DESFLURANE
Clinical safety rating
cautionComprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).
Desflurane is a volatile general anesthetic that potentiates inhibitory GABA and glycine neurotransmission and inhibits excitatory NMDA glutamate receptors, leading to neuronal hyperpolarization and reduced neuronal excitability.
| Metabolism | Minimal hepatic metabolism (<0.02%) via CYP2E1; primarily eliminated unchanged by the lungs. |
| Excretion | Primarily eliminated via exhalation; minimal hepatic metabolism (<0.02%). Renal excretion of metabolites negligible. >99% excreted unchanged by lungs. |
| Half-life | Terminal elimination half-life is 3.5–4.5 minutes (context-sensitive half-life after prolonged anesthesia can be longer due to distribution, but true elimination is rapid due to low blood/gas partition coefficient). |
| Protein binding | Approximately 5–10% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Vd approximately 0.2–0.5 L/kg (small, reflecting limited tissue distribution; consistent with lipophilic but rapidly equilibrating profile). |
| Bioavailability | Inhalation: ~100% bioavailable into systemic circulation via lungs. |
| Onset of Action | Inhalation: Loss of consciousness within 1–2 minutes at appropriate inspired concentrations (e.g., 4–11% in oxygen). |
| Duration of Action | Duration depends on inspired concentration and duration of administration; rapid emergence within 5–10 minutes after discontinuation due to low solubility. |
| Molecular Weight | 168.03 |
Induction: 3-12% inhaled, titrated to effect; maintenance: 2-6% inhaled, adjusted to maintain adequate anesthetic depth with up to 1 MAC (6.0% at 37°C, 1 atm).
| Dosage form | LIQUID |
| Renal impairment | No dosage adjustment required for renal impairment; desflurane is minimally metabolized and not dependent on renal excretion. |
| Liver impairment | No specific Child-Pugh based adjustments; use with caution in severe hepatic impairment due to potential for increased hepatotoxicity, but no dose modification guidelines exist. |
| Pediatric use | Induction: 3-12% inhaled (up to 18% for mask induction); maintenance: 3-6% inhaled; adjust based on age and response; higher MAC requirements in infants. |
| Geriatric use | Reduce dose by 20-30% compared to younger adults; typical maintenance 2-5% inhaled; lower MAC (approx 4.5% at 65 years); monitor for hypotension and bradycardia. |
| