Dosage form:  Liquid for inhalation. Compound: As an active substance- halothane;

excipient- thymol.

Description: A transparent, colorless, heavy, mobile, highly volatile liquid with an odor reminiscent of chloroform. Pharmacotherapeutic group:Agent for inhalation general anesthesia ATX:  

N.01.A.B.01 Halothane

N.01.A.B Halogenated hydrocarbons

Pharmacodynamics:Causes rapid induction of anesthesia without or with minimal manifestation of the arousal stage. It has an analgesic and muscle relaxant effect (does not create sufficient muscle relaxation, and therefore additional use of muscle relaxants is required). Increases n.vagus tone, causing bradycardia. Due to the direct negative inotropic effect, it reduces myocardial contractility and stroke volume. By increasing the sensitivity of cardiomyocytes to catecholamines, it increases the likelihood of developing arrhythmias. Proportional to the depth of general anesthesia, it weakens the contractility of the uterus. At a concentration of 0.5 to 3-4 vol.%, the surgical stage of anesthesia is achieved in 4-6 minutes; after the end of general anesthesia, awakening occurs in 5-15 minutes. Pharmacokinetics:When inhaled, it is absorbed from the lumen of the alveoli into the bloodstream, and the concentration in the alveoli and blood quickly balances. Distributed into organs with good vascularization (brain, heart, liver), muscles, adipose tissue. Quickly passes histohematic barriers, including blood-brain and placental. After the cessation of entry into the body, the decrease in its concentration in plasma is exponential. Excreted by the lungs - 60 and 80% unchanged; kidneys - 20% in the form of inactive metabolites.

Metabolized by oxidation in the liver, the main metabolites are trifluoroacetic acid, chlorides, bromides. It is excreted mainly by the lungs unchanged and in the urine in the form of metabolites. At low oxygen tension, it is metabolized to the free radical chlorotrifluoroethyl, which is able to react with components of the hepatocyte membrane.

Indications: Induction and maintenance of anesthesia in adults and children. Contraindications:Hypersensitivity, unexplained jaundice, fever, or history of fever following halothane administration; pheochromocytoma, hypercatecholaminemia, arterial hypotension, myasthenia gravis, use of halothane for general anesthesia less than 3 months ago, pregnancy (1st trimester), childbirth and early postpartum period, performing dental procedures on children and adolescents under 18 years of age outside of a hospital setting. With caution:Taking cardiac glycosides. The drug is contraindicated in patients with a known or suspected genetic predisposition to malignant hyperthermia. Pregnancy and lactation:Contraindicated in the 1st trimester of pregnancy, during childbirth and in the early postpartum period. After anesthesia with the drug, breastfeeding should be stopped for 24 hours. Directions for use and dosage:

Suitable for any type of inhalation anesthesia. The correct dose is achieved using a calibration evaporator located outside the closed circulation system (to avoid overdose).

Adults

Induction

For induction of anesthesia at a flow rate of 8 l/min. start by supplying halothane at a concentration of 0.5 vol.% (with oxygen), then gradually increase the concentration of halothane vapor in the mixture to 0.5 - 3 vol.%. As a maintenance concentration, as a rule, 0.5 - 1.5 vol.% is sufficient for adults.

Children

During induction, children, starting from newborns, require greater concentration than adults.

Elderly

Elderly patients require a lower dosage of halothane, but the actual dosage is based on the patient's physical condition.

The surgical stage of anesthesia is usually achieved in 4-6 minutes.

The minimum alveolar concentration (MAC) for adults when mixed with oxygen is 0.77 vol.%, when mixed with nitrous oxide - 0.3 vol.%. MAC of halothane when mixed with oxygen for children up to 6 months. - 1.08 vol.%; up to 10 years - 0.92 vol.%; for persons over 70 years old - 0.64 o6.%.

At the end of the operation, the oxygen flow is increased to more quickly eliminate fluorotane and eliminate possible hypercapnia.

To avoid side effects associated with excitation of the vagus nerve (bradycardia, arrhythmia), the patient is administered metacin before anesthesia. For premedication, it is preferable to use promedol rather than morphine, which stimulates the centers of the vagus nerve less. If it is necessary to enhance muscle relaxation, it is preferable to prescribe relaxants of a depolarizing type of action (ditilin); when using drugs of a non-depolarizing (competitive) type, the dose of the latter is reduced compared to the usual one. The concentration of fluorotane when using muscle relaxants (with controlled breathing) should not exceed 1 - 1.5 vol.%.

