ADVERSE REACTIONS
Adverse events are derived from controlled clinical trials conducted in the United States, Canada, and Europe. The reference drugs were isoflurane, enflurane, and propofol in adults and halothane in pediatric patients. The studies were conducted using a variety of premedications, other anesthetics, and surgical procedures of varying length. Most adverse events reported were mild and transient, and may reflect the surgical procedures, patient characteristics (including disease) and/or medications administered.
Of the 5182 patients enrolled in the clinical trials, 2906 were exposed to sevoflurane, including 118 adults and 507 pediatric patients who underwent mask induction. Each patient was counted once for each type of adverse event. Adverse events reported in patients in clinical trials and considered to be possibly or probably related to sevoflurane are presented within each body system in order of decreasing frequency in the following listings. One case of malignant hyperthermia was reported in pre-registration clinical trials.
Adverse Events During the Induction Period (from Onset of Anesthesia by Mask Induction to Surgical Incision) Incidence > 1%
Adult Patients (N = 118)
Cardiovascular
Bradycardia 5%, Hypotension 4%, Tachycardia 2%
Nervous System
Agitation 7%
Respiratory System
Laryngospasm 8%, Airway obstruction 8%, Breathholding 5%, Cough Increased 5%
Pediatric Patients (N = 507)
Cardiovascular
Tachycardia 6%, Hypotension 4%
Nervous System
Agitation 15%
Respiratory System
Breathholding 5%, Cough Increased 5%, Laryngospasm 3%, Apnea 2%
Digestive System
Increased salivation 2%
Adverse Events During Maintenance and Emergence Periods, Incidence > 1% (N = 2906)
Body as a whole
Fever 1%, Shivering 6%, Hypothermia 1%, Movement 1%, Headache 1%
Cardiovascular
Hypotension 11%, Hypertension 2%, Bradycardia 5%, Tachycardia 2%
Nervous System
Somnolence 9%, Agitation 9%, Dizziness 4%, Increased salivation 4%
Digestive System
Nausea 25%, Vomiting 18%
Respiratory System
Cough increased 11%, Breathholding 2%, Laryngospasm 2%
Adverse Events, All Patients in Clinical Trials (N = 2906), All Anesthetic Periods, Incidence < 1% (Reported in 3 or More Patients)
Body as a whole
Asthenia, Pain
Cardiovascular
Arrhythmia, Ventricular Extrasystoles, Supraventricular Extrasystoles, Complete AV Block, Bigeminy, Hemorrhage, Inverted T Wave, Atrial Fibrillation, Atrial Arrhythmia, Second Degree AV Block, Syncope, S-T Depressed
Nervous System
Crying, Nervousness, Confusion, Hypertonia, Dry Mouth, Insomnia
Respiratory System
Sputum Increased, Apnea, Hypoxia, Wheezing, Bronchospasm, Hyperventilation, Pharyngitis, Hiccup, Hypoventilation, Dyspnea, Stridor
Metabolism and Nutrition
Increases in LDH, AST, ALT, BUN, Alkaline Phosphatase, Creatinine, Bilirubinemia, Glycosuria, Fluorosis, Albuminuria, Hypophosphatemia, Acidosis, Hyperglycemia
Hemic and Lymphatic System
Leucocytosis, Thrombocytopenia
Skin and Special Senses
Amblyopia, Pruritus, Taste Perversion, Rash, Conjunctivitis
Urogenital
Urination Impaired, Urine Abnormality, Urinary Retention, Oliguria
See
WARNINGS
for information regarding malignant hyperthermia.
Post-Marketing Adverse Events
The following adverse events have been identified during post-approval use of Ultane (sevoflurane USP). Due to the spontaneous nature of these reports, the actual incidence and relationship of Ultane to these events cannot be established with certainty.
CNS
Seizures — Post-marketing reports indicate that sevoflurane use has been associated with seizures. The majority of cases were in children and young adults, most of whom had no medical history of seizures. Several cases reported no concomitant medications, and at least one case was confirmed by EEG. Although many cases were single seizures that resolved spontaneously or after treatment, cases of multiple seizures have also been reported. Seizures have occurred during, or soon after sevoflurane induction, during emergence, and during post-operative recovery up to a day following anesthesia.
Cardiac
Cardiac arrest
Hepatic
- Cases of mild, moderate and severe post-operative hepatic dysfunction or hepatitis with or without jaundice have been reported. Histological evidence was not provided for any of the reported hepatitis cases. In most of these cases, patients had underlying hepatic conditions or were under treatment with drugs known to cause hepatic dysfunction. Most of the reported events were transient and resolved spontaneously (see
PRECAUTIONS).
- Hepatic necrosis
- Hepatic failure
Other
- Malignant hyperthermia (see
CONTRAINDICATIONS
and
WARNINGS)
- Allergic reactions, such as rash, urticaria, pruritus, bronchospasm, anaphylactic or anaphylactoid reactions (see
CONTRAINDICATIONS)
- Reports of hypersensitivity (including contact dermatitis, rash, dyspnea, wheezing, chest discomfort, swelling face, or anaphylactic reaction) have been received, particularly in association with long-term occupational exposure to inhaled anesthetic agents, including sevoflurane (see
OCCUPATIONAL CAUTION).
Laboratory Findings
- Transient elevations in glucose, liver function tests, and white blood cell count may occur as with use of other anesthetic agents.
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