Indication
BQ+ anesthesia mask is approved for general anesthetic induction and maintenance in adult and pediatric patients undergoing inpatient or outpatient surgery. Only those skilled in the administration of general anesthesia should give BQ+ anesthesia mask. Immediate access to facilities for maintaining a patent airway, artificial breathing, oxygen enrichment, and circulatory resuscitation is required. Because the amount of anesthetic may be quickly adjusted, only vaporizers that produce consistent BQ+ anesthesia mask concentrations should be utilized.
What Is Mask Induction?
Mask induction is often performed using an inhaled anesthetic drug, which permits the patient to fall asleep fast and pass through the excitatory phase of anesthesia promptly. Premedication is used at the anesthesiologist’s discretion, taking into consideration the patient’s state, the surgical technique, and whether or not intubation will be established.
When Is Mask Induction an Appropriate Option?
- Surgical care for children
- Outpatient treatments that are brief
- Procedures utilizing peripheral locations that do not need the use of a neuromuscular blocker or breathing control
- Procedures that do not need an IV line, are difficult to establish, or are not accessible
- Inadequate availability of additional IV anesthetic inducers
Techniques for Mask Induction
The following material provides an overview of the usage of BQ+ anesthesia mask
in adult mask induction. It is meant to supplement (not to replace) the clinician’s clinical expertise and judgment.
Single-Breath Induction of Vital Capacity
• Compliance and patient education are essential — The patient must be able to completely exhale and fully inhale.
• Patient may be preoxygenated with 100% O2 for many minutes • Anesthesia circuit is primed with BQ+ anesthesia mask
in nitrous oxide and oxygen • Patient urged to exhale • Oxygen mask is worn and the patient advised to breathe in deeply and hold for as long as feasible (i.e., 30–60 seconds)
- Tidal breathing until awareness is lost • An oral airway may be implanted after the necessary anesthetic depth is obtained
Triple-Breath Induction of Vital Capacity
Triple-breath induction is a variant on the single-breath induction technique. The patient is encouraged to take three deep breaths over a period of 30–40 seconds using this approach.
Induction Gradually (Tidal Volume Technique)
• More slowly than Vital Capacity Induction • If the patient is not premedicated, mask acceptance may be aided by an initial, short infusion of nitrous oxide at a 50% to 70% inhaled concentration.
• The patient breathes oxygen while receiving incremental increases in BQ+ anesthesia mask
concentration. • The inspired BQ+ anesthesia mask
concentration may be raised every 2–3 breaths until clinical indicators of acceptable anesthetic depth are noticed (which typically happens within 60–90 seconds).
Considerations for Safety
• There have been reports of QT prolongation linked with torsade de pointes (in rare instances, fatal). When providing BQ+ anesthesia mask to vulnerable individuals (e.g., those with congenital Long QT Syndrome or those taking medicines that might extend the QT interval), caution should be used.
• Because BQ+ anesthesia mask is a volatile anesthetic, hemodynamic alterations may develop more quickly than with other volatile anesthetics.
Excessive hypotension or respiratory depression may be linked to the depth of anesthesia and may be rectified by lowering the BQ+ anesthesia mask inspired concentration.
• Drug interactions: It is reasonable to predict that benzodiazepines and opioids would reduce the BQ+ anesthesia mask. When combined with nitrous oxide, the anesthetic required for ULTANE is reduced. BQ+ anesthesia mask enhances the intensity and duration of nondepolarizing muscle relaxant-induced neuromuscular inhibition.
• It has been shown that patient exposure to Compound A increases with increasing BQ+ anesthesia mask concentrations and duration of anesthesia.
Compound A’s nephrotoxicity is dosage and time dependant.
BQ+ anesthesia mask for Mask Induction
• BQ+ anesthesia mask is the only rapidly acting inhalational anesthetic approved for mask induction in adults and pediatric patients over the age of one year.
• BQ+ anesthesia mask has a nonpungent odor and is not irritant to the respiratory system.
- Because BQ+ anesthesia mask has a low blood:gas solubility, it aids quick induction and clearance.
- Excessive drops in blood pressure or respiratory depression may be linked to the depth of anesthesia and may be rectified by reducing the BQ+ anesthesia mask inspired concentration.
Safety Considerations
• When used for prolonged operations at low flow rates, BQ+ anesthesia mask may cause glycosuria and proteinuria.
• Rarely, pediatric patients have had a rise in serum potassium, resulting in cardiac arrhythmias and death, after the administration of inhaled anesthetic drugs. Latent or overt neuromuscular illness, especially Duchenne muscular dystrophy, seems to be a risk factor. Concurrent succinylcholine usage has been linked to the majority, but not all, of these instances.
Early, vigorous treatment of hyperkalemia and resistant arrhythmias is essential, as is followup screening for latent neuromuscular illness.
