Desflurane
SUPRANE
What it isVolatile anesthetic; maintenance of anesthesia.
Why this oneThe lowest blood solubility of the volatiles, so onset and emergence are the fastest.
What limits itAirway irritation makes it unsuitable for induction, and it causes tachycardia if increased rapidly. The highest greenhouse impact of the volatiles.
FDA-approved for
- inhalational anesthesia (1992)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| General anesthesia (maintenance) | Adult | Titrate to effect (MAC ~6% at 45 yr, lower with age/N2O) | Individualized to patient response |
Renal Undefined
Hepatic Undefined
MAC decreases with increasing age and with concomitant N2O
Instructions
- Administer by inhalation via a desflurane-specific vaporizer, by anesthesia-trained personnel only
- Individualize dose to patient response; MAC decreases with age and with concomitant N2O, opioids, or benzodiazepines
- Replace desiccated CO2 absorbent before use to avoid carbon monoxide formation
Contraindications
- Known/suspected genetic susceptibility to malignant hyperthermia
- Patients in whom general anesthesia is contraindicated
- Induction of anesthesia in pediatric patients
- History of moderate-to-severe hepatic dysfunction after halogenated anesthetics, not otherwise explained
Cautions
- Malignant hyperthermia - discontinue triggering agents, give IV dantrolene
- Perioperative hyperkalemia (esp. Duchenne muscular dystrophy/neuromuscular disease)
- Respiratory adverse reactions in non-intubated children; airway narrowing in asthma/recent URI
- QTc prolongation - monitor cardiac rhythm in susceptible patients
- Carbon monoxide from reaction with desiccated CO2 absorbents
- Sensitivity hepatitis with repeated halogenated anesthetic exposure
- Pediatric neurotoxicity with exposures >3 h in children <3 yr
- Postoperative agitation in children
Adverse reactions
- Coughing, breath holding, apnea, nausea, vomiting
- Laryngospasm, increased secretions, oxyhemoglobin desaturation, pharyngitis
Pregnancy No adequate studies; embryo-fetal toxicity in animals; uterine relaxant
Lactation Undefined
NO BOXED WARNINGS
Principal riskAirway irritation; the highest greenhouse impact of the volatiles
Classes and tags
Clinical profile
Mechanism of action: Desflurane ballicule
