vasodilator. As such, it induces a dose dependent reduction in blood pressure and cardiac output. Though it is a bronchodilator, ketamine is preferred over it as an anaesthetic for asthmatic patients. However, in patients with pre-existing lung pathology, sevoflurane may precipitate coughing and laryngospasm. It reduces the ventilatory response to hypoxia and hypercapnia, and impedes hypoxic pulmonary vasoconstriction. Sevoflurane vasodilatory properties also cause it to increase intracranial pressure and cerebral blood flow. However, it reduces cerebral metabolic rate.[14][15]
Sevoflurane has been linked to severe brain damage in persons, especially children, with the 11232T>C genetic anomaly. This anomaly originated in Venezuela and is at increased risk for those of Venezuelan ancestry. The genetic anomaly is not known to present with any other symptoms, so those with this mutation will not otherwise know that they are in this group.[16]
Sevoflurane has an excellent safety record,[13] but is under review for potential hepatotoxicity, and may accelerate Alzheimer's.[17] There were rare reports involving adults with symptoms similar to halothane hepatotoxicity.[13] Sevoflurane is the preferred agent for mask induction due to its lesser irritation to mucous membranes.
Sevoflurane is an inhaled anesthetic that is often used to induce and maintain anesthesia in children for surgery.[18] During the process of awakening from the medication, it has been associated with a high incidence (>30%) of agitation and delirium in preschool children undergoing minor noninvasive surgery.[18] It is not clear if this can be prevented.[18]
Studies examining a current significant health concern, anesthetic-induced neurotoxicity (including with sevoflurane, and especially with children and infants) are "fraught with confounders, and many are underpowered statistically", and so are argued to need "further data... to either support or refute the potential connection".[19]
Concern regarding the safety of anaesthesia is especially acute with regard to children and infants, where preclinical evidence from relevant animal models suggest that common clinically important agents, including sevoflurane, may be neurotoxic to the developing brain, and so cause neurobehavioural abnormalities in the long term; two large-scale clinical studies (PANDA and GAS) were ongoing as of 2010, in hope of supplying "significant [further] information" on neurodevelopmental effects of general anaesthesia in infants and young children, including where sevoflurane is used.[20]
In 2021, researchers at Massachusetts General Hospital published in Communications Biology research that sevoflurane may accelerate existing Alzheimer's or existing tau protein to spread: "These data demonstrate anesthesia-associated tau spreading and its consequences. [...] This tau spreading could be prevented by inhibitors of tau phosphorylation or extracellular vesicle generation." According to Neuroscience News, "Their previous work showed that sevoflurane can cause a change (specifically, phosphorylation, or the addition of phosphate) to tau that leads to cognitive impairment in mice. Other researchers have also found that sevoflurane and certain other anesthetics may affect cognitive function."[17]
Additionally, there has been some investigation into potential correlation of sevoflurane use and renal damage (nephrotoxicity).[21] However, this should be subject to further investigation, as a recent study shows no correlation between sevoflurane use and renal damage as compared to other control anesthetic agents.[22] There is also evidence that renal damage may be caused by compound A, a product of the degradation of sevoflurane;[23] however, while compound A has been shown to mediate nephrotoxicity in animals (particularly in rats), it has not been shown to cause clinically relevant kidney injury in human subjects.[24][25]
In addition to other reported effects, studies have found that sevoflurane anaesthesia may reduce urine output and sodium excretion while increasing plasma renin concentrations compared with propofol anaesthesia[26]. To further investigate the underlying mechanism, one study examined the effects of sevoflurane on renal function in relation to renal sympathetic nerve activity. The findings indicated that sevoflurane promotes renal sodium and water retention in paediatric patients. To clarify the role of renal sympathetic input, the researchers subsequently used a sheep model with renal denervation and demonstrated that denervation attenuated the reduction in renal excretory function observed during sevoflurane anaesthesia[27].
