Sevoran - instructions for use, doses, side effects, contraindications

Active substanceSevofluraneSevoflurane

Similar drugsTo uncover

Sevoran®

solution d / inhal.

Abbott Laboratories SA Spain

Sevoflurane

solution d / inhal.

Baxter Healthcare Corporation Puerto Rico

Sevofluran-Vial

liquid d / inhal.

VIAL, LLC Russia

Dosage form: & nbspinhalation fluid

Composition:Sevoflurane

Description:Transparent, colorless, easily mobile.

Pharmacotherapeutic group:inhalation anesthetic

ATX: & nbsp

N.01.A.B Halogenated hydrocarbons

N.01.A.B.08 Sevoflurane

Pharmacodynamics:

Sevoflurane provides a quick introduction to anesthesia and rapid exit from it.

The depth of anesthesia can change rapidly depending on the change in the concentration of sevoflurane in the inhaled mixture.

The induction of anesthesia with sevoflurane is accompanied by a slightly pronounced excitation or minimal signs of irritation of the upper respiratory tract, does not cause excessive secretion in the tracheobronchial tree and stimulation of the central nervous system. Like other powerful tools for inhalation anesthesia, sevoflurane causes a dose-dependent suppression of respiratory function and a decrease in blood pressure (BP). In studies in children, it was shown that the occurrence of cough was statistically less frequent with the use of masked introductory anesthesia with sevoflurane than with halothane.The threshold of arrhythmogenic effect of epinephrine with the use of sevoflurane is the same as with isoflurane and higher than with halothane. The incidence of myocardial ischemia and myocardial infarction in patients with risk factors for these diseases is comparable with the use of sevoflurane and isoflurane.

Influence on blood circulation in the brain (intracranial pressure, cerebral blood flow, cerebral oxygen metabolism, cerebral perfusion pressure) is also comparable in sevoflurane and isoflurane. Sevoflurane has a minimal effect on intracranial pressure and does not reduce the response to CO2. Sevoflurane not

affects the concentration of the kidneys, even with prolonged anesthesia (up to about 9 hours).

The minimum alveolar concentration (MAC) is the concentration at which 50% of patients do not have a motor response to a single irritation (incision of the skin). MAK sevoflurana in different age groups are given in the section "Method of administration and dose".

MAQ of sevoflurane in oxygen is 2.05% for a 40-year-old adult. MAK sevoflurana, like other halogenated preparations, decreases with age and with the addition of dinitrogen oxide.

Pharmacokinetics:

Solubility

The low solubility of sevoflurane in the blood provides a rapid increase in alveolar concentration when administered to general anesthesia and a rapid decrease after discontinuation of inhalation. The ratio of alveolar concentration at the end of inspiration and concentration in the inhaled mixture 30 minutes after the inhalation of sevoflurane was 0.85. In the elimination phase, the ratio of alveolar concentrations after 5 min was 0.15.

Distribution and Metabolism

The rapid removal of sevoflurane from the lungs minimizes the metabolism of the drug. In humans less than 5% of the absorbed dose of sevoflurane is metabolized by cytochrome P450 (isoenzyme CYP2E1) into hexafluoroisopropanol with the release of inorganic fluorine and carbon dioxide (or one carbon dioxide). The resulting hexafluoroisopropanol is not active, not genotoxic, rapidly combines with glucuronic acid and is excreted from the body by the kidneys, the toxicity is comparable to the toxicity of sevoflurane. Other ways of metabolism of sevoflurane are not established. It is the only fluorinated volatile agent for anesthesia that is not metabolized to trifluoroacetic acid.

The concentration of fluoride ions depends on the duration of general anesthesia, the concentration of sevoflurane administered and the composition of the mixture for anesthesia.

Barbiturates do not cause defluorination of sevoflurane.

Approximately 7% of adults who had in clinical studies measured concentrations of inorganic fluoride, they exceeded 50 μmol / l; clinically significant changes in kidney function in none of these patients have not been identified.

Indications:

Introductory and supportive general anesthesia in adults and children in surgical operations inpatient and outpatient settings.

Contraindications:

Hypersensitivity to sevoflurane or other halogenated drugs (for example, history of associated hepatotoxicity associated with the use of these drugs, usually including increased activity of liver enzymes, fever, leukocytosis and / or eosinophilia).
Confirmed or suspected genetic susceptibility to the development of malignant hyperthermia.
Breastfeeding period

Carefully:

Renal failure.

