Desflurane
SUPRANE
What it isVolatile anesthetic; maintenance of anesthesia.
Why this oneLowest 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)
Principal riskAirway irritation; the highest greenhouse impact of the volatiles
Classes and tags
Clinical profile
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- sol 100 %
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
Cost
Desflurane (SUPRANE)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 100 % | sol | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Desflurane is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
Open Desflurane in the interactive console ↗
Self-check
- Why is desflurane unsuitable for induction?
Airway irritation. - What explains desflurane’s rapid onset and emergence?
Lowest blood solubility among volatiles.