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Foran - instructions for use, reviews, analogs and forms of release (liquid for inhalation anesthesia 100 ml and 250 ml) of the drug for anesthesia, preparation for surgery and diagnosis in adults, children and pregnancy. Composition

Foran - instructions for use, reviews, analogs and forms of release (liquid for inhalation anesthesia 100 ml and 250 ml) of the drug for anesthesia, preparation for surgery and diagnosis in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Foran. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on using Foran in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Foran analogs in the presence of existing structural analogs.Use for anesthesia, preparation for surgery and diagnosis in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Foran - a preparation for inhalation anesthesia. It causes a rapid onset of general anesthesia and a quick exit from it. A minor irritant effect of isoflurane (the active substance of the drug Foran) may limit the rate of administration to general anesthesia. The drug does not cause excessive secretion of salivary and tracheobronchial glands. Pharyngeal and laryngeal reflexes are rapidly suppressed.

 

The level of general anesthesia with the use of isoflurane can change rapidly. With an increase in the depth of general anesthesia, suppression of spontaneous breathing occurs, so it should be carefully monitored and, if necessary, maintained.

 

At the stage of introduction into the general anesthesia, the blood pressure (BP) decreases, which quickly normalizes in the surgical stage of anesthesia, the heart rate does not change.

 

With maintenance anesthesia, blood pressure decreases in proportion to the depth of anesthesia, but the heart rate remains stable. During mechanical ventilation (IVL) at normal partial pressure of carbon dioxidegas in the blood (pCO2), the minute volume of the heart remains constant, regardless of the depth of general anesthesia, and is maintained mainly by increasing the heart rate (heart rate). With spontaneous breathing, developing hypercapnia can lead to an increase in heart rate and a minute volume of the heart, which exceed those on awakening.

 

With superficial anesthesia, cerebral blood flow does not change, but tends to increase with deep anesthesia, which can lead to a transient increase in cerebrospinal fluid pressure (CSF). An increase in CSF pressure can be prevented or reduced by hyperventilation before or during anesthesia.

 

Changes in the electroencephalogram (EEG) and convulsive activity are extremely rare with isoflurane. In general, Foran causes changes in the EEG, comparable with those when using other drugs for inhalation anesthesia.

 

Isoflurane significantly lessens the sensitivity of the myocardium to the action of adrenaline than enflurane. There is limited evidence that subcutaneous infiltration of up to 50 ml of an adrenaline solution 1: 200,000 does not cause ventricular arrhythmia in patients undergoing general anesthesia with isoflurane.

 

With a normal level of general anesthesia, muscle relaxation may be adequate for some intra-abdominal operations. If more expressed muscle relaxation is required, intravenous administration of small doses of muscle relaxants is possible. The depth of anesthesia is easily manageable.

 

Isoflurane can be used to introduce into general anesthesia and maintain general anesthesia.

 

Composition

 

Isoflurane + auxiliary substances.

 

Pharmacokinetics

 

The maximum concentration of inorganic fluoride in serum is usually less than 5 μmol / L and is determined 4 hours after anesthesia. The level of fluoride returns to normal within 24 hours. In the body, only a small amount of Foran is metabolized. The known metabolites of isoflurane did not have toxicity or were determined in too low concentrations. In the postoperative period, only 0.17% of the isoflurane dose can be detected as metabolites in the urine.

 

Indications

  • induction and maintenance of general inhalation anesthesia (anesthesia);
  • sedation (immersion in a state that looks like a nap, sleep, while the person feels relaxed and calm) for 48 hours in patients,which carries out mechanical ventilation in the intensive care unit;
  • preparatory procedures for subsequent treatment and examination (diagnosis).

 

Forms of release

 

Liquid for inhalation anesthesia 100 ml and 250 ml in vials.

 

Instructions for use and dosing regimen

 

Specially calibrated evaporators should be used to accurately control the feed concentration of isoflurane.

 

The levels of the minimum alveolar concentration (MAQ) of isoflurane in oxygen depend on age.