- Increased intracranial

pressure.

Neuromuscular diseases.
Mitochondrial diseases.
Cardiac ischemia.
Dysfunction of the liver.
Simultaneous use of drugs that can cause damage to the liver.
Propensity to develop seizures.
Application for obstetrical operations.
Propensity to lengthen the interval QT and tachycardia of the "pirouette" type in the anamnesis.

Pregnancy and lactation:

In reproductive studies at the of animals sevoflurane in doses up to 1 MAC influenced reproductive function and damaging action on fetus.

Studies in pregnant women do not were conducted.

Sevoflurane can be used when pregnancy only if potential benefit to the mother justifies the possible risk to the fetus.

Since the information on the excretion of sevoflurane breast milk is not, women, breastfeeding, should refrain from breastfeeding during the period application and within 48 hours after its application.

Childbirth

In a clinical study demonstrated safety sevoflurane for mother and newborn when used for general anesthesia with caesarean section. Security sevoflurane during the generic activities and childbirth through natural birth canal is not established. Sevoflurane, like other drugs for inhalation anesthesia, causes relaxation of the musculature of the uterus, as a result of which there is a potential risk of uterine bleeding.

In obstetrical operations sevoflurane should be used with caution.

Dosing and Administration:

Remembrance

Means for premedication should be selected by an anesthesiologist individually.

General anesthesia during surgical interventions

During general anesthesia, it is necessary to know the concentration of sevoflurane coming from the evaporator. For precise control of the applied concentration of sevoflurane, specially calibrated evaporators should be used.

Introduction to general anesthesia

The dose is selected individually and titrated until the desired effect is achieved, taking into account the age and condition of the patient. Prior to the inhalation of sevoflurane, a high-speed barbiturate or another drug for intravenous general anesthesia may be administered. For administration to general anesthesia sevoflurane can be used in a mixture with oxygen or with oxygen and dinitrogen oxide.Before surgery, inhalation of sevoflurane at a concentration of up to 8% usually provides the introduction of a general anesthesia in less than 2 minutes in both adults and children. Supportive general anesthesia

The required level of general anesthesia can be maintained by inhaling sevoflurane at a concentration of 0.5-3% in combination with or without dinitrogen.

The MAC values for adults and children, taking into account the age

Age of the patient (years)	Sevoflurane in oxygen	Sevoflurane at 65% of the dinitrogen oxide / 35% o2
0-1 month *	3.3%
1- <6 months	3.0%
6 months	2.8%	2.0%**
3-12	2.5%
25	2.6%	1.4%
40	2.1%	1.1%
60	1.7%	0.9%
80	1.4%	0.7%

* Post-war newborns. MAC in preterm infants was not determined.

** Children from 1 year to 3 years of age used 60% of dinitrogen oxide / 40% Og.

With age, the MAC decreases. The average concentration of sevoflurane, providing MAK in an 80-year-old man, is approximately 50% of that of a 20-year-old patient.

Exit from general anesthesia -

Patients usually leave the general anesthesia with sevoflurane quickly. In this regard, they may sooner require postoperative analgesia. Later, kidney failure may develop, so you should monitor and, if possible, maintain diuresis.

Side effects:TOAs well as all powerful means for inhalation anesthesia, sevofluinjury can cause a dose-dependent inhibition of heart and respiratory function. Most adverse reactions are mild or moderate and transient. Often after surgery and general anesthesia, nausea and vomiting are noted, which may be associated with inhalation anesthetics, other drugs administered intraoperatively or postoperatively, and with the patient's response to surgery. The most common adverse reactions were:

in adult patients: decreased blood pressure, nausea, vomiting;
in elderly patients: bradycardia, decreased blood pressure, nausea;
in patients of childhood: agitation, cough, nausea and vomiting.

Adverse reactions recorded in clinical trials and post-marketing observations, possibly associated with the use of sevoflurane, are reflected with a distribution according to organ systems and frequency of occurrence: very often (> 1/10); often (> 1/100, <1/10); infrequently (> 1/1000, <1/100).

From the immune system:

Unknown: anaphylactic reactions **, pseudo-anaphylactic reactions, hypersensitivity.

From the side of metabolism and nutrition Unknown: hyperkalemia, hypercreatininaemia.

