Sevofluran Baxter (Sevoflurane)
Volatile inhalation anesthetic for general anesthesia in adults and children
Quick Facts about Sevofluran Baxter
Key Takeaways
- Hospital-only medication: Sevofluran Baxter is only administered by trained anesthesiologists in clinical settings with full monitoring equipment
- Suitable for all ages: Widely used for both adults and children, with particularly smooth mask induction in pediatric patients
- Rapid onset and recovery: Low blood-gas solubility allows induction in 1–3 minutes and awakening within 5–15 minutes after discontinuation
- Malignant hyperthermia risk: Contraindicated in patients with known or suspected susceptibility to malignant hyperthermia
- Common side effects are mild: Nausea, vomiting, agitation, and low blood pressure are the most frequent effects and typically resolve quickly
What Is Sevofluran Baxter and What Is It Used For?
Sevofluran Baxter contains sevoflurane, a volatile halogenated ether anesthetic used to induce and maintain general anesthesia during surgical procedures. It is delivered as an inhaled vapor and works by producing dose-dependent central nervous system depression, resulting in unconsciousness, amnesia, and pain relief.
Sevoflurane was first synthesized in the 1960s and entered clinical practice in the 1990s, where it rapidly became one of the most popular inhalation anesthetics worldwide. Its chemical structure as a fluorinated methyl isopropyl ether gives it unique pharmacological properties that make it exceptionally well-suited for modern anesthetic practice. The drug is manufactured by Baxter International and supplied as a clear, colorless liquid in 250 ml aluminum bottles.
The mechanism of action of sevoflurane, like other volatile anesthetics, involves multiple molecular targets in the central nervous system. It enhances the activity of gamma-aminobutyric acid type A (GABA-A) receptors, the primary inhibitory neurotransmitter system in the brain, while simultaneously inhibiting excitatory N-methyl-D-aspartate (NMDA) glutamate receptors. This dual action produces the characteristic clinical effects of general anesthesia: loss of consciousness, amnesia, immobility in response to surgical stimulation, and autonomic reflex suppression.
One of the distinguishing features of sevoflurane is its low blood-gas solubility coefficient of approximately 0.65, which is among the lowest of all volatile anesthetics. This physical property means that the drug equilibrates rapidly between the lungs and the brain, allowing for quick induction of anesthesia (typically within 1 to 3 minutes of breathing the vapor) and equally rapid emergence when the administration is discontinued. Patients typically regain consciousness within 5 to 15 minutes after the sevoflurane supply is stopped.
Sevoflurane is particularly valued in pediatric anesthesia because it has a sweet, non-pungent odor that does not irritate the airways. Unlike some older anesthetics, it rarely causes coughing, breath-holding, or laryngospasm during mask induction, making it the preferred choice for children who require anesthesia but do not yet have intravenous access. The ability to induce anesthesia smoothly and calmly through a face mask is one of the primary reasons sevoflurane has become the dominant inhalation agent for pediatric surgery globally.
Liquid sevoflurane is converted into a precisely controlled vapor concentration using a specially calibrated vaporizer attached to the anesthesia machine. The vapor is then mixed with oxygen (and sometimes nitrous oxide) and delivered to the patient through a breathing circuit, face mask, or endotracheal tube. The anesthesiologist continuously adjusts the concentration to maintain the appropriate depth of anesthesia throughout the procedure.
What Should You Know Before Receiving Sevofluran Baxter?
Sevofluran Baxter should only be administered by healthcare professionals trained in general anesthesia and under the direct supervision of an anesthesiologist. Several important contraindications and precautions must be considered before use.
