Suprane Baxter

Induction of Anesthesia in Adults

Suprane Baxter (Suprane Baxter, USP) is indicated as an inhalation agent for induction of anesthesia for inpatient and outpatient surgery in adults.

Suprane Baxter is contraindicated as an inhalation agent for the induction of anesthesia in pediatric patients because of a high incidence of moderate to severe uppoer airway adverse events.

Maintenance of Anesthesia

Suprane Baxter is indicated as an inhalation agent for maintenance of anesthesia for inpatient and outpatient surgery in adults and in pediatric patients.

After induction of anesthesia with agents other than Suprane Baxter, and tracheal intubation, Suprane Baxter is indicated for maintenance of anesthesia in infants and children. Suprane Baxter is not approved for maintenance of anesthesia in non-intubated children due to an increased incidence of respiratory adverse reactions, including coughing, laryngospasm, and secretions .

Suprane Baxter belongs to the group of medicines known as general anesthetics. Inhaled Suprane Baxter is used to cause general anesthesia (loss of consciousness) before and during surgery in adults. It is also used as a maintenance anesthesia in adults and children after receiving other anesthetics before and during surgery.

Suprane Baxter is to be given only by or under the direct supervision of a trained doctor.

Only persons trained in the administration of general anesthesia should administer Suprane Baxter. Only a vaporizer specifically designed and designated for use with Suprane Baxter should be utilized for its administration. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation must be immediately available.

Suprane Baxter is administered by inhalation. The administration of general anesthesia must be individualized based on the patient's response. Hypotension and respiratory depression increase as anesthesia with Suprane Baxter is deepened. The minimum alveolar concentration (MAC) of Suprane Baxter decreases with increasing patient age. The MAC for Suprane Baxter is also reduced by concomitant N2O administration. The dose should be adjusted accordingly. The following table provides mean relative potency based upon age and effect of N2O in predominately ASA physical status I or II patients.

Benzodiazepines and opioids decrease the MAC of Suprane Baxter. Suprane Baxter (Suprane Baxter, USP) also decreases the doses of neuromuscular blocking agents required. The dose should be adjusted accordingly.

Preanesthetic Medication

Issues such as whether or not to premedicate and the choice of premedication(s) must be individualized. In clinical studies, patients scheduled to be anesthetized with Suprane Baxter frequently received IV preanesthetic medication, such as opioid and/or benzodiazepine.

Induction

In adults, some premedicated with opioid, a frequent starting concentration was 3% Suprane Baxter, increased in 0.5-1.0% increments every 2 to 3 breaths. End-tidal concentrations of 4-11%, Suprane Baxter with and without N2O, produced anesthesia within 2 to 4 minutes. When Suprane Baxter was tested as the primary anesthetic induction agent, the incidence of upper airway irritation (apnea, breathholding, laryngospasm, coughing and secretions) was high. During induction in adults, the overall incidence of oxyhemoglobin desaturation (SpO2< 90%) was 6%.

After induction in adults with an intravenous drug such as thiopental or propofol, Suprane Baxter can be started at approximately 0.5-1 MAC, whether the carrier gas is O2 or N2O/O2.

Inspired concentrations of Suprane Baxter greater than 12% have been safely administered to patients, particularly during induction of anesthesia. Such concentrations will proportionately dilute the concentration of oxygen; therefore, maintenance of an adequate concentration of oxygen may require a reduction of nitrous oxide or air if these gases are used concurrently.

Maintenance

Surgical levels of anesthesia in adults may be maintained with concentrations of 2.5-8.5% Suprane Baxter (Suprane Baxter, USP) with or without the concomitant use of nitrous oxide. In children, surgical levels of anesthesia may be maintained with concentrations of 5.2-10% Suprane Baxter with or without the concomitant use of nitrous oxide.

During the maintenance of anesthesia with inflow rates of 2 L/min or more, the alveolar concentration of Suprane Baxter will usually be within 10% of the inspired concentration [FA/FI, see Figure 2 in Clinical Pharmacology (12.3)].

During the maintenance of anesthesia, increasing concentrations of Suprane Baxter produce dose-dependent decreases in blood pressure. Excessive decreases in blood pressure may be due to depth of anesthesia and in such instances may be corrected by decreasing the inspired concentration of Suprane Baxter.

Concentrations of Suprane Baxter exceeding 1 MAC may increase heart rate. Thus with this drug, an increased heart rate may not serve reliably as a sign of inadequate anesthesia.

Maintenance of Anesthesia in Intubated Pediatric Patients

Suprane Baxter is indicated for maintenance of anesthesia in infants and children after induction of anesthesia with agents other than Suprane Baxter, and tracheal intubation.

Suprane Baxter (Suprane Baxter, USP), with or without N2O, and halothane, with or without N2O were studied in three clinical trials of pediatric patients aged 2 weeks to 12 years (median 2 years) and ASA physical status I or II. The concentration of Suprane Baxter (Suprane Baxter, USP) required for maintenance of general anethesia is age-dependent.

Changes in blood pressure during maintenance of and recovery from anesthesia with Suprane Baxter/N2O/O2 are similar to those observed with halothane/N2O/O2. Heart rate during maintenance of anesthesia is approximately 10 beats per minute faster with Suprane Baxter than with halothane. Patients were judged fit for discharge from post-anesthesia care units within one hour with both Suprane Baxter and halothane. There were no differences in the incidence of nausea and vomiting between patients receiving Suprane Baxter or halothane.

Recovery

The recovery from general anethesia should be assessed carefully before patients are discharged from the post anesthesia care unit (PACU).

Use in Patients with Coronary Artery Disease

In patients with coronary artery disease, maintenance of normal hemodynamics is important to prevent myocardial ischemia. A rapid increase in Suprane Baxter concentration is associated with marked increase in pulse rate, mean arterial pressure and levels of epinephrine and norepinephrine. Suprane Baxter should not be used as the sole agent foranesthetic induction in patients with coronary artery disease or patients where increases in heart rate or blood pressure are undesirable. It should be used with other medications, preferably intravenous opioids and hypnotics.

Neurosurgical Use

Suprane Baxter may produce a dose-dependent increase in cerebrospinal fluid pressure (CSFP) when administered to patients with intracranial space occupying lesions. Suprane Baxter should be administered at 0.8 MAC or less, and in conjunction with a barbiturate induction and hyperventilation (hypocapnia) until cerebral decompression in patients with known or suspected increases in CSFP. Appropriate attention must be paid to maintain cerebral perfusion pressure.

Observations Related to Vaporizer Use

Yellow discoloration of Suprane Baxter sometimes accompanied by particulates, has been observed through the vaporizer sight glass or after draining the vaporizer. The presence of discoloration or particulates in these situations, does not alter the quality or efficacy of Suprane Baxter. If observed, refer to the respective vaporizer Instructions For Use (IFU) for recommended actions or contact Baxter Product Surveillance.

The use of Suprane Baxter, USP, Liquid for Inhalation is contraindicated in the following conditions:

• Known or suspected genetic susceptibility to malignant hyperthermia.
• Patients in whom general anesthesia is contraindicated.
• Induction of anesthesia in pediatric patients.
• Patients with known sensitivity to Suprane Baxter, USP, Liquid for Inhalation or to other halogenated agents.
• Patients with a history of moderate to severe hepatic dysfunction following anesthesia with Suprane Baxter, USP, Liquid for Inhalation or other halogenated agents and not otherwise explained.

No clinically significant adverse interactions with commonly used preanesthetic drugs, or drugs used during anesthesia (muscle relaxants, intravenous agents, and local anesthetic agents) were reported in clinical trials. The effect of Suprane Baxter on the disposition of other drugs has not been determined. Similar to isoflurane, Suprane Baxter does not predispose to premature ventricular arrhythmias in the presence of exogenously infused epinephrine in swine.

Benzodiazepines And Opioids (MAC Reduction)

Benzodiazepines and opioids decrease the amount of Suprane Baxter (MAC) needed to produce anesthesia. This effect is shown in Table 3 for intravenous midazolam (25-50 μg/kg) and intravenous fentanyl (3-6 μg/kg) in patients of two different age groups.

Table 3 : Suprane Baxter (Suprane Baxter, USP) MAC with Fentanyl or Midazolam Mean ± SD (percent reduction)

Neuromuscular Blocking Agents

Anesthetic concentrations of Suprane Baxter at equilibrium (administered for 15 or more minutes before testing) reduced the ED95 of succinylcholine by approximately 30% and that of atracurium and pancuronium by approximately 50% compared to NO reduces the MAC of Suprane Baxter.

See also:
What are the possible side effects of Suprane Baxter?

Applies to Suprane Baxter: inhalation liquid, inhalation solution

As well as its needed effects, Suprane Baxter (the active ingredient contained in Suprane Baxter) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking Suprane Baxter, check with your doctor or nurse immediately:

More common:

• Bluish lips or skin
• body aches or pain
• congestion
• cough
• dryness or soreness of the throat
• fever
• hoarseness
• not breathing
• runny nose
• tender, swollen glands in the neck
• tightness in the chest
• trouble breathing
• trouble swallowing
• voice changes

• Blurred vision
• chest pain or discomfort
• dizziness
• fast, pounding, or irregular heartbeat or pulse
• headache
• lightheadedness, dizziness, or fainting
• nervousness
• pounding in the ears
• slow or irregular heartbeat
• unusual tiredness

• Dark urine
• difficulty with moving
• feeling of warmth or heat
• flushing or redness of the skin, especially on the face and neck
• general tiredness and weakness
• joint pain
• light-colored stools
• muscle aching or cramping
• muscle pains or stiffness
• nausea and vomiting
• noisy breathing
• pain or discomfort in the arms, jaw, back, or neck
• sweating
• swollen joints
• upper right abdominal or stomach pain
• yellow eyes and skin

• Abdominal or stomach pain
• confusion
• convulsions
• decreased urine
• dry mouth
• increased thirst
• loss of appetite
• no blood pressure or pulse
• numbness or tingling in the hands, feet, or lips
• stopping of heart
• unconsciousness
• weakness or heaviness of the legs

Minor Side Effects

Some Suprane Baxter side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common:

• Increased watering of the mouth
• redness of the white part of the eyes or inside of the eyelids

• Anxiety
• hyperventilation
• irritability
• itching skin
• restlessness
• shaking
• trouble sleeping

Suprane Baxter is a highly fluorinated methyl ethyl ether used for maintenance of general anaesthesia. Volatile agents such as Suprane Baxter may activate GABA channels and hyperpolarize cell membranes. In addition, they may inhibit certain calcium channels and therefore prevent release of neurotransmitters and inhibit glutamate channels. Volatile anesthetics easily partition into cellular membranes and could expand the volume of the cell membrane and subsequently distort channels necessary for sodium ion flux and the development of action potentials necessary for synaptic transmission. Suprane Baxter preconditions human myocardium against ischemia through activation of mitochondrial K(ATP) channels, adenosine A1 receptor, and alpha and beta adrenoceptors.