Sevoflurane questions

[Toz]

Hello, I'm not really sure if ADD is the right place to put this but I figure you people have the most knowledge when it comes to drugs and how they actually work. I know Sevoflurane isn't really your typical drug that people use, but I have a few questions about it. What is it's mechanism of action and is it bad to use it during opiate and benzo withdrawal? I mean, I really don't want to wake up with worse withdrawals, after surgery. I'm pretty sure I'd throw myself out the window if that happens.

I am going through benzodiazepine / gabapentin and opiate withdrawal (all at the same time, not too smart I know). However I need surgery, therefore I also need anaesthesia. I spoke to the anaesthesiologist about my withdrawals (forgot to mention the gabapentin but I think it's irrelevant). He said they could skip using Propofol and use only Sevoflurane since propofol would re-trigger benzo withdrawal according to him (something I'd have to agree on). He seemed positive that the Sevoflurane alone would not worsen withdrawals afterward.

So I'm asking here for a second oppinion, as I have learned the hard way before...

 

[stormyskier]

I just had surgery and it went fine and I happen to work in the medical field, in the OR. Sevoflurane is an inhalation gas that they use to help keep you asleep when they initialize with propofol.
I have seen them just give kids the inhalation gas to get them to sleep when they are to scared for an IV. Sounds like the anesthesiologist knows what he is doing, just be honest and upfront. I have seen some crazy things when people are not honest about what they are or have been on. Good luck with your surgery!!

 

[sekio]

What is it's mechanism of action

i think, and i may be wrong here, it's disruption of the cell membrane. although binding to other taergets like gaba, nmda etc may play some role.

Sevoflurane induces a reduction in junctional conductance by decreasing gap junction channel opening times and increasing gap junction channel closing times. Sevoflurane also activates calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane. It also appears to bind the D subunit of ATP synthase and NADH dehydogenase and also binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the glutamate receptor, and the glycine receptor.

http://www.drugbank.ca/drugs/DB01236

either way it should not be cross tolerant with benzos or opioids.

 

[Toz]

1. Gamma-aminobutyric-acid receptor subunit alpha-1
Pharmacological action: yes
Actions: agonist

GABA, the major inhibitory neurotransmitter in the vertebrate brain, mediates neuronal inhibition by binding to the GABA/benzodiazepine receptor and opening an integral chloride channel

http://www.drugbank.ca/drugs/DB01236

^this worries me, though it's action might not be signifcant enough to re-trigger benzo withdrawal (I'm pretty sure n2o also works on GABA A in some way and that wouldn't do it, I've used it to help sleep)

thoughts?

 

[sekio]

GABA agonism isn't its main mode of action, and using a short-duration anesthetic once (and usually without the ability to access more) isn't going to put you into severe w/d... (most people have after effects from general anesthesia anyway)

I'd trust your anesthesiologist on this one.