Fernández-Ginés F Dámaso, Gerónimo-Pardo Manuel, Cortiñas-Sáenz Manuel
Department of Pharmacy, Hospital Universitario Torrecárdenas, Almería. Spain..
Department of Anesthesiology and Resuscitation, Complejo Hospitalario Universitario de Albacete, Albacete. Spain..
Farm Hosp. 2021 Jul 21;45(5):277-281.
Sevoflurane is a volatile liquid from the family of ether-derived alogenated hydrocarbons that is approved for the induction and maintenance of inhalational general anesthesia in the hospital setting. This review describes the pioneering experience of a Spanish Pain Unit in the home treatment of complicated painful wounds using topical sevoflurane instillations according to a protocol approved for off-label use. Aspects of safety and efficacy, both analgesic, antimicrobial and pro-healing are addressed, and some future lines of research are discussed in terms of new formulations for topical use. After more than seven years of use of the protocol, an experience of over 70,000 applications of topical sevoflurane has been gained. In general terms, the analgesic effect appears quickly, is highly intense and persists for several hours. As a result, patients can reduce their consumption of systemic analgesics and benefit from an improvement in their quality of life. In addition, there are signs that suggest sevoflurane also possesses antimicrobial and pro-healing properties. Regarding safety, pruritus at the level of the periulcerous skin is the most frequently reported adverse effect, although it is usually transient and well-tolerated, and no systemic toxicity has been reported. Overall, the risk-benefit balance of the drug has so far been very favorable. To avoid manipulation of this volatile liquid, we have developed a new formulation of sevoflurane in gel form, which has made it possible to successfully apply sevoflurane in the context of painful pathologies where the skin remains intact. Furthermore, these types of new formulations, including sevoflurane microspheres, which we have also developed, could improve the efficacy and safety of topical sevoflurane while reducing the occupational exposure of healthcare staff. This means that the development of new formulations is a field with a very promising future.
七氟醚是一种源自醚类卤代烃家族的挥发性液体，已被批准用于医院环境中吸入性全身麻醉的诱导和维持。本综述描述了西班牙一家疼痛治疗单元在家用治疗复杂疼痛伤口方面的开创性经验，即根据一项批准用于非标签用途的方案，使用局部滴注七氟醚。文中讨论了七氟醚在镇痛、抗菌和促进愈合方面的安全性和有效性，并就局部用新制剂探讨了一些未来的研究方向。经过七年多对该方案的使用，已积累了超过70000次局部使用七氟醚的经验。总体而言，镇痛效果出现迅速、强度高且持续数小时。因此，患者可以减少全身镇痛药的用量，并受益于生活质量的改善。此外，有迹象表明七氟醚还具有抗菌和促进愈合的特性。关于安全性，溃疡周围皮肤瘙痒是最常报告的不良反应，不过通常是短暂的且耐受性良好，并且未报告有全身毒性。总体而言，到目前为止该药物的风险效益平衡非常有利。为避免对这种挥发性液体进行操作，我们开发了一种凝胶形式的七氟醚新制剂，这使得在皮肤保持完整的疼痛病症中成功应用七氟醚成为可能。此外，我们还开发了包括七氟醚微球在内的这类新制剂，它们可以提高局部使用七氟醚的疗效和安全性，同时减少医护人员的职业暴露。这意味着新制剂的开发是一个前景非常广阔的领域。