Side effects:From the side of the central nervous system: after waking up, headache and tremor are possible; increased intracranial pressure.

From the cardiovascular system: arterial hypotension, bradycardia, heart rhythm disturbances.

From the digestive system: impaired liver function up to the development of jaundice, hepatitis, liver necrosis, especially with repeated administrations; Nausea and postoperative vomiting are possible after waking up. Others: respiratory depression, increased intracranial pressure, eosinophilia, possible development of malignant hyperthermia. Malignant hyperthermia is a very severe, often fatal, complication of anesthesia, especially in children and adolescents. Clinically, this complication is manifested by severe tachycardia, a drop in blood pressure, impaired gas exchange and a sharp increase in the child’s body temperature to 40-42°C. Malignant hyperthermia can quickly lead to cerebral edema and death.

Malignant hyperthermia syndrome is usually observed in individuals with a hereditary predisposition to malignant hyperthermia. Body temperature quickly rises to 42 °C (!) and higher, generalized rhabdomyolysis occurs, and severe acidosis develops.

The possibility of developing malignant hyperthermia should be remembered if there is insufficient muscle relaxation at the beginning of anesthesia, as well as if fasciculations occur in response to the administration of ditilin. In some patients, the first sign of muscle damage is trismus, which develops during intubation. Although the increase in temperature is the result of muscle contraction, it can increase very quickly.

Overdose: Symptoms: severe bradycardia, arrhythmias, hypotension, hyperthermic crisis, depressed breathing.

Treatment: mechanical ventilation with pure oxygen, symptomatic therapy.

Interaction: Sympathomimetics increase the risk of developing arrhythmias. Enhances the effect of non-depolarizing muscle relaxants, antihypertensive drugs, bradycardia under the influence of digitalis drugs and cholinesterase inhibitors (neostigmine), weakens the effect of uterotonic drugs. and phenothiazine derivatives enhance the depressant effect on the central nervous system.

Increases the risk of liver damage with phenytoin. Aminoglycosides and polymyxins deepen neuromuscular blockade (can cause apnea). increases the half-life, nitrous oxide, and phenothiaziazines- the potency of general anesthesia. The likelihood of developing malignant hyperthermia is increased by suxamethonium, and arrhythmias by xatin.

Strengthens and prolongs the action and toxicity of tubocurarine chloride.

Ganglion blockers are prescribed in smaller doses, since their effect is potentiated by fluorotane.

When oxytocin is combined with ftorotan, arterial hypotension, sinus bradycardia, and pathological atrioventricular rhythm in the mother during labor are possible.

In combination with MAO inhibitors, the risk of increased blood pressure increases.

In addition, MAO inhibitors aggravate the toxic effect of ftorotane. Preoperative use of the beta-blocker timolol in the form of eye drops during fluorotane anesthesia can cause hypotension and bradycardia.

Special instructions:Fluorotane has hepatotoxicity, since in the liver it is converted into free radicals, initiators of lipid peroxidation, and also forms metabolites (fluoroethanol) that covalently bind to biomacromolecules. The incidence of hepatitis is 1 case per 10,000 anesthesia in adult patients. In children, liver damage develops much less frequently.

Causes muscle relaxation, so it should be used with caution in patients with myasthenia gravis and/or when used concomitantly with aminoglycoside antibiotics. During anesthesia, an increase in blood flow in the cerebral vessels and/or an increase in intracranial pressure may be observed. These effects are usually more pronounced in the presence of intracranial tumors. To counteract these effects, moderate hyperventilation is used in neurosurgery.

There is a risk of developing random tachycardia in children.

Monitoring the patient's condition under anesthesia is carried out by monitoring the pulse, blood pressure (measured manually or automatically, direct and indirect methods), continuous recording of the ECG, oxygen content in the blood (observing the color of the skin and mucous membranes, using a pulse oximeter or analysis blood), temperature of the “core” and surface of the body, pupil reaction, diuresis rate, blood tests for gases, electrolyte composition and acid-base status.