From the side of the psyche:

Very often: agitation.

From the nervous system

Often: drowsiness, dizziness, headache.

Infrequently: confusion.

Unknown: convulsions, dystonia, increased intracranial pressure.

From the cardiovascular system:

Very often: bradycardia, lowering blood pressure.

Often: tachycardia, increased blood pressure.

Infrequent: arrhythmia, ventricular extrasystole, supraventricular extrasystole, complete atrioventricular blockade, bigemia, inversion of the T wave, atrial fibrillation, atrial arrhythmia, atrioventricular blockade of the second degree, segment decline ST, bleeding, syncopal conditions.

Unknown: cardiac arrest (<0.01%), ventricular fibrillation, lengthening of the interval QT.

On the part of the respiratory system Very often: cough.

Often: breathing disorders, laryngospasm, airway obstruction, respiratory arrest.

Infrequently: apnea, bronchospasm, hypoxia.

Unknown: dyspnea **, wheezing **, respiratory depression. From the side of the digestive system Very often: nausea, vomiting.

Often: increased salivation.

From the liver and biliary tract

Unknown: hepatitis, hepatic insufficiency, liver necrosis, pancreatitis, jaundice.

From the skin and subcutaneous tissues

Unknown: rash **, hives, itching, contact dermatitis **, swelling persons **.

From the musculoskeletal and connective tissue Unknown: muscle rigidity.

From the side of the kidneys and urinary tract Unknown: tubular interstitial nephritis.

General disorders and disorders at the site of administration Unknown: edema.

Other

Often: chills, fever, hypothermia.

Unknown: malignant hyperthermia (see section "Special instructions"), a feeling of discomfort in the chest area **. Changes in laboratory indicators

Often: transient violations of liver function, changes in glucose concentration, changes in the number of leukocytes, a transient increase in the concentration of fluorides *.

It is not known: an increase in the concentration of phosphorus in the blood plasma.

* - during and after general anesthesia with sevoflurane there may be a transient increase in the serum concentration of inorganic fluorides in the blood plasma. Usually, their concentration reaches a maximum within 2 hours after ceasing the administration of sevoflurane and returns to the preoperative value for 48 hours.In clinical studies, an increase in the concentration of phytoRidov did not lead to impaired renal function.

** - the effect can be associated with hypersensitivity reactions, especially in cases of prolonged professional contact with inhalation anesthetics.

Liver and bile ducts

In the postoperative period, cases of liver or hepatic dysfunction (of mild, moderate and severe course, with or without jaundice) were noted. However, histologically, none of the cases of hepatitis was confirmed by histological examination. In most cases, patients with a history had already had liver function abnormalities, or the use of drugs capable of causing such disorders was noted. Most of the reported reactions were transient and resolved independently.

ccn

Convulsions: according to post-marketing surveillance, seiz- flurane has been reported in cases of seizures. Most cases have been reported in children and adult patients of a young age, without cases of a history of seizures. In several cases, concomitant therapy has not been reported; At least 1 case of seizures is confirmed by EEG.In most cases, single episodes of seizures have been reported that were resolved on their own or afterappropriate therapy; nevertheless, cases of multiple seizures were also noted. Seizures arose during induction with sevoflurane, or soon after, during withdrawal from anesthesia and during the postoperative period - for up to 1 day after anesthesia.

Hypersensitivity

Hypersensitivity cases have been reported (including cases of contact dermatitis, rash, dyspnoea, wheezing, feelings of discomfort in the chest, facial swelling, anaphylactic reactions); in particular, such cases were noted against a background of prolonged professional contact with inhalation anesthetics, including - sevoflurane.

Hypermetabolism of muscles

In sensitive patients, powerful inhalation anesthetics, including - sevoflurane, can provoke the development of hypermetabolic state of skeletal muscles, which leads to an increase in the need for oxygen and manifests itself as a clinical syndrome of malignant hyperthermia.

Overdose:

In case of an overdose, it is necessary to stop the introduction of sevoflurane, maintain the patency of the respiratory tract, start ancillary or controlled ventilation of the lungs with the introduction of oxygen and maintain an adequate function of the cardiovascular system.

