[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Inhaled anaesthetics](https://durgical.com/en/pharmacology/classes/inhaled-anaesthetics/) › Sevoflurane

[Pharmacology](https://durgical.com/en/pharmacology/) · [Inhaled anaesthetics](https://durgical.com/en/pharmacology/classes/inhaled-anaesthetics/)

# Sevoflurane

Inhaled anaesthetic with a mild smell and fast effect, ideal for putting children to sleep by mask. It can trigger malignant hyperthermia.

Updated 2026-11-01

- Class: [Inhaled anaesthetics](https://durgical.com/en/pharmacology/classes/inhaled-anaesthetics/)
- Target: Several central nervous system ion channels (GABA-A and glycine receptors, potassium channels)
- ATC code: N01AB08
- WHO Model List of Essential Medicines

Also called: Sevofluorane

## Mechanism of action

Sevoflurane is vaporised and inhaled; it passes from the alveoli into the blood and then the brain. It enhances inhibitory receptors (GABA-A and glycine) and modulates other channels, depressing neuronal activity: unconsciousness, amnesia and immobility. Because it is poorly soluble in blood, its brain concentration rises and falls quickly when the vaporiser setting changes.

- Vaporised and inhaled down to the alveoli
- Poorly soluble in blood: brain concentration rises fast
- Enhances inhibitory receptors and depresses neurons
- Removed by the lungs when the vaporiser is turned off

## Pharmacokinetics

**Absorption**
Through the lungs; low blood solubility allows fast induction and emergence.

**Metabolism**
A small fraction is metabolised in the liver by CYP2E1, releasing inorganic fluoride.

**Elimination**
Almost all is exhaled unchanged.

## Indications

- Mask induction of general anaesthesia, especially in children
- Maintenance of general anaesthesia in adults and children

## Adverse effects

### Common

- Concentration-dependent hypotension
- Respiratory depression
- Postoperative nausea and vomiting
- Emergence agitation in children
- Cough and laryngospasm (uncommon)

### Serious (rare, important)

- Malignant hyperthermia
- Perioperative hyperkalaemia in patients with myopathies
- Seizures, especially in children
- QT prolongation and torsade de pointes
- Severe bradycardia in children with Down syndrome during induction
- Possible kidney injury from compound A with low gas flows

## Contraindications

- Known or suspected genetic susceptibility to malignant hyperthermia
- Hypersensitivity to sevoflurane or other halogenated agents

## Key interactions

**Non-depolarising neuromuscular blockers**
Enhances and prolongs the block.

**Suxamethonium**
Higher risk of malignant hyperthermia.

**Epinephrine**
Higher risk of ventricular arrhythmias.

**Nitrous oxide, opioids and benzodiazepines**
Reduce the amount of sevoflurane needed (lower MAC).

**Isoniazid and chronic alcohol use**
Induce CYP2E1 and increase its metabolism.

## What is monitored

- End-tidal agent concentration and anaesthetic depth
- Blood pressure, ECG and saturation
- End-tidal CO2 and temperature (signs of malignant hyperthermia)
- Agitation on emergence

## Administration and safety

- Only with a calibrated vaporiser specific for sevoflurane.
- Change the CO2 absorbent if it may be dry: with a desiccated absorbent, heat, smoke and degradation products form.
- Keep dantrolene available where it is used.

## Nursing care

- Before: ask about personal or family history of malignant hyperthermia and myopathies.
- In recovery: watch breathing, saturation, nausea and agitation as the child wakes.
- If high fever, rigidity, tachycardia or rising CO2 appear during anaesthesia: report at once.
- Warn that the ability to drive or operate machinery may be reduced after anaesthesia.

## Pregnancy and breastfeeding

It relaxes uterine smooth muscle and can contribute to uterine atony and bleeding. Animal studies show developmental effects with long exposures.

## Memory aid

SEVOflurane = Sweet for kids (mild smell, mask), Volatile and fast, Oh, watch for malignant hyperthermia.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does sevoflurane allow fast induction and emergence?

Because of its low blood solubility: alveolar, blood and brain partial pressures reach equilibrium quickly.

## What is compound A?

A degradation product of sevoflurane in the CO2 absorbent, potentially nephrotoxic, which increases with low fresh gas flows.

## Which signs suggest malignant hyperthermia during sevoflurane anaesthesia?

Unexplained rise in end-tidal CO2, tachycardia, muscle rigidity (for example of the masseters), hyperthermia, acidosis and hyperkalaemia.

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## Related drugs

- [Isoflurane](https://durgical.com/en/pharmacology/isoflurane/)
- [Desflurane](https://durgical.com/en/pharmacology/desflurane/)
- [Nitrous oxide](https://durgical.com/en/pharmacology/nitrous-oxide/)
- [Suxamethonium](https://durgical.com/en/pharmacology/suxamethonium/)

[← Back to the class: Inhaled anaesthetics](https://durgical.com/en/pharmacology/classes/inhaled-anaesthetics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - SEVOFLURANE liquid](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=22700993-851a-48aa-941e-1d2b6b04081f) (DailyMed (U.S. National Library of Medicine), 2026); [Malignant hyperthermia: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/malignant-hyperthermia/) (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 24 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01AB08) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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