Cannot be stored in evaporators; Before new use, the evaporator must be cleaned of residual fluorotane and its decomposition products. Thymol (used for stabilization) does not evaporate, remains in the evaporator, coloring the solution yellowish, it is highly soluble, and is eliminated with ether. It is necessary to discontinue levodopa 6-8 hours before the start of general anesthesia.

Patients with chronic alcoholism require large doses for anesthesia.

Impact on the ability to drive vehicles. Wed and fur.:

During the day after anesthesia, you should refrain from driving vehicles, machines and mechanisms.

Release form/dosage:Liquid for inhalation. Package: 50 ml in orange glass dropper bottles or brown glass bottles for medical preparations, packaged with instructions for use in cardboard packs for consumer packaging in accordance with GOST 7933-89. Storage conditions:Store in a dry place, protected from light at temperatures up to 15 ° C

Ftorotan is used only in medical institutions.

Best before date: Shelf life: 3 years. Do not use after expiration date. Close Instructions

Ftorotan is a drug used for inhalation general anesthesia.

Release form and composition

The dosage form of Ftorotan is a liquid for inhalation: colorless, transparent, highly volatile, with an odor that resembles chloroform (in dark glass bottles and dark glass dropper bottles of 50 ml, 1 bottle in a cardboard box).

1 bottle of liquid contains:

• active substance: halothane – 50 ml;
• auxiliary component: thymol.

Indications for use

Ftorotan is prescribed for induction and maintenance of anesthesia in children and adults.

Contraindications

• arterial hypotension;
• hypercatecholaminemia;
• history of jaundice, fever or fever of unexplained origin after administration of halothane;
• pheochromocytoma;
• known or suspected genetic predisposition to malignant hyperthermia;
• myasthenia gravis;
• a period of less than 3 months after the administration of halothane for general anesthesia;
• age up to 18 years when performing dental procedures outside a hospital setting;
• childbirth and early postpartum period;
• I trimester of pregnancy;
• hypersensitivity to the components of the drug.

Ftorotan is prescribed with caution during simultaneous therapy with cardiac glycosides.

Stop breastfeeding for 24 hours after using the drug.

Directions for use and dosage

The liquid is used for any type of inhalation anesthesia. Using a calibration sprayer, which is located outside the closed circulation system, the required dose is selected.

In adults, induction of anesthesia at a flow rate of 8000 ml per minute begins with the supply of Ftorotan in a concentration of 0.5 volume % (with oxygen), then the concentration of drug vapor in the mixture is gradually increased to 0.5–3 volume %. As a rule, for adults, 0.5–1.5% by volume is sufficient as a maintenance concentration.

Children, including newborns, require greater concentrations during induction than adults.

Elderly patients are prescribed a lower dose of the drug. The current dose is determined based on the physical condition of the patient.

In most cases, after 4–6 minutes after administration, the surgical stage of anesthesia is achieved.

The minimum alveolar concentration of halothane for adults when mixed with nitrous oxide is 0.3% by volume, with oxygen - 0.77% by volume; for children aged< 6 месяцев при смеси с кислородом – 1,08 объемных %, детей в возрасте < 10 лет – 0,92 объемных %; для пациентов в возрасте >70 years – 0.64% by volume.

To eliminate possible hypercapnia and achieve faster elimination of Ftorotan, the oxygen flow is increased after the end of the operation.

Before anesthesia, patients are administered metacin or atropine to avoid the development of side effects associated with excitation of the vagus nerve (arrhythmia, bradycardia). It is recommended to use promedol instead of morphine for premedication, since the former has a less stimulating effect on the centers of the vagus nerve. To enhance muscle relaxation (if necessary), relaxants of a depolarizing type of action (ditiline) are prescribed; when prescribing drugs of a non-depolarizing (competitive) type, their dose is reduced compared to the usual one. When using muscle relaxants (in cases of controlled breathing), the concentration of fluorotane should not be greater than 1–1.5% by volume.

Side effects

• central nervous system: tremor, headache (after the patient awakens), increased intracranial pressure;
• cardiovascular system: heart rhythm disturbances, bradycardia, arterial hypotension;
• digestive system: impaired liver function, including hepatitis, jaundice, liver necrosis (especially with repeated administrations); postoperative vomiting, nausea (after the patient awakens);
• other: depressed breathing, eosinophilia, malignant hyperthermia (including impaired gas exchange, severe tachycardia, a sharp increase in the child’s body temperature to 40–42°C, a drop in blood pressure, cerebral edema, death).

Special instructions

The drug is hepatotoxic because, when it enters the liver, it is converted into free radicals, initiators of lipid peroxidation, and also forms metabolites (fluoroethanol) that covalently bind to biomacromolecules. In adult patients, the chance of developing hepatitis is 1 in 10,000 times anesthesia. Liver damage in children is observed much less frequently.

Ftorotan causes muscle relaxation, and therefore it is prescribed with caution for myasthenia gravis and/or concomitant therapy with aminoglycoside antibacterial drugs. During anesthesia, there may be an increase in intracranial pressure and/or an increase in blood flow in the vessels of the brain. These effects are in most cases more pronounced against the background of intracranial neoplasms. To counter them, moderate hyperventilation is used in neurosurgery.

It should be taken into account that during treatment children may develop unsystematic tachycardia.

Monitoring the patient’s condition during anesthesia is carried out by monitoring the following indicators:

• pulse;
• blood pressure (measured manually or automatically, directly and indirectly);
• continuous recording of the electrocardiogram;
• oxygen content in the blood (the color of the skin and mucous membranes is taken into account using a blood test or pulse oximeter);
• body core and surface temperature;
• diuresis rate;
• blood gas test;
• electrolyte composition;
• acid-base state.

The liquid should not be stored in evaporators; Before new use, the evaporator is cleaned of drug residues and its decomposition products. Thymol used for stabilization does not evaporate; it remains in the evaporator, giving the solution a yellow tint; it is highly soluble and can be removed with ether.

Levodopa therapy is discontinued 6–8 hours before general anesthesia.

In chronic alcoholism, large doses are used for anesthesia.

For 24 hours after anesthesia, patients should refrain from engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

Drug interactions

The effect of halothane on drugs/substances during combination therapy:

• uterotonics: weakens their effect;
• antihypertensive drugs, muscle relaxants of non-depolarizing action: enhances their effect;
• tubocurarine chloride: enhances and prolongs its action and toxicity;
• ganglion blockers: potentiates their action, and therefore they are prescribed in smaller doses;
• drugs that cause uterine contractions (ergot alkaloids, oxytocin): reduces the sensitivity of the uterus to them.

Effect of drugs/substances on halothane when administered in combination:

• morphine, phenothiazine derivatives: enhance its depressant effect on the central nervous system;
• ketamine: prolongs its half-life;
• phenothiaziazines, morphine, nitrous oxide, methyldopa: increase the strength of general anesthesia;
• monoamine oxidase inhibitors: aggravate its toxic effect;
• nitrous oxide, opioid analgesics: enhance its analgesic effect.

When halothane is used simultaneously with certain drugs/substances, the following effects may develop:

• sympathomimetics: increased risk of arrhythmias;
• phenytoin: increased risk of liver damage;
• polymyxin, lincomycin, aminoglycosides: deepening of neuromuscular blockade (possible development of apnea);
• suxamethonium: increased likelihood of developing malignant hyperthermia;
• xanthine: increased likelihood of developing arrhythmia;
• oxytocin: possible development of arterial hypotension, sinus bradycardia, pathological atrioventricular rhythm in the mother during childbirth;
• monoamine oxidase inhibitors: risk of increased blood pressure;
• timolol in the form of eye drops: development of hypotension and bradycardia when instilled before surgery;
• theophylline, sympathomimetics: increased likelihood of developing heart rhythm disturbances;
• antidepolarizing muscle relaxants, aminoglycosides: increased neuromuscular blockade;
• Digitalis preparations, cholinesterase inhibitors: increased bradycardia.
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Indications for use:
Ftorotan is a powerful narcotic, which allows it to be used independently (with oxygen or air) to achieve the surgical stage of anesthesia or as a component of combined anesthesia in combination with other narcotic drugs, mainly with nitrous oxide.
Under fluorotane anesthesia, various surgical interventions can be performed, including on the abdominal and thoracic cavities,
in children and the elderly. Non-flammability makes it possible to use it when using electrical and X-ray equipment during surgery.
Ftorotan is convenient for use during operations on the organs of the chest cavity, since it does not cause irritation of the mucous membranes of the respiratory tract, inhibits secretion, relaxes the respiratory muscles, which facilitates artificial ventilation. Fluorothane anesthesia can be used in patients with bronchial asthma. The use of fluorotan is especially indicated in cases where it is necessary to avoid agitation and tension of the patient (neurosurgery, ophthalmic surgery, etc.).

Pharmacological action:
A powerful narcotic for inhalation anesthesia.
Pharmacokinetically, fluorotane is easily absorbed from the respiratory tract and rapidly excreted unchanged by the lungs; Only a small part of fluorotane is metabolized in the body. The drug has a rapid narcotic effect, stopping soon after the end of inhalation.
Ftorotan vapors do not cause irritation of mucous membranes. There are no significant changes in gas exchange during anesthesia with fluorotane; blood pressure usually decreases, which is partly due to the inhibitory effect of the product on the sympathetic ganglia and the expansion of peripheral vessels. The tone of the vagus nerve remains elevated, which creates conditions for bradycardia. To some extent, fluorotane has a depressing effect on the myocardium. In addition, ftorotan increases the susceptibility of the myocardium to catecholamines: the administration of adrenaline and norepinephrine during anesthesia can cause ventricular fibrillation. Ftorotan does not affect kidney function.

Ftorotan method of application and dose:
To induce anesthesia, begin with the supply of fluorotane at a concentration of 0.5 vol. % (with oxygen), then over 1.5 - 3 minutes increase it to 3-4 vol. %. To maintain the surgical stage of anesthesia, a concentration of 0.5 - 2 vol is used. %.
When using fluorotane, consciousness usually turns off after 1-2 minutes after the start of inhalation of its vapors. After 3-5 minutes, the surgical stage of anesthesia begins. After 3-5 minutes after stopping the supply of fluorotane, patients begin to awaken. Anesthesia depression completely disappears after 5 - 10 minutes after short-term anesthesia and after 30 - 40 minutes after long-term anesthesia. Excitement is observed infrequently and is weakly expressed.
During anesthesia with fluorotane, it is necessary to precisely and smoothly regulate the supply of its vapor. It is necessary to take into account the rapid change of stages of anesthesia. Therefore, fluorotane anesthesia is carried out using special evaporators located outside the circulation system. The oxygen concentration in the inhaled mixture must be at least 50%. For short-term operations, fluorotan is sometimes used with the help of a regular anesthesia mask. When ftorotan is applied to the mask in an amount of 30-40 drops per minute, the period of excitation lasts within 1 minute, and the surgical stage of anesthesia usually occurs in the 3rd - 5th minute. As a rule, they start by applying fluorotane to the mask at a rate of 5 - 15 drops per minute, then the supply is quickly increased to 30 - 50 drops per minute; to maintain the surgical stage of anesthesia, 10 - 25 drops per minute are given. It is not recommended to use fluorotane through a mask in children.
To avoid side effects associated with stimulation of the vagus nerve (bradycardia, arrhythmia), the patient is administered atropine or metacin before anesthesia. For premedication, it is preferable to use promedol rather than morphine, which stimulates the centers of the vagus nerve less.
If it is necessary to enhance muscle relaxation, it is preferable to prescribe relaxants of a depolarizing type of action (ditilin); when using
For non-depolarizing (competitive) type products, the dose is subsequently reduced compared to the usual one. Fluorothane concentration when used
muscle relaxants (with controlled breathing) should not exceed 1 - 1.5 vol.%.
Ganglion blockers are prescribed in smaller doses, since their effect is potentiated by fluorotane.

Ftorotan contraindications:
Anesthesia with fluorotane should not be used for pheochromocytoma (adrenal tumors), severe hyperthyroidism (thyroid disease) and in other cases when the level of adrenaline in the blood is increased, with severe hyperthyroidism. It should be used with caution in patients with heart rhythm disturbances, hypotension, and organic liver damage. During gynecological operations, it should be taken into account that fluorotane can cause a decrease in the tone of the uterine muscles and increased bleeding. The use of fluorotan in obstetrics and gynecology practice should be limited only to those cases where relaxation of the uterus is indicated. Under the influence of fluorotane, the uterine susceptibility to products that cause its contraction (ergot alkaloids, oxytocin) decreases.
During anesthesia with fluorotane, adrenaline and norepinephrine should not be used to avoid arrhythmias.