Interaction:

The safety and efficacy of sevoflurane is confirmed when used simultaneously with various drugs that are often used in surgical practice, including those affecting the function of the central and autonomic nervous system, muscle relaxants, antimicrobials, including aminoglycosides, hormones and their synthetic substitutes, blood products and cardiovascular drugs, including epinephrine. '

It has been shown that other fluorinated volatile compounds for inhalation anesthesia displace drugs from the connection with blood and tissue proteins in vitro. The ability of sevoflurane to displace medicinal products from the connection with serum and tissue proteins has not been studied. However, in clinical trials of undesirable effects in the appointment of sevoflurane to patients,receiving drugs with a high binding capacity with plasma proteins and a low volume of distribution (for example, phenytoin), was not observed.

Barbiturates, benzodiazepines. narcotic analgesics

Sevoflurane can be used with barbiturates, but also with benzodiazepines and narcotic analgesics.

Benzodiazepines and narcotic analgesics presumably reduce the MAC of sevoflurane.

Dinitrogen oxide

MAK of sevoflurane decreases with simultaneous application of dinitrogen oxide. The equivalent of MAK is reduced by approximately 50% in adults and approximately 25% in children. Muscle relaxants

Sevoflurane has an effect on the intensity and duration of neuromuscular blockade caused by nondepolarizing muscle relaxants. With the introduction of sevoflurane as an adjunct to the general anesthesia with alfentanil-dinitrogen oxide, it enhances the effect of pancuronium bromide, vecuronium bromide and atracurium bezylate. With the appointment of these muscle relaxants in combination with sevoflurane their doses should be adjusted in the same way as with isoflurane. The effect of sevoflurane on the effect of suxamethonium and the duration of action of depolarizing muscle relaxants has not been studied.

Since the increase in the effect of muscle relaxants is observed a few minutes after the onset of inhalation of sevoflurane, a decrease in the dose of muscle relaxants during an introductory general anesthesia may lead to a delay in intubation of the trachea or inadequate muscle relaxation.

Among non-depolarizing muscle relaxants, the interaction with vecuronium bromide, pancuronium bromide and atracurium bezylate was studied. Although no specific recommendations for their use are available, however, (1) in endotracheal intubation, doses of nondepolarizing muscle relaxants should not be reduced; (2) while maintaining general anesthesia, doses of nondepolarizing muscle relaxants should probably be lower than with anesthesia, dinitrogen oxide / narcotic analgesics. Additional doses, muscle relaxants are administered taking into account the response to nerve stimulation.

Special instructions:

General recommendations

The drug Sevoran® can be used only by specialists,

trained in general anesthesia, in the department

equipped with everything necessary to ensurerespiratory tract, artificial ventilation, oxygen therapy and resuscitation.

All patients undergoing anesthesia with sevoflurane should be monitored, including monitoring the electrocardiogram (ECG), blood pressure (BP), oxygen saturation, and partial pressure of carbon dioxide (CO2) at the end of exhalation.

During anesthesia, increasing the concentration of sevoflurane leads to the development of a dose-dependent blood pressure. Because the sevoflurane insoluble in the blood, indicated hemodynamic changes may occur earlier than with the use of other inhalation anesthetics. Deep anesthesia can be associated with a significant reduction in blood pressure and respiratory depression; to correct these phenomena it is recommended to reduce the concentration of sevoflurane in the gas mixture.

The concentration of the drug coming from the evaporator must be accurately known. Since inhalation anesthetics differ in their physical properties, only specially calibrated evaporators for the drug Sevoran® should be used to deliver Sevoran®. Dosage of the drug during general anesthesia should be selected individually depending on the patient's response.With an increase in the concentration of the drug, there may be an increase in arterial hypotension and oppression of respiratory function.

Individual reports were received on the lengthening of the interval QT, very rarely associated with tachycardia such as "pirouette" (in some cases lethal). The drug Sevoran "should be used with caution to patients who are prone to these complications.

Separate reports were received on cases of ventricular arrhythmia in patients of childhood with Pompe disease. Formulations for general anesthesia, including Sevoran® drug should be used with caution in patients with mitochondrial diseases.

Increasing the concentration of sevoflurane to maintain general anesthesia causes a dose-related decrease in blood pressure. Excessive reduction in blood pressure can be associated with profound general anesthesia; in such cases it can be increased by decreasing the concentration of the sevoflurane fed.

When using the drug SevoranAs well as other means for general anesthesia in patients with coronary heart disease is necessary to maintain stable hemodynamics to avoid myocardial ischemia.

