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IsoFlo 100% w/w Inhalation Vapour, liquid 250ml

Zoetis

Item no: ISOFLO
 
Indicated for the induction and maintenance of general anaesthesia in horses, dogs, cats ornamental birds, reptiles, rats, mice, hamsters, chinchillas, gerbils, guinea pigs and ferrets.
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Uses
Indicated for the induction and maintenance of general anaesthesia in horses, dogs, cats ornamental birds, reptiles, rats, mice, hamsters, chinchillas, gerbils, guinea pigs and ferrets.
Dosage and administration
Inhalation use.
Isoflurane should be administered using an accurately calibrated vaporiser in an appropriate anaesthetic circuit, since levels of anaesthesia may be altered rapidly and easily.
Isoflurane may be administered in oxygen or oxygen/nitrous oxide mixtures.
The MAC (minimal alveolar concentration in oxygen) or effective dose ED50 values and suggested concentrations given below for the target species should be used as a guide or starting point only. The actual concentrations required in practice will depend on many variables, including the concomitant use of other drugs during the anaesthetic procedure and the clinical status of the patient.
Isoflurane may be used in conjunction with other drugs commonly used in veterinary anaesthetic regimes for premedication, induction and analgesia. Some specific examples are given in the individual species information. The use of analgesia for painful procedures is consistent with good veterinary practice.
Recovery from isoflurane anaesthesia is usually smooth and rapid. The analgesic requirements of the patient should be considered before the termination of general anaesthesia. Although anaesthetics have a low potential for damage to the atmosphere, it is good practice to use charcoal filters with scavenging equipment, rather than to discharge them into the air.
Horse
The MAC for isoflurane in the horse is approximately 1.31%.
Premedication
Isoflurane may be used with other drugs commonly used in veterinary anaesthetic regimes. The following drugs have been found to be compatible with isoflurane: acepromazine, alfentanil, atracurium, butorphanol, detomidine, diazepam, dobutamine, dopamine, guaiphenesin, ketamine, morphine, pentazocine, pethidine, thiamylal, thiopentone and xylazine. Drugs used for premedication should be selected for the individual patient. However, the potential interactions below should be noted.
Interactions
Detomidine and xylazine have been reported to reduce the MAC for isoflurane in horses.
Induction
As it is not normally practicable to induce anaesthesia in adult horses using isoflurane, induction should be by the use of a short acting barbiturate such as thiopentone sodium, ketamine or guaiphenesin. Concentrations of 3 to 5% isoflurane may then be used to achieve the desired depth of anaesthesia in 5 to 10 minutes.
Isoflurane at a concentration of 3 to 5% in a high flow oxygen may be used for induction in foals.
Maintenance
Anaesthesia may be maintained using 1.5% to 2.5% isoflurane.
Recovery
Recovery is usually smooth and rapid.
Dog
The MAC for isoflurane in the dog is approximately 1.28%.
Premedication
Isoflurane may be used with other drugs commonly used in veterinary anaesthetic regimes. The following drugs have been found to be compatible with isoflurane: acepromazine, atropine, butorphanol, buprenorphine, bupivacaine, diazepam, dobutamine, ephedrine, epinephrine, etomidate, glycopyrrolate, ketamine, medetomidine, midazolam, methoxamine, oxymorphone, propofol, thiamylal, thiopentone and xylazine. Drugs used for premedication should be selected for the individual patient. However, the potential interactions below should be noted.
Interactions
Morphine, oxymorphone, acepromazine, medetomidine, medetomidine plus midazolam have been reported to reduce the MAC for isoflurane in dogs.
The concomitant administration of midazolam/ketamine during isoflurane anaesthesia may result in marked cardiovascular effects, particularly arterial hypotension.
The depressant effects of propanolol on myocardial contractility are reduced during isoflurane anaesthesia, indicating a moderate degree of ß-receptor activity.
Induction
Induction is possible by face mask using up to 5% isoflurane, with or without premedication.
Maintenance
Anaesthesia may be maintained using 1.5% to 2.5% isoflurane.