 

When Forean is mixed with pure oxygen, the average MAC is 0-1 months - 1.6%, 1-6 months - 1.87%, 6-12 months - 1.8%, 1-5 years - 1.6%, 20 years - 1.28%, 22-30 years - 1.28%, 37-51 year - 1.15%, 59-69 years - 1.05%. When the medicine is mixed with the oxygen-oxide mixture, the average MAC is 226 years - 0.56%, 37-51 year - 0.56%, 59-69 years - 0.37%.

 

Drugs used for premedication should be selected individually, bearing in mind that isoflurane can cause depression of the respiratory center. Optionally, you can use anticholinergic drugs.

 

Short-acting barbiturates or other drugs used for induction anesthesia are usually applied with subsequent inhalation of isoflurane.As an alternative, isoflurane may be used with oxygen or with oxygen-base mixture.

 

When inhaled for general anesthesia with isoflurane, a 0.5% concentration is recommended at the beginning. Concentrations from 1.5% to 3.0% usually cause a surgical level of general anesthesia after 7-10 minutes.

 

Maintenance of the surgical level of anesthesia can be provided by 1-2.5% isoflurane in the oxygen-base mixture. When using Foran in pure oxygen, its concentration should be increased by 0.5-1%. If necessary, additional use of muscle relaxants is possible.

 

To ensure anesthesia with caesarean section, it is sufficient to use 0.5-0.75% isoflurane in an oxygen-base mixture.

 

During maintenance of general anesthesia, the level of blood pressure in the absence of other factors is inversely proportional to the level of alveolar concentration of isoflurane. With deepening of anesthesia, the concentration of isoflurane in the inhaled mixture should be reduced in order to prevent an excessive decrease in blood pressure.

 

To maintain the surgical level of general anesthesia, elderly patients require lower concentrations of isoflurane.

 

Sedation can be maintained by 0.1-1% isoflurane in the oxygen-base mixture, the appropriate dose is selected individually.

 

Side effect

  • respiratory depression;
  • heart rhythm disturbances;
  • arterial hypotension (low blood pressure);
  • transient increase in the number of white blood cells, even in the absence of surgical stress;
  • liver damage (from a small and transient increase in hepatic enzyme activity to necrosis of hepatocytes);
  • in the postoperative period: chills, nausea, vomiting and intestinal obstruction.

 

Contraindications

  • malignant hyperthermia in the anamnesis;
  • hypersensitivity to isoflurane.

 

Application in pregnancy and lactation

 

Safety of Forana application in pregnancy is not established.

 

The blood loss associated with abortion in cases of isoflurane is comparable to blood loss when using other means for inhalation anesthesia.

 

Data on the efficacy and safety of Foran for general anesthesia in obstetrics are not available, except for caesarean section.

 

Isoflurane in concentrations up to 0.75% demonstrated safety for effective maintenance of anesthesia in cesarean section.There were no adverse reactions to the use of isoflurane in cesarean section.

 

There is no information on the excretion of isoflurane with breast milk. During the period of breastfeeding, Foran should be used with caution.

 

Use in children

 

Foran can be used in newborns and children under 2 years of age with acceptable for all other commonly used means for anesthesia the degree of benefit and risk.

 

special instructions

 

The drug significantly enhances cerebral blood flow, especially with deep anesthesia. There may be a transient increase in the pressure of cerebrospinal fluid, which is returned to the original in hyperventilation. When using isoflurane, postoperative cerebral complications were relatively rare.

 

With the introduction of Foran, the level of general anesthesia can change quickly and easily, so it is recommended that only carefully calibrated evaporators be used or that monitoring be performed to assess the inhaled and exhaled concentration. With an increase in the depth of general anesthesia, there is an increase in arterial hypotension and suppression of respiratory function.The degree of arterial hypotension and respiratory depression can be an indication of the depth of general anesthesia.

 

Clinical experience with Foran administration, even with prolonged exposure, does not provide information on hepatotoxicity. However, the lack of a large experience of repeated use of the drug does not allow us to identify symptoms of effects on liver function.

 

Like other halogen-containing drugs, Foran should be used with caution in patients with increased intracranial pressure. In these cases, controlled hyperventilation may be necessary.

 

Against the background of taking isoflurane, there was a transient change in the bromsulflatein test, an increase in glucose and serum creatinine, and a decrease in residual urea nitrogen, serum cholesterol and alkaline phosphatase.