Contraindications
Your anesthesiologist will not administer Sevofluran Baxter in the following situations:
- Allergy to sevoflurane or other halogenated anesthetics: If you have a known hypersensitivity to sevoflurane vapor or any other volatile inhalation anesthetic (such as isoflurane or desflurane), you must not receive this medication
- Previous liver injury from halogenated anesthetics: If you have a confirmed history of hepatitis (liver inflammation) caused by sevoflurane or another inhalation anesthetic, or if you have experienced unexplained liver problems with jaundice, fever, and elevated white blood cell counts (eosinophilia) following a previous anesthetic
- Malignant hyperthermia susceptibility: If you have a known or suspected genetic predisposition to malignant hyperthermia, a rare but potentially fatal condition characterized by a sudden and dangerous rise in body temperature during or shortly after anesthesia
- Medical contraindication to general anesthesia: If there are specific medical reasons why you should not undergo general anesthesia at all
Warnings and Precautions
Inform your doctor or anesthesiologist before receiving Sevofluran Baxter if any of the following apply to you:
- You have received an inhalation anesthetic previously, particularly if this was repeated over a short period of time. Repeated exposure to halogenated anesthetics has been associated with a slightly increased risk of liver injury, though this remains extremely rare with sevoflurane
- You have low blood pressure (hypotension) or reduced blood volume (hypovolemia), as sevoflurane can further lower blood pressure through peripheral vasodilation
- You have impaired kidney function, since approximately 3–5% of sevoflurane is metabolized to inorganic fluoride, which at very high concentrations could theoretically affect kidney function
- You suffer from coronary artery disease or other significant cardiovascular conditions that may be affected by the hemodynamic changes produced by sevoflurane
- You are at risk of increased intracranial pressure, as sevoflurane can cause mild cerebral vasodilation at higher concentrations
- You have current or previous liver problems, including hepatitis or jaundice from any cause
- You are taking medications that can cause liver problems, as this may increase the risk of hepatic injury
- You have a known risk of seizures, since epileptiform electroencephalographic (EEG) activity has been reported during sevoflurane anesthesia, particularly at higher concentrations
- You have a neuromuscular disease such as Duchenne muscular dystrophy, which is associated with an increased risk of hyperkalemia and cardiac complications during general anesthesia
- You have a mitochondrial disorder, as volatile anesthetics may affect mitochondrial function
Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic condition that can be triggered by volatile anesthetics including sevoflurane. It manifests as a rapid, uncontrolled increase in body temperature, severe muscle rigidity, metabolic acidosis, and rhabdomyolysis. If MH occurs, the anesthesiologist will immediately discontinue sevoflurane and administer dantrolene sodium along with supportive care. Fatal cases of MH have been reported with sevoflurane. If you have a family history of MH or have previously experienced an episode, inform your anesthesiologist immediately.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, inform your doctor or anesthesiologist before receiving Sevofluran Baxter. Like all volatile anesthetics, sevoflurane crosses the placenta and can relax uterine smooth muscle, which may increase the risk of uterine hemorrhage during obstetric procedures such as cesarean sections. Your anesthesiologist will carefully weigh the potential benefits against the risks in your specific clinical situation.
Animal studies have not demonstrated teratogenic effects at clinically relevant concentrations, but adequate controlled studies in pregnant women are limited. Sevoflurane should only be used during pregnancy when clearly necessary. Small amounts of sevoflurane and its metabolites may be excreted in breast milk, but given the short duration of exposure and rapid elimination, the clinical significance for the breastfed infant is considered minimal. Consult your doctor about the appropriate timing for resuming breastfeeding after anesthesia.
Driving and Operating Machinery
Sevofluran Baxter has a significant impact on your ability to drive and use tools or machinery. General anesthetics can affect your alertness, judgment, and coordination for several days following the procedure. Do not drive, operate heavy machinery, or make important legal decisions until your doctor confirms it is safe to do so. Most anesthesiologists recommend a minimum of 24 hours of abstinence from driving after any general anesthetic, though individual recovery may vary.
How Does Sevofluran Baxter Interact with Other Drugs?
Sevoflurane interacts with a wide range of medications, including other anesthetics, opioid painkillers, muscle relaxants, and cardiovascular drugs. Many of these interactions are deliberately utilized by anesthesiologists to optimize the anesthetic regimen, but some require careful monitoring.
Always inform your doctor, pharmacist, surgeon, or anesthesiologist about all medications you are currently taking, have recently taken, or may take, including herbal remedies, vitamins, and supplements. The following interactions are clinically significant:
| Medication | Interaction Type | Clinical Effect | Significance |
|---|---|---|---|
| Nitrous oxide (N2O) | Synergistic | Reduces the MAC (minimum alveolar concentration) of sevoflurane needed, allowing lower doses | Routinely used together |
| Opioids (morphine, fentanyl, remifentanil) | Synergistic | Reduces MAC of sevoflurane; enhances analgesic effect; may increase respiratory depression | Routinely used together |
| Neuromuscular blocking agents (pancuronium, atracurium) | Potentiation | Sevoflurane enhances the effect of non-depolarizing muscle relaxants, prolonging block duration | Dose adjustments may be needed |
| Benzodiazepines (diazepam, lorazepam) | Additive | Enhanced sedation and reduced MAC of sevoflurane | Monitor sedation level |
| Epinephrine (adrenaline) | Cardiac sensitization | Sevoflurane sensitizes the myocardium to catecholamines, potentially causing arrhythmias | Limit epinephrine dose |
| Verapamil | Additive | Increased risk of AV block and cardiovascular depression | Use with caution |
| Beta-blockers (atenolol, propranolol) | Additive | Enhanced hypotension and bradycardia | Monitor hemodynamics |
| Indirect sympathomimetics (amphetamines, ephedrine) | Cardiac risk | Risk of arrhythmias and hypertensive crisis during anesthesia | Avoid if possible |
| Isoniazid | Hepatotoxicity | May increase the risk of liver damage by inducing CYP2E1, which metabolizes sevoflurane | Monitor liver function |
| St. John’s Wort | Enzyme induction | May alter sevoflurane metabolism; risk of delayed recovery or enhanced side effects | Discontinue 2 weeks before surgery |
| Alcohol | Enzyme alteration | Chronic alcohol use may increase anesthetic requirements; acute intoxication may reduce requirements | Inform anesthesiologist |
Food and Drink
As Sevofluran Baxter is a general anesthetic used during surgical procedures, you will be required to fast before receiving it. Your anesthesiologist or surgical team will provide specific instructions about when to stop eating and drinking before your procedure. These fasting guidelines are essential to reduce the risk of aspiration (inhaling stomach contents into the lungs) during anesthesia. After waking from anesthesia, your medical team will advise you on when and what you can safely eat and drink.
What Is the Correct Dosage of Sevofluran Baxter?
Sevofluran Baxter dosing is determined by the anesthesiologist and expressed as the concentration (%) of sevoflurane in the inspired gas mixture. The dose varies based on age, physical status, the type of surgical procedure, and concurrent medications. It is administered through a specially calibrated vaporizer.
Sevoflurane dosing in clinical practice is guided by the concept of minimum alveolar concentration (MAC), which represents the concentration of an inhaled anesthetic at 1 atmosphere that prevents movement in response to a standardized surgical stimulus in 50% of patients. MAC values vary with age, being highest in infants and declining progressively with increasing age.
Adults
Induction of Anesthesia
Induction concentrations of up to 5% sevoflurane with or without nitrous oxide in oxygen are typically used. At these concentrations, surgical levels of anesthesia are usually achieved within 1 to 3 minutes. Alternatively, anesthesia may be induced intravenously with another agent (such as propofol) and then maintained with sevoflurane.
Maintenance of Anesthesia
Surgical anesthesia is typically maintained with concentrations of 0.5% to 3% sevoflurane, often in combination with nitrous oxide. The MAC for sevoflurane in a 40-year-old adult is approximately 2.1% in oxygen alone, and approximately 1.1% when combined with 60% nitrous oxide. The anesthesiologist continuously titrates the concentration based on clinical signs of anesthetic depth.
Children
Pediatric Dosing
Children generally require higher MAC values than adults due to age-related pharmacokinetic differences. In neonates, the MAC is approximately 3.3%; in infants aged 1–6 months, approximately 3.0%; and in children aged 1–12 years, approximately 2.5%. Mask induction in children is typically achieved using 6–8% sevoflurane in oxygen, sometimes with the addition of nitrous oxide to speed the process. The sweet, non-pungent odor of sevoflurane makes it particularly well-tolerated for mask induction in children.
Elderly Patients
Geriatric Dosing
Elderly patients typically require lower concentrations of sevoflurane. The MAC decreases with age: in an 80-year-old patient, the MAC is approximately 1.4% in oxygen, compared to 2.1% in a 40-year-old. Dose reductions of 25–50% may be necessary. Additionally, elderly patients may be more susceptible to the cardiovascular depressant effects of sevoflurane, including hypotension and bradycardia, and thus require more careful hemodynamic monitoring.
Overdose
Since Sevofluran Baxter is administered by trained healthcare professionals in a controlled clinical environment, overdose is unlikely. However, if an excessive concentration is delivered, the anesthesiologist will immediately reduce or discontinue the sevoflurane supply and initiate supportive measures. Signs of overdose would include profound hypotension, severe bradycardia, and respiratory depression. Management involves maintaining airway patency, providing supplemental oxygen, supporting circulation with intravenous fluids and vasopressors as needed, and mechanical ventilation if respiratory depression occurs.
| Age Group | MAC in O2 (%) | MAC in 60% N2O (%) |
|---|---|---|
| Neonates (0–1 month) | 3.3% | N/A |
| Infants (1–6 months) | 3.0% | N/A |
| Children (6 months–3 years) | 2.8% | ~2.0% |
| Children (3–12 years) | 2.5% | ~1.4% |
| Adults (25 years) | 2.6% | ~1.4% |
| Adults (40 years) | 2.1% | ~1.1% |
| Adults (60 years) | 1.7% | ~0.9% |
| Elderly (80 years) | 1.4% | ~0.7% |
What Are the Side Effects of Sevofluran Baxter?
Like all medications, Sevofluran Baxter can cause side effects, though not everyone experiences them. Most side effects are mild to moderate and resolve quickly after the anesthetic wears off. However, some rare side effects can be serious and require immediate medical attention.
Severe allergic reactions including anaphylaxis and anaphylactoid reactions can occur. If symptoms such as severe swelling of the face or throat, breathing difficulties, or a sudden drop in blood pressure develop during anesthesia, the anesthesiologist will discontinue sevoflurane immediately and initiate emergency treatment.
Very Common
- Agitation (restlessness and anxiety, especially during emergence in children)
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Coughing
- Nausea and vomiting
Common
- Drowsiness or excessive tiredness
- Headache
- Dizziness
- Tachycardia (rapid heart rate)
- Hypertension (high blood pressure)
- Respiratory disturbances, airway obstruction
- Slow and shallow breathing (respiratory depression)
- Laryngospasm (throat muscle spasm)
- Increased salivation
- Fever and chills
- Elevated or decreased white blood cell counts
- Elevated blood glucose levels
- Elevated liver enzymes (detected by blood tests)
- Elevated blood fluoride levels
- Hypothermia (low body temperature)
Uncommon
- Confusion
- Palpitations or irregular heartbeat
- Atrioventricular (AV) block
- Apnea (cessation of breathing)
- Bronchospasm (asthma-like symptoms)
- Hypoxia (low blood oxygen levels)
- Elevated serum creatinine (indicator of impaired kidney function)
Rare / Frequency Not Known
- Anaphylaxis and anaphylactoid reactions (severe allergic reaction)
- Skin rash, hives (urticaria), itching, flushing
- Angioedema (swelling of face, lips, tongue, or throat)
- Cardiac arrest
- Seizures and convulsions (may occur during or up to one day after anesthesia)
- Malignant hyperthermia (dangerously high body temperature)
- Hepatitis (liver inflammation) or liver failure
- Pancreatitis (inflammation of the pancreas)
- Elevated potassium levels (hyperkalemia)
- Muscle rigidity (rhabdomyolysis)
- Jaundice (yellowing of the skin)
- Nephritis (kidney inflammation)
- Chest discomfort
- Increased intracranial pressure
Emergence agitation is particularly common in young children waking from sevoflurane anesthesia and typically resolves within 15–30 minutes. Seizures have been reported occasionally, most often in children and young adults, and can occur during anesthesia or up to one day afterward during recovery. Children with Down syndrome may experience a more pronounced reduction in heart rate (bradycardia) during sevoflurane anesthesia.
Blood fluoride levels may increase slightly during and immediately after anesthesia due to the hepatic metabolism of sevoflurane. These elevations are transient and not considered clinically harmful, as they return to normal levels rapidly after discontinuation. Unlike the earlier volatile anesthetic methoxyflurane, sevoflurane is not associated with clinically significant fluoride nephrotoxicity at standard clinical doses.
How Should Sevofluran Baxter Be Stored?
Sevofluran Baxter should be stored out of the sight and reach of children, used before the expiration date on the label, and does not require any special storage conditions.
The product has no special temperature or humidity storage requirements. It should be kept in its original aluminum container and stored in a well-ventilated area. The container should be tightly closed when not in use to prevent evaporation. As a liquid at room temperature, sevoflurane should be handled carefully to avoid spillage, as inhalation of the vapor in an uncontrolled setting could cause sedation. Healthcare facilities should follow their local guidelines for the safe storage and handling of volatile anesthetics.
Do not use Sevofluran Baxter after the expiration date printed on the label. The expiration date refers to the last day of the month indicated. Unused or expired medication should be disposed of in accordance with local pharmaceutical waste regulations. Do not dispose of medications through household waste or wastewater.
What Does Sevofluran Baxter Contain?
Sevofluran Baxter contains only one ingredient: sevoflurane 100%. There are no excipients, preservatives, or additives in the formulation.
Sevoflurane (chemical name: fluoromethyl 2,2,2-trifluoro-1-[trifluoromethyl]ethyl ether; molecular formula: C4H3F7O) is a clear, colorless, non-flammable liquid with a mild, sweet odor. It has a boiling point of 58.6°C and a molecular weight of 200.05 g/mol. The product is supplied in aluminum bottles containing 250 ml of liquid sevoflurane. The bottle may be sealed with either a plastic screw cap or an integrated filling valve that connects directly to a compatible vaporizer. Available pack sizes include 1 and 6 bottles, though not all pack sizes may be marketed in every country.
The manufacturer and marketing authorization holder is Baxter International, with production facilities located in Lessines, Belgium. Sevofluran Baxter is a registered trademark of Baxter International Inc. For additional information about this medicine, contact the local representative of the marketing authorization holder in your country.
Frequently Asked Questions
Sevoflurane is a volatile inhalation anesthetic used for inducing and maintaining general anesthesia during surgical procedures in both adults and children. It is delivered as a vapor through a face mask or airway device connected to an anesthesia machine. Its rapid onset, pleasant smell, and smooth induction properties make it particularly popular for pediatric mask induction, though it is widely used across all age groups for a broad range of surgical procedures.
Sevoflurane is considered one of the safest inhalation anesthetics for children and is the most commonly used volatile agent in pediatric anesthesia worldwide. Its non-irritating, sweet-smelling properties allow smooth, calm mask induction without causing coughing, breath-holding, or laryngospasm. However, emergence agitation is more common in young children than in adults. As with all general anesthetics, sevoflurane must be administered by trained anesthesiologists with appropriate monitoring equipment.
Sevoflurane has one of the fastest onset and offset profiles among volatile anesthetics due to its low blood-gas solubility coefficient (0.65). Induction of anesthesia typically occurs within 1 to 3 minutes when breathing sevoflurane vapor through a face mask. Recovery after discontinuation is equally rapid, with patients typically awakening within 5 to 15 minutes. However, full cognitive and psychomotor recovery may take several hours, which is why patients are advised not to drive or operate machinery for at least 24 hours.
Malignant hyperthermia (MH) is a rare but potentially life-threatening pharmacogenetic reaction that can be triggered by volatile anesthetics like sevoflurane and by the depolarizing muscle relaxant succinylcholine. It causes an uncontrolled increase in skeletal muscle metabolism, leading to a rapid rise in body temperature (sometimes exceeding 40°C), severe muscle rigidity, metabolic acidosis, and organ failure. MH is caused by inherited mutations in the ryanodine receptor (RYR1) gene. Treatment involves immediate discontinuation of the triggering agent and intravenous administration of dantrolene sodium.
While hepatotoxicity is very rare with sevoflurane, cases of liver inflammation (hepatitis) and liver failure have been reported in post-marketing surveillance. The risk appears to be higher with repeated exposures over a short time period. Mild, transient elevations in liver enzymes are common and usually not clinically significant. However, if you have a history of unexplained liver problems following a previous halogenated anesthetic, you should not receive sevoflurane. Your anesthesiologist will assess your liver health before surgery.
Sevoflurane can be used in obstetric anesthesia when clinically indicated, but it should only be used during pregnancy when the benefits clearly outweigh the risks. Like all volatile anesthetics, sevoflurane crosses the placenta and can cause uterine relaxation, which may increase the risk of uterine bleeding during delivery. When used for cesarean section, the concentration is carefully controlled and kept to the minimum necessary. The anesthesiologist will take all precautions to ensure the safety of both mother and baby.
References
- European Medicines Agency (EMA). Sevoflurane – Summary of Product Characteristics. EMA/CHMP. Available at: www.ema.europa.eu.
- Miller RD, Eriksson LI, Fleisher LA, et al. Miller’s Anesthesia, 9th Edition. Elsevier, 2020. Chapter 20: Inhaled Anesthetics.
- U.S. Food and Drug Administration (FDA). Sevoflurane – FDA Prescribing Information. Available at: www.fda.gov.
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd List. Geneva: World Health Organization, 2023.
- Patel SS, Goa KL. Sevoflurane: A review of its pharmacodynamic and pharmacokinetic properties and its clinical use in general anesthesia. Drugs. 1996;51(4):658–700. doi:10.2165/00003495-199651040-00009
- De Hert S, Moerman A. Sevoflurane. F1000Research. 2015;4:626. doi:10.12688/f1000research.6288.1
- Rosenberg H, Pollock N, Schiemann A, et al. Malignant hyperthermia: a review. Orphanet Journal of Rare Diseases. 2015;10:93. doi:10.1186/s13023-015-0310-1
- British National Formulary (BNF). Sevoflurane – Drug Monograph. National Institute for Health and Care Excellence (NICE). Available at: bnf.nice.org.uk.
- Constant I, Seeman R, Murat I. Sevoflurane and epileptiform EEG changes. Pediatric Anesthesia. 2005;15(4):266–274. doi:10.1111/j.1460-9592.2004.01538.x
- Brunt EM, Ramrakhiani S, Cordes BG, et al. Concurrence of histologic features of steatohepatitis with other forms of chronic liver disease. Modern Pathology. 2003;16(1):49–56.
Editorial Team
This article has been written, fact-checked, and medically reviewed by the iMedic Medical Editorial Team, which includes board-certified specialists in anesthesiology, pharmacology, and clinical medicine.
iMedic Medical Editorial Team
Specialists in pharmacology and drug information with extensive experience in evidence-based medical communication.
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All drug information on iMedic is based on approved product labeling (EMA SmPC, FDA prescribing information), peer-reviewed pharmacological literature, and established clinical references including Miller’s Anesthesia and the British National Formulary. We follow the GRADE evidence framework and maintain strict independence from pharmaceutical industry funding. Read our full editorial standards.