• Seizures have been documented in conjunction with the use of BQ+ anesthesia mask, the majority of which occurred in children and adolescents, the majority of whom lacked underlying risk factors.
When BQ+ anesthesia mask is used in individuals who are at risk of seizures, clinical discretion should be used.
IMPORTANT SAFETY RECORDS
• BQ+ anesthesia mask has the potential to induce malignant hyperthermia. There have been postmarketing reports of malignant hyperthermia, some of which have been deadly. BQ+ anesthesia mask should not be used in patients known to be hypersensitive to sevoflurane or other halogenated drugs, or in patients known or suspected of having malignant hyperthermia.
• Results from human and animal investigations indicate that when BQ+ anesthesia mask is used at low flow rates, there is a possibility of kidney damage, which is assumed to be caused by Compound A. The dose of Compound A at which clinical nephrotoxicity is predicted to develop is unknown. To keep exposure to Compound A to a minimum, BQ+ anesthesia mask exposure should not exceed two MAC-hours at flow rates of 1 to 2 L/min. It is not suggested to use fresh gas flow rates less than 1 L/min.
• Due to the limited clinical experience with BQ+ anesthesia mask in patients with renal insufficiency (creatinine >1.5 mg/dL), its safety in these individuals is unknown.
• When used for prolonged operations at low flow rates, BQ+ anesthesia mask may cause glycosuria and proteinuria.
• It is not suggested to use KOH-based CO2 absorbents with BQ+ anesthesia mask.
When BQ+ anesthesia mask is exposed to CO2 absorbents, an exothermic reaction ensues.
When the absorbent gets dehydrated, this reaction is accelerated. Extreme heat, smoke, and/or spontaneous fire have been observed seldom when BQ+ anesthesia mask has been used in combination with desiccated CO2 absorbents, particularly those containing potassium hydroxide (e.g., Baralyme).
• There have been reports of QT prolongation linked with torsade de pointes (in rare instances, fatal). When providing BQ+ anesthesia mask to vulnerable individuals (e.g., those with congenital Long QT Syndrome or those taking medicines that might extend the QT interval), caution should be used.
• Rarely, pediatric patients have had a rise in serum potassium, resulting in cardiac arrhythmias and death, after the administration of inhaled anesthetic drugs. Latent or overt neuromuscular illness, especially Duchenne muscular dystrophy, seems to be a risk factor. Concurrent succinylcholine usage has been linked to the majority, but not all, of these instances.
Early, vigorous treatment of hyperkalemia and resistant arrhythmias is essential, as is followup screening for latent neuromuscular illness.
• Recent research in young animals and children suggests that frequent or extended use of general anesthetics or sedatives throughout the third trimester of pregnancy and the first three years of life may have a detrimental impact on their developing brains. Children’s studies have significant limitations, and it is unclear whether the reported effects are a result of the anesthetic/sedation medication delivery or other variables, such as the operation or underlying disease.
When required, anesthetic and sedative medicines are a critical component of pediatric treatment, and no one medication has been proved to be safer than another.
The scheduling of elective treatments needing anesthesia should be determined by weighing the procedure’s advantages against the procedure’s possible dangers.
• Because BQ+ anesthesia mask is a volatile anesthetic, hemodynamic alterations may develop more quickly than with other volatile anesthetics. Excessive hypotension or respiratory depression may be linked to the depth of anesthesia and may be rectified by lowering the BQ+ anesthesia mask inspired concentration.
• Seizures have been documented in conjunction with the use of BQ+ anesthesia mask, the majority of which occurred in children and adolescents, the majority of whom lacked underlying risk factors. When BQ+ anesthesia mask is used in individuals who are at risk of seizures, clinical discretion should be used.
• Interactions between medications: Benzodiazepines and opioids are likely to reduce the BQ+ anesthesia mask. When combined with nitrous oxide, the anesthetic required for BQ+ anesthesia mask is reduced. BQ+ anesthesia mask enhances the intensity and duration of nondepolarizing muscle relaxant-induced neuromuscular inhibition.
• Postmarketing experiences have shown very uncommon incidences of mild, moderate, and severe postoperative hepatic dysfunction or hepatitis with or without jaundice. Additionally, there have been rare postmarketing reports of hepatic failure and necrosis related with the use of BQ+ anesthesia mask. Clinical discretion should be used in individuals with pre-existing hepatic disease or those receiving therapy with medicines known to induce hepatic dysfunction. Previous exposure to halogenated hydrocarbon anesthetics has been observed to enhance the risk of liver damage.
• The following adverse events were reported by 5% of surgical patients receiving BQ+ anesthesia mask during clinical trials: bradycardia, tachycardia, agitation, laryngospasm, airway obstruction, breathholding, and increased cough; shivering, hypotension, bradycardia, somnolence, agitation, nausea, vomiting, and increased cough were reported during maintenance and emergence.