 

In susceptible people, means for inhalation anesthesia, including isoflurane, can cause a state of skeletal muscle hypermetabolism, which leads to an increase in their oxygen demand and the development of a clinical syndrome known as malignant hyperthermia. The first sign of this syndrome is hypercapnia, and its clinical symptoms may include muscle stiffness, tachycardia, tachypnea, cyanosis, arrhythmias and / or unstable blood pressure.Some of these nonspecific symptoms may also occur with mild anesthesia, acute hypoxia, hypercapnia, and hypovolemia.

 

Treatment of malignant hyperthermia involves the withdrawal of drugs that caused its development, intravenous dantrolene and maintenance of symptomatic therapy. Later, kidney failure may develop, so you should monitor and, if possible, maintain diuresis.

 

The use of funds for inhalation anesthesia in children caused, in rare cases, an increase in serum potassium levels, which led to the development of cardiac arrhythmias and death in the postoperative period. This condition in particular can develop in patients with latent or evident neurological diseases, especially in patients with Duchenne's myodystrophy. In some cases, there was a connection with simultaneous use of succinylcholine. In these patients, there was also a significant increase in the level of creatine phosphokinase (CK) in the serum, a change in the composition of urine and myoglobinuria. In contrast to malignant hyperthermia and some similarity in the manifestation of such patients, there was never a muscle rigidity or symptoms associated with muscle hypermetabolism.If the development of such conditions threatens, especially if a patient has a latent current neuromuscular disease, immediate measures should be initiated to stop hyperkalemia and stable arrhythmia.

 

There are reports of individual cases of an increase in the level of carboxyhemoglobin using halogen containing anesthetics containing a group - CF2H, such as dezoflurane, enflurane and isoflurane. In the presence of normally moistened carbon dioxide (CO2) sorbents, no increase in the concentration of carbon monoxide is observed.

 

When using isoflurane with over-dried CO2 sorbents (especially those containing potassium hydroxide), rare cases of excessive overheating and / or spontaneous ignition in anesthesia apparatus are described.

 

If the anesthetist suspects that the sorbent CO2 is overdried, then it should be replaced before applying Foran. When drying CO2 sorbent, the color of the indicator does not always change. Consequently, the absence of color changes in the indicator can not be considered a confirmation of adequate hydration. Sorbents CO2 must be regularly changed regardless of the color of the indicator.

 

Drug Interactions

 

Isoflurane significantly potentiates the action of all known muscle relaxants, and more of the non-depolarizing muscle relaxants.

 

Neostigmine eliminates the effects of nondepolarizing muscle relaxants, but does not affect the muscle relaxation caused by isoflurane itself.

 

All muscle relaxants are compatible with isoflurane.

 

With the simultaneous use of Foran with nitric oxide (N2O), a decrease in MAK was observed in adult patients.

 

Analogues of the drug Foran

 

Structural analogs for the active substance:

  • Aerran.

 

Analogues of the drug Foran on the pharmacological group (anesthesia):

  • Aerran;
  • Nitrogen is a nitrous oxide;
  • Brietal;
  • Halothane;
  • Diprivan;
  • Calypsole;
  • Ketalar;
  • Ketamine;
  • Ketanest;
  • XeMed;
  • Medksenone;
  • Midazolam;
  • Narcotane;
  • Sodium oxybate;
  • Sodium oxybutyrate;
  • Pofol;
  • Proanes;
  • After proving;
  • Propovan;
  • Propofol;
  • Radenarcon;
  • Rekofol;
  • Sevoran;
  • Sevoflurane;
  • Sombrevin;
  • Supran;
  • Thiopental;
  • Fluorotane;
  • Fuldsed;
  • Etran;
  • The ether is medical.

 

Recall of an anesthesiologist

 

Foran - a well-proven drug for inhalation anesthesia. The equipment in our clinic allows you to precisely monitor the patient's drug concentration.We use Foran both for introduction to general anesthesia, and for maintaining the surgical level of anesthesia. Patients, as a rule, tolerate this kind of anesthesia well. In my practice there were cases of transient transient respiratory depression and cardiac arrhythmias. In addition, we use Foran for sedation of patients who are in the intensive care unit on artificial ventilation. We select the dose individually for each patient.

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