After exiting anesthesia, patients need additional monitoring prior to transfer to the profile department.

Replacement of over-dried sorbents CO?

When using the drug Sevoran ® in anesthesia apparatus, with(especially potassium hydroxide-containing potassium hydroxide), rare cases of excessive overheating and / or spontaneous smoke and / or inflammation of anesthesia apparatus are described. When the reservoirs with CO2 sorbent are overheated, there may be an unusual delay in the increase or an unexpected decrease in the inhaled concentration of the Sevoran® preparation, despite the existing evaporator settings.

Exothermic reaction of decomposition of sevoflurane with the formation of products of this decomposition, which occurs when sevoflurane interacts with the sorbent CO2, increases if the sorbent dries up; for example, with the long passage of dry gas through a reservoir with sorbent CO2. Formation of decomposition products of sevoflurane (methanol, formaldehyde, carbon monoxide, and components A, B, C and D) was observed in the respiratory circuit of experimental anesthesia machines with over-dried sorbents, when the concentration of sevoflurane reached a maximum (8%) for 2 or more hours.Concentrations of formaldehyde, formed in such conditions, reached values that can cause mild irritation of the respiratory tract. The clinical evaluation of the effects of the decomposition products of sevoflurane on the organism under extreme conditions has not been carried out.

If the anesthetist suspects that the sorbent CO2 overdried, then its should be replaced before applying sevoflurane. When dryof sorbent CO2 the color of the indicator does not always change. Consequently, the absence of color changes in the indicator can not be considered a confirmation of adequate hydration. Sorbents CO2 It is necessary to change regularly irrespective of color of the indicator.

Hyperkalemia in the perioperative period

The use of funds for inhalation anesthesia in children caused in rare cases an increase in the concentration of potassium in the serum, which led to the development of cardiac arrhythmias and death in the postoperative period. The risk is higher in patients with latent and clinically manifested neuromuscular diseases, especially in patients with Duchenne myodystrophy. In most cases, there was a connection between the development of these complications and the simultaneous use of suxamethonium.These patients also had a significant increase in serum creatine phosphocinase activity and, in some cases, a change in the urine composition indicating myoglobinuria. Despite some resemblance to manifestations of malignant hyperthermia, none of these cases showed muscle stiffness or symptoms associated with increased metabolism in the muscles. It should immediately begin activities to stop hyperkalemia and stable arrhythmia and conduct a survey to identify a latent neuromuscular disease.

Impaired renal function

Safety of the drug Sevoran in this group of patients has not been fully established, it should be used with caution in patients with renal insufficiency.

Materials of controlled studies with a low rate of gas mixture flow are limited, however, clinical and experimental data indicate the possibility of kidney damage, presumably due to component A. According to these data, the use of sevoflurane for 2 MAK x hours at a low feed rate of the gas mixture (less than 2 l / min) may be associated with the development of proteinuria and glucosuria.

The exposure level of component A, at which clinical nephrotoxicity is possible, is not established; nevertheless, all the factors that lead to an increase in the exposure of component A in children, in particular, the duration of exposure, the speed of the gas mixture and the concentration of sevoflurane, should be taken into account. In the course of anesthesia, the concentration of the inhaled sevoflurane should be titrated and the rate of delivery of the gas mixture monitored to reduce the exposure of component A to a minimum. For this purpose, the exposure of sevoflurane should not exceed 2 MACs x hour at a feed rate of 1 to <2 l / min. The feed rate of the gas mixture <1 l / min is not recommended.

Clinical experience with sevoflurane in patients with renal disease insufficiency (creatinine clearance> 1.5 mg / dl) is limited;

thus, the safety of the drug in these patients is not established.

Impaired liver function

Post-marketing observations recorded very rare cases of violations of the liver function (from mild to severe) or hepatitis (with jaundice or without it) in the postoperative period.

Sevoflurane should be used with caution in patients with impaired liver function, as well as with the joint use of drugs that can cause a violation of liver function.There is evidence that the use of halogenated anesthetics in history, especially during the previous 3 months, may increase the risk of developing liver damage.

There are reports that exposure to halogenated hydrocarbons in history may increase the potential for liver damage.

