Desflurane

Indications

Desflurane is used for: General Anesthesia

Adult Dose

General Anesthesia Induction: Initial 3% inhaled, increase by 0.5-1% increments q2-3Breaths Maintenance: 2.5-8.5% with or without nitrous oxide

Child Dose

General Anesthesia Maintenance Indicated for maintenance of anesthesia in infants and children who are tracheally intubated following induction with agents other than desflurane Maintenance: 5.2-10% with or without nitrous oxide

Renal Dose

Administration

Contra Indications

Patients with known or suspected genetic susceptibility to malignant hyperthermia Patients in whom general anesthesia is contraindicated Induction of anesthesia in pediatric patients Patients with known sensitivity to halogenated agents Patients with a history of moderate to severe hepatic dysfunction following anesthesia with halogenated agents and not otherwise explained.

Precautions

Malignant Hyperthermia: Malignant hyperthermia may occur. Discontinue triggering agents, administer intravenous dantrolene sodium, and apply supportive therapy. Perioperative Hyperkalemia: Perioperative hyperkalemia may occur. Patients with latent or overt neuromuscular disease, particularly with Duchenne muscular dystrophy, appear to be most vulnerable. Early, aggressive intervention is recommended. Respiratory Adverse Reactions in Pediatric Patients: - Not approved for maintenance of anesthesia in non-intubated children due to an increased incidence of respiratory adverse reactions. Monitor and treat accordingly. - May cause airway narrowing and increased airway resistance in children with asthma or a history of recent upper airway infection. Monitor and treat accordingly. Interactions with Desiccated Carbon Dioxide (CO2) Absorbents: May react with desiccated CO2 absorbents to produce carbon monoxide. Replace the desiccated CO2 absorbent before administration of Desflurane. Hepatobiliary Disorders: May cause sensitivity hepatitis in patients sensitized by previous exposure to halogenated anesthetics. Approach repeated anesthesia with caution Pediatric Neurotoxicity: In developing animals, exposures greater than 3 hours cause neurotoxicity. Weigh benefits against potential risks when considering elective procedures in children under 3 years old.

Pregnancy-Lactation

Pregnancy There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies, embryo-fetal toxicity (reduced viable fetuses and/or increased post-implantation loss) was noted in pregnant rats and rabbits administered 1 MAC desflurane for 4 hours a day (4 MAC-hours/day) during organogenesis; there are no data on pregnancy exposures in primates corresponding to periods prior to the third trimester in humans Lactation It is not known whether drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised when administering therapy to a nursing woman

Interactions

Concomitant use of N2O, benzodiazepines and/or opioids reduces the MAC of Desflurane. Adjust dose accordingly. Desflurane decreases the doses of neuromuscular blocking agents required. Adjust dose accordingly. Contraindicated (1) dronedarone

Adverse Effects

Side effects of Desflurane : >10% Cough (3% to 34% adult induction; 26% pediatric maintenance and 72% pediatric induction ) Apnea (3% to 15% ) Interrupted breathing (30% adult induction; 3% pediatric maintenance and 68% pediatric induction ) Laryngeal spasm (3% to 10% adult induction; 13% pediatric maintenance and 50% pediatric induction ) Nausea (27% ) Desaturation of blood (3% to 10% adult induction; 2% pediatric maintenance and 26% pediatric induction ) Vomiting (16% ) Cardiovascular: Alteration in heart rate (greater than 1% ); hypotension (8% geriatric patients) 1-10% Hypotension (8% geriatric patients) Alteration in heart rate (>1% ) Bradyarrhythmia (>1% ) Heart failure, Hypertension (>1% ) Malignant hypertension, Shock, Sinus arrhythmia (>1% ) Tachycardia (>1% ) Excessive salivation (>1% ) Headache (>1% ) Delirium (>1%) Pharyngitis (>1% ) <1% Cardiac arrest, Cardiac dysrhythmia Torsades de pointes Hyperkalemia, Perioperative (rare ) Malignant hyperthermia Pancreatitis, acute Hepatic necrosis, Hepatitis, Liver failure Rhabdomyolysis Seizure Nephrotoxicity Respiratory failure Complication of anesthesia, During induction

Mechanism of Action

Volatile liquid inhalation anesthetic; may enhance inhibitory postsynaptic channel activity and may inhibit excitatory synaptic activity