The exact mechanism of the action of general anaesthetics has not been delineated.[28] Sevoflurane acts as a positive allosteric modulator of the GABAA receptor in electrophysiology studies of neurons and recombinant receptors.[29][30][31][32] However, it also acts as an NMDA receptor antagonist,[33] potentiates glycine receptor currents,[32] and inhibits nAChR[34] and 5-HT3 receptor currents.[35][36][37]
Sevoflurane was discovered by Ross Terrell alongside Louise Speers in the early 1960s researching at Airco Industrial Gases.[38] Sevoflurane was concurrently synthesized by Richard Wallin.[38] The rights for sevoflurane worldwide were held by AbbVie. It is available as a generic drug.
Sevoflurane is a greenhouse gas. The twenty-year global-warming potential, GWP(20), for sevoflurane is 349, however this is significantly lower than isoflurane or desflurane.[39]
Sevoflurane will degrade into what is most commonly referred to as compound A (fluoromethyl 2,2-difluoro-1-(trifluoromethyl)vinyl ether) when in contact with CO2 absorbents, and this degradation tends to enhance with decreased fresh gas flow rates, increased temperatures, and increased sevoflurane concentration.[40] Compound A may be correlated with renal damage;[23] while compound A has been shown to be nephrotoxic in animal models, clinically relevant kidney injury has not been demonstrated in humans.[24][25]
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Source: Wikipedia. Article content is retrieved live through the MediaWiki API.
Sevoflurane, sold under the brand name Sevorane, among others, and informally known as sevo, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset. While its offset may be faster than agents other than desflurane in a few circumstances, its offset is more often similar to that of the much older agent isoflurane. While sevoflurane is only half as soluble as isoflurane in blood, the tissue blood partition coefficients of isoflurane and sevoflurane are quite similar. For example, in the muscle group: isoflurane 2.62 vs. sevoflurane 2.57. In the fat group: isoflurane 52 vs. sevoflurane 50. As a result, the longer the case, the more similar will be the emergence times for sevoflurane and isoflurane. It is on the World Health Organization's List of Essential Medicines.
Halothane (bromochlorotrifluoroethane), sold under the brand name Fluothane among others, is a halocarbon with the chemical formula CF3CHBrCl. It is used as a general anaesthetic given by inhalation. It can be used to induce or maintain anaesthesia. Its use in developed countries has been mostly replaced by newer anesthetic agents such as sevoflurane. One of its benefits is that it does not increase the production of saliva, which can be particularly useful in those who are difficult to intubate. Side effects include an irregular heartbeat, respiratory depression, and hepatotoxicity. Like all volatile anesthetics, it should not be used in people with a personal or family history of malignant hyperthermia. It appears to be safe in porphyria. It is unclear whether its usage during pregnancy is harmful to the fetus, and its use during a C-section is generally discouraged. Halothane is a chiral molecule that is used as a racemic mixture. Halothane was discovered in 1951. It was approved for medical use in the United States in 1958. It was removed from the World Health Organization's List of Essential Medicines in 2025 in favor of safer alternatives. It is not available in the United States. Halothane may contribute to ozone depletion.
An inhalational anesthetic is a chemical compound possessing general anesthetic properties that is delivered via inhalation. They are administered through a face mask, laryngeal mask airway or tracheal tube connected to an anesthetic vaporizer and an anesthetic delivery system. Agents of significant contemporary clinical interest include volatile anesthetic agents such as isoflurane, sevoflurane and desflurane, as well as certain anesthetic gases such as nitrous oxide and xenon.
Synthane (development code BAX-3224) is a halocarbon agent which was investigated as an inhalational anesthetic but was never marketed. It is an isomer of sevoflurane.
Before the 1921 destruction of Tulsa’s Greenwood District, Black residents had created a remarkable center of business and community life. The district included stores, professional offices, entertainment venues and homes owned by Black citizens. Understanding Greenwood means learning what was built—not only what was burned.
MORE →Brown v. Board of Education in 1954.