Ftorotan side effects:
During anesthesia with fluorotane, due to the suppression of the sympathetic ganglia and the expansion of peripheral vessels, high bleeding is possible, which requires careful hemostasis, and, if necessary, compensation for blood loss.
Due to the rapid awakening after cessation of anesthesia, patients may feel pain, so early use of analgesics is necessary.
Sometimes chills are observed in the post-operative period (due to vasodilation and heat loss during surgery). In these cases, patients need to be warmed with heating pads. Nausea and vomiting usually do not occur, but the possibility of their occurrence in connection with the administration of analgesics (morphine) should be taken into account.
It should be taken into account that persons working with fluorotane may develop allergic reactions.

Release form:
In well-closed orange glass bottles of 50 ml.

Synonyms:
Halothane, Fluotan, Narcotan, Anestan, Fluctan, Galan, Rodialotan, Somnotan.

Storage conditions:
List B. In a dry, cool, dark place.

Ftorotan composition:
1,1,1-Trifluoro-2-chloro-2-bromoethane.
A colorless, transparent, mobile, easily volatile liquid with an odor reminiscent of chloroform, a sweet and pungent taste. Density 1.865 - 1.870. Boiling point (distillation) + 49 - 51 C°. Slightly soluble in water (0.345%), miscible with anhydrous alcohol,
ether, chloroform, trichlorethylene, oils. Oil/water distribution coefficient 330. Vapor pressure at + 20 C°
equal to 241.5 mm Hg. Art. Ftorotan does not burn or ignite. Fluorotane slowly decomposes when exposed to light.

Attention!
Before using the medication "Ftorotan" You should consult your doctor.
The instructions are provided for informational purposes only. Ftorotan».

Ftorotan is a synthetic medication used for inhalation general anesthesia during operations of varying complexity and duration.

Pharmacological action of Ftorotan

The active component of Ftorotan is a powerful narcotic drug. This allows you to use it independently for anesthesia during surgical operations of varying complexity for people of all ages. Ftorotan is characterized by a rapid introduction to anesthesia with a minimal stage of excitation. Most often, this type of anesthesia is used during operations in which it is necessary to avoid overexcitation, for example, in neurosurgery and ophthalmic surgery.

It can also be combined with other anesthetics (usually nitrous oxide). Fluorotane is an integral part of the azeotron mixture, where it is included in equal parts along with ether. This anesthesia mixture has a stronger and faster effect than ether, but less pronounced than Ftorotan.

Ftorotan has a rapid effect - the surgical stage of anesthesia usually occurs in 3-5 minutes. After stopping the supply of anesthesia, awakening begins. After short-term anesthesia, the disappearance of anesthesia depression is observed after 5-10 minutes, and after prolonged general anesthesia - after 30-40 minutes.

For premedication, it is more preferable to use promedol rather than morphine, which has less stimulation on the centers of the vagus nerve.

Ftorotan vapors do not cause irritation of the mucous membranes, however, a decrease in blood pressure is observed, which is caused by its inhibitory effect on the sympathetic ganglia and dilation of peripheral vessels.

In order not to cause ventricular fibrillation, simultaneous use of Ftorotan with adrenaline and norepinephrine is not recommended, which is associated with increased sensitivity of the myocardium to catecholamines. Ftorotan has no effect on kidney function.

Release form and composition of Ftorotan

The medication Ftorotan is produced in bottles in the form of a liquid for inhalation containing the active substance (halothane) in an amount of 50 ml.

Ftorotan's analogs

There are no analogues of the medicine based on the active substance. Analogs of Ftorotan with a similar mechanism of action belonging to the same drug group are the drugs Foran, Aerran, Sevoran, Supran, Sevoflurane and Trichlorethylene in the form of a liquid for inhalation and Chloroform in the form of an emulsion for external use.

Indications for use of Ftorotan

Anesthesia with Ftorotan (as general anesthesia) is used during surgical interventions of varying duration.

In addition, Ftorotan is prescribed as an anesthetic according to the instructions against the background of:

• Bronchial asthma;
• Chronic obstructive pulmonary disease;
• Diabetes mellitus.

Contraindications

The use of anesthesia with Ftorotan is contraindicated:

• Against the background of jaundice;
• During the first trimester of pregnancy and during childbirth;
• Against the background of liver diseases;
• With malignant hyperthermia, which is noted in the anamnesis due to the use of halothane;
• If local use of epinephrine is necessary during surgery (due to an increased risk of arrhythmias);
• Against the background of intracranial hypertension;
• With thyrotoxicosis;
• Against the background of pheochromocytoma;
• Against the background of liver failure;
• Within three months after general anesthesia with halothane;
• Against the background of hypercatecholaminemia;
• With arterial hypotension;
• In case of hypersensitivity to the main (halothane) or auxiliary components included in the anesthesia liquid Ftorotan;
• With myasthenia gravis;
• For arrhythmia.

Particular caution is required when using Ftorotan according to the instructions simultaneously with taking cardiac glycosides.

Directions for use and dosage

The drug Ftorotan is applicable for any type of inhalation anesthesia. The correct dosage of anesthesia with Ftorotan can be achieved using a calibrated evaporator, which is located outside a closed circulation system to avoid overdose.

To introduce anesthesia, the concentration of vapors of the active substance (halothane) in oxygen or a mixture of dinitrogen oxide and oxygen is gradually increased to 3-4 vol.%.

The usual maintenance concentration of Ftorotan is 0.5-2 vol.%.

As a rule, depression of the respiratory center is observed in most cases at a concentration of 30-38 mg%.

According to the instructions, Ftorotan cannot be stored in evaporators. Before each new use, the evaporator must be cleaned of Ftorotan residues, as well as its decomposition products. The thymol remaining in the evaporator, which is used for stabilization, does not evaporate, but it dissolves well and is easily removed with ether.

6-8 hours before the start of general anesthesia with Ftorotan, levodopa must be discontinued.

Against the background of chronic alcoholism, large doses may be required to provide anesthesia with the medication.

Side effects

During the use of Ftorotan, various disorders of many body systems may be observed. Most often they appear as:

• Tremor and headache after waking up, increased intracranial pressure (central nervous system);
• Bradycardia, arterial hypotension, heart rhythm disturbances (cardiovascular system);
• Nausea upon awakening, liver dysfunction, which can in some cases cause the development of jaundice, liver necrosis, hepatitis, which is most often observed with repeated administration of the drug (digestive system).

Also, the use of Ftorotan can lead to the development of malignant hyperthermia, a decrease in blood pressure and an increase in the sensitivity of the heart to catecholamines.

In case of an overdose, symptoms associated with disruption of the cardiovascular and respiratory systems may develop, manifested in the form of severe bradycardia, decreased blood pressure, arrhythmia, hypertensive crisis and respiratory depression. Treatment usually involves artificial ventilation of the lungs with pure oxygen.

Drug interactions Ftorotan

During anesthesia with Ftorotan, it should be taken into account that:

• There is an increase in the effect of non-depolarizing muscle relaxants and antihypertensive drugs;
• Suxamethonium increases the likelihood of malignant hyperthermia;
• Adrenergic stimulants increase the risk of developing arrhythmias;
• The depressant effect on the central nervous system is enhanced by phenothiazines and morphine;
• The effect of uterotonic medications is weakened;
• Neuromuscular blockade is deepened by lincomycin, aminoglycosides and polymyxins;
• Methyldopa, morphine, dinitrogen oxide and phenothiazines increase the strength of general anesthesia;
• The risk of liver damage increases when taken concomitantly with phenytoin;
• Xanthine increases the likelihood of arrhythmia.

Storage conditions and periods

The medication Ftorotan is an anesthetic agent with a shelf life of 24 months, provided it is stored under the necessary conditions. Since Ftorotan gradually decomposes under the influence of light, it is stored in orange glass bottles.

Ftorotan is an anesthetic inhalation drug that can be used as a single agent (in combination with oxygen) or in combination with various anesthetics to achieve the required level of anesthesia.

This anesthetic agent is quite easily absorbed from the respiratory tract and is excreted from the lungs in an unchanged form. Partially exposed to metabolism. The drug has an immediate narcotic effect, which is leveled off upon completion of the anesthetic delivery.

Application in modern practice

Fluorothane anesthesia can be used during a wide variety of surgical operations, including on the thoracic and abdominal organs. It is approved for use by children and pensioners, as well as for other respiratory diseases.

Fluorotan has become particularly widespread in ophthalmology, neurosurgery and other medical fields, where during the operation it is extremely important to prevent tension and excitement of the person being operated on. During operations on the thoracic cavity, fluorotan is used especially often, because does not irritate the mucous membranes of the respiratory tract, calms the respiratory muscles, inhibits secretion, which allows doctors to easily perform any procedures to support breathing.

At the same time, the drug is non-flammable, so its use is permitted if the operation requires the use of X-ray equipment and other electrical equipment.

To put the patient into a state of deep anesthesia, fluorotane is administered at a concentration of 0.5 vol. % in combination with oxygen, after which after a few minutes the dose is increased to 3-5 vol. %. Maintenance dosage of the drug during surgical operations is 0.5-2 vol. %.

During anesthesia with fluorotane, the supply of anesthetic vapor is smoothly and precisely regulated and the change in stages of anesthesia is necessarily taken into account. In this regard, such anesthesia is carried out using special evaporators, which are located outside the circulation system. The oxygen level in the inhaled mixture must be at least 50%. When carrying out short-term medical interventions, the anesthetic can be applied through a simple anesthesia mask.

The use of fluorotane is not recommended for pheochromocytoma and in any other case when there is a high concentration of adrenaline in the blood. The anesthetic is used with caution in patients with cardiac arrhythmias, organic liver damage, and hypotension. When performing gynecological operations, it must be taken into account that the anesthetic reduces the tone of the uterus and increases bleeding. Under the influence of the drug, the uterus loses sensitivity to drugs that cause its contraction.

Effect of the drug

In the case of using fluorotane, blackout occurs, as a rule, after a minute and a half. Surgical anesthesia is observed after a few minutes. Awakening occurs a few minutes after the end of the anesthetic administration. It is impossible not to note the fairly rapid disappearance of anesthesia depression - within 7-8 minutes after short-term and half an hour after long-term anesthesia. Excitement is observed in a small number of patients and it is rather mild.

Ftorotan vapors do not irritate mucous membranes. In addition, no significant changes are observed during anesthesia. In most cases, blood pressure decreases, which is partly due to the negative effect of the anesthetic on the sympathetic ganglia and an increase in peripheral blood vessels.

At the same time, there is an increase in the tone of the vagus nerve, which creates conditions for the development of bradycardia. Ftorotan will also have a depressant effect on the heart muscle. In addition, the anesthetic increases its sensitivity to catecholamines and due to the administration of norepinephrine and adrenaline during anesthesia, ventricular fibrillation occurs.

This anesthetic does not have any effect on the functioning of the kidneys, but in rare cases it causes disturbances in the liver, which leads to the appearance of jaundice.

Side effects and contraindications

The side effects of this drug are quite varied:

• Bradycardia;
• Reduced blood pressure;
• Increased sensitivity of the heart muscle to catecholamines;
• Respiratory depression;
• Liver dysfunction;
• Arrhythmias;
• Malignant hyperthermia;
• Intracranial hypertension;
• Post-anesthetic delirium.

In addition, patients often experience nausea, tremors, and headaches after waking up. Side effects develop quite rarely and are mild in nature, so even if there are minor contraindications, the doctor often chooses fluorotan, because in dangerous situations and in seriously ill patients this anesthetic drug will have minimal negative effects on the human body.

In case of an anesthetic overdose, patients develop arrhythmias, severe bradycardia, decreased blood pressure, respiratory depression and hyperthermic crisis. Treatment of overdose is carried out in almost all cases using mechanical ventilation with pure oxygen.

Among the main contraindications for use, we highlight:

• First trimester of pregnancy, period of childbirth;
• High sensitivity to the drug;
• Jaundice;
• Liver diseases;
• Malignant hyperthermia;
• Intracranial hypertension;
• Liver failure;
• Thyrotoxicosis;
• Pheochromotoma;
• Arterial hypotension;
• Myasthenia;
• Arrhythmias;
• Liver diseases;
• Severe cardiovascular failure with hypotension.

In recent years, there has been a tendency to abandon the use of fluorotane due to toxicity and harmful effects on the patient.

In addition to the patient, medical personnel working in the operating room also suffer from this gas, since there is always a small concentration in their work area.