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

Sensitivity to halogenated agents 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 following anesthesia with desflurane or other halogenated agents

Precautions

Volatile liquid; use appropriate vaporizer for inhalation Not approved for maintenance of anesthesia in nonintubated children due to an increased incidence of respiratory adverse reactions, including coughing (26%), laryngospasm (13%), and secretions (12%) Decrease in hepatic and renal blood flow reported Risk of hyperkalemia increased in pediatric patients with underlying neuromuscular disease (eg, Duchenne muscular dystrophy) Increase in intracranial pressure reported with use Emergence from anesthesia in children may evoke a brief state of agitation that may hinder cooperation Malignant hyperthermia may occur in susceptible individuals; fatal outcomes reported Should not be used as sole agent of induction in patients with CAD, heart failure, or patients where increase in heart rate or BP are undesirable Children, particularly if 6 years old or younger, under an anesthetic maintenance of desflurane delivered via laryngeal mask airway (LMA™ mask) are at increased risk for adverse respiratory reactions, including coughing and laryngospasm, especially with removal of the laryngeal mask airway under deep anesthesia; closely monitor these patients for signs and symptoms associated with laryngospasm and treat accordingly When used for maintenance of anesthesia in children with asthma or history of recent upper airway infection, there is increased risk for airway narrowing and increases in airway resistance; closely monitor these patients for signs and symptoms associated with airway narrowing and treat accordingly QTc prolongation, associated with torsade de pointes, reported; carefully monitor cardiac rhythm when administering drug to susceptible patients (e.g., patients with congenital Long QT Syndrome or patients taking drugs that can prolong the QT interval)

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

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