Recovery
Recovery is usually smooth and rapid.
Cat
The MAC for isoflurane in the cat is approximately 1.63%.
Premedication
Isoflurane may be used with other drugs commonly used in veterinary anaesthetic regimes. The following drugs have been found to be compatible with isoflurane: acepromazine, atracurium, atropine, diazepam, ketamine, and oxymorphone. Drugs used for premedication should be selected for the individual patient. However, the potential interactions below should be noted.
Interactions
Intravenous administration of midazolam- butorphanol has been reported to alter several cardio-respiratory parameters in isoflurane- induced cats as has epidural fentanyl and medetomidine. Isoflurane has been shown to reduce the sensitivity of the heart to adrenaline (epinephrine).
Induction
Induction is possible by face mask using up to 4% isoflurane, with or without premedication.
Maintenance
Anaesthesia may be maintained using 1.5% to 3% isoflurane.
Recovery
Recovery is usually smooth and rapid.
Ornamental birds
Few MAC/ED50 values have been recorded. Examples are 1.34% for the Sandhill crane, 1.45% for the racing pigeon, reduced to 0.89% by the administration of midazolam, and 1.44% for cockatoos, reduced to 1.08% by the administration of butorphanol analgesic.
The use of isoflurane anaesthesia has been reported for many species, from small birds such as zebra finches, to large birds such as vultures, eagles and swans.
Interactions
Propofol has been demonstrated in the literature to be compatible with isoflurane anaesthesia in swans. Butorphanol has been reported to reduce the MAC for isoflurane in cockatoos. Midazolam has been reported to reduce the MAC for isoflurane in pigeons.
Induction: Induction with 3 to 5% isoflurane is normally rapid. Induction of anaesthesia with propofol, followed by isoflurane maintenance, has been reported for swans.
Maintenance
The maintenance dose depends on the species and individual. Generally, 2 to 3% is suitable and safe.
Only 0.6 to 1% may be needed for some stork and heron species.
Up to 4 to 5% may be needed for some vultures and eagles.
3.5 to 4% may be needed for some ducks and geese.
Generally, birds respond very rapidly to changes in concentration of isoflurane.
Recovery
Recovery is usually smooth and rapid.
Reptiles
Isoflurane is considered by several authors to be the anaesthetic of choice for many species. The literature records its use on a wide variety of reptiles (e.g. various species of lizard, tortoise, iguanas, chameleon and snakes).
The ED50 was determined in the desert iguana to be 3.14% at 35°C and 2.83% at 20°C.
Interactions
No specific publications on reptiles have reviewed compatibilities or interactions of other drugs with isoflurane anaesthesia.
Induction
Induction is usually rapid at 2 to 4% isoflurane.
Maintenance
1 to 3% is a useful concentration.
Recovery
Recovery is usually smooth and rapid.
Rats, mice, hamsters, chinchillas, gerbils, guinea pigs & ferrets
Isoflurane has been recommended for anaesthesia of a wide variety of small mammals. The MAC for mice has been cited as 1.34%, and for the rat as 1.38%, 1.46% and 2.4%.
Interactions
No specific publications on small mammals have reviewed compatibilities or interactions of other drugs with isoflurane anaesthesia.
Induction
Isoflurane concentration 2 to 3%.
Maintenance
Isoflurane concentration 0.25 to 2%.
Recovery
Recovery is usually smooth and rapid.
Contra-indications, warnings, etc
Do not use in cases of known susceptibility to malignant hyperthermia.
Do not use in cases of hypersensitivity to isoflurane.
The metabolism of isoflurane in birds and small mammals can be affected by decreases in body temperature that may occur secondary to a high surface area to bodyweight ratio. Therefore body temperature should be monitored and kept stable during treatment. Drug metabolism in reptiles is slow and highly dependent upon environmental temperature. Reptiles may be difficult to induce with inhalation agents due to breath holding.
The ease and rapidity of alteration of the depth of anaesthesia with isoflurane and its low metabolism, may be considered advantageous for its use in special groups of patients such as the old or young, and those with impaired hepatic, renal or cardiac function.
Isoflurane has little or no analgesic properties. Adequate analgesia should always be given before surgery. The analgesic requirements of the patient should be reviewed again before the general anaesthesia has ended.
Isoflurane causes depression of the cardiovascular and respiratory systems.
It is important to monitor pulse quality and rate in all patients. The use of the product in patients with cardiac disease should only be considered after a benefit risk assessment by the responsible veterinary surgeon. In the case of cardiac arrest, complete cardio pulmonary resuscitation should be performed.
Isoflurane produces hypotension and respiratory depression in a dose-related manner. Cardiac arrhythmias and transient bradycardia have been reported only rarely. Cardiac and/or respiratory arrest has been very rarely reported.
Malignant hypothermia has been reported very rarely in susceptible animals.
When using isoflurane to anaesthetise an animal with a head injury, consideration should be given as to whether artificial ventilation is appropriate to maintain normal CO2 levels, so that cerebral blood flow does not increase.
The frequency of adverse reactions is defined using the following convention:
-very common (more than 1 in 10 animals treated displaying adverse reaction(s))
-common (more than 1 but less than 10 animals in 100 animals treated)
-uncommon (more than 1 but less than 10 animals in 1,000 animals treated)
-rare (more than 1 but less than 10 animals in 10,000 animals treated)
-very rare (less than 1 animal in 10,000 animals treated, including isolated reports).
Isoflurane overdose may result in profound respiratory depression. Therefore, respiration must be monitored closely and supported when necessary with supplementary oxygen and/or assisted ventilation.
In cases of severe cardiopulmonary depression, administration of isoflurane should be discontinued, the breathing circuit should be flushed with oxygen, the existence of a patent airway ensured, and assisted or controlled ventilation with pure oxygen initiated. Cardiovascular depression should be treated with plasma expanders, pressor agents, antiarrhythmic agents or other appropriate techniques.
Pregnancy: Use only according to the benefit/risk assessment by the responsible veterinarian. Isoflurane has been safely used for anaesthesia during caesarean section in the dog and cat.
Lactation: Use only according to the benefit/risk assessment by the responsible veterinarian.
Withdrawal period
Horses (meat): 2 days. Not to be used for the treatment of mares producing milk for human consumption.
User warnings
Do not breathe the vapour. Users should consult their National Authority for advice on Occupational Exposure Standards for isoflurane.
Operating rooms and recovery areas should be provided with adequate ventilation or scavenging systems to prevent the accumulation of anaesthetic vapour. All scavenging/extraction systems must be adequately maintained.
Pregnant and breast-feeding women should not have any contact with the product and should avoid operating rooms and animal recovery areas. Avoid using masking procedures for prolonged induction and maintenance of general anaesthesia.
Use cuffed endotracheal intubation when possible for the administration of IsoFlo during maintenance of general anaesthesia.
Care should be taken when dispensing isoflurane, with any spillage removed immediately using an inert and absorbent material e.g. sawdust. Wash any splashes from skin and eyes, and avoid contact with the mouth. If severe accidental exposure occurs remove the operator from the source of exposure, seek urgent medical assistance and show this label.
Halogenated anaesthetic agents may induce liver damage. In case of isoflurane this is an idiosyncratic response very rarely seen after repeated exposure.
Advice to Doctors: Ensure a patent airway and give symptomatic and supportive treatment. Note that adrenaline and catecholamines may cause cardiac dysrhythmia
Pharmaceutical precautions
Do not store above 25°C.
Keep the bottle in the outer carton. Store in the original bottle. Keep the bottle tightly closed. Protect from direct sunlight and heat.
Any unused veterinary medicinal product or waste materials derived from such veterinary medicinal product should be disposed of in accordance with local requirements.
Keep out of the sight and reach of children.
For animal treatment only.
Legal category
Legal category:POM-V
Packaging quantities
Supplied in Type III amber glass bottles containing 100 or 250 ml. Not all pack sizes may be marketed.

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