There have been reports of rare cases of mild, moderate or severe postoperative liver or hepatitis dysfunction (with or without jaundice). It is advisable to use caution when applying sevoflurane against a background of liver disorders or in patients who receive treatment with drugs known to cause liver dysfunction. In patients who survived after administrationother inhalation anesthetics, liver damage,jaundice, fever of unknown origin or eosinophilia, it is recommended to avoid the use of sevoflurane if it is possible to perform general anesthesia with intravenous medications or regional anesthesia. Malignant hyperthermia

In susceptible people, powerful means for inhalation anesthesia, including sevoflurane, can cause a state of skeletal muscle hypermetabolism, which leads to an increase in their oxygen demand and the development of a clinical syndrome known as malignant hyperthermia. The first sign of this syndrome is hypercapnia. Muscular stiffness, tachycardia, rapid breathing, cyanosis, arrhythmias and / or unstable blood pressure can also be observed. Some of these nonspecific symptoms may also occur with mild anesthesia, acute hypoxia, hypercapnia, and hypovolemia.

In clinical trials, one case of malignant hyperthermia was reported. In addition, cases of malignant hyperthermia (including fatal) were reported in post-marketing observations.

Treatment of malignant hyperthermia involves the abolition of drugs that caused its development (for example, sevoflurane), intravenous dantrolene (detailed information on the use of dis given in its instructions for use) and supportliving intensive symptomatic therapy, including maintenance of normal body temperature, respiratory and circulatory functions, control of water-electrolyte and acid-alkaline balance.Later, kidney failure may develop, so you should monitor and, if possible, maintain diuresis.

Neurosurgical interventions

If the patient is at risk of increasing intracranial pressure, the drug Sevoran® should be used with caution in combination with measures aimed at reducing intracranial pressure, such as hyperventilation.

Convulsions

There are reports of rare cases of seizures associated with the use of sevoflurane.

Use in children

Cases of seizures are known against sevoflurane. Many of these cases occurred in children (starting from the age of two months) and adolescents; most of them had no risk factors for seizures.

Sevoflurane should be used with caution in patients with a tendency to develop seizures.

Children who were prescribed sevoflurane for the induction of anesthesia, observed dystonic movements that disappeared independently,not requiring treatment. The causal relationship with sevoflurane is not confirmed.

Children with Down's syndrome have an increased risk of bradycardia and hypotension during and after sevoflurane induction.

Anesthesia in Obstetrics

Sevoflurane has a relaxing effect on the uterus, which is due to its pharmacological effects. A study performed with interruption of pregnancy indicates an increase in uterine bleeding.

The available data confirming the safety of the sevoflurane for the mother and the child in the course of the planned caesarean section are limited. The safety of sevoflurane during delivery through the natural birth canal has not been studied.

Effect on the ability to drive transp. cf. and fur:

Although after ceasing the supply of sevoflurane, consciousness is usually restored after a few minutes, its effect on cognitive function was not studied within 2-3 days after general anesthesia. Within a few days after applying sevoflurane, as well as other means for general anesthesia, there may be slight changes in mood. Patients should be informed that,that after general anesthesia, the ability to perform various tasks that require the speed of psychomotor reactions, such as driving a car or working with a technique that requires special attention, may worsen. The possibility of resuming employment by these activities is determined by the anesthesiologist.

Form release / dosage:Liquid for inhalation.

Packaging:

100 ml or 250 ml in bottles of polyethylene naphthalate of dark color, closed with a screw-on aluminum cap with a polyethylene liner, or a special closure system (type Quick-fill) made of polyacetal / polyethylene. One vial with instructions for use in a cardboard bundle or six vials with instructions for use in a box of corrugated cardboard with a cardboard separator.

Storage conditions:

Store at temperatures between 15 ° and 30 ° C. Keep out of the reach of children. Store in a tightly closed bottle.

Shelf life:

3 years.

Do not use after the expiration date stated on the package

Terms of leave from pharmacies:On prescription

Registration number:П N016015 / 01

Date of registration:06.10.2009

The owner of the registration certificate:Abbott Laboratories SAAbbott Laboratories SA Spain

Manufacturer: & nbsp

AESICA QUEENBOROUGH, Limited United Kingdom

Representation: & nbspEbbVi Ltd.EbbVi Ltd.Russia

Information update date: & nbsp15.09.2015

Illustrated instructions

Instructions

Sevoran® (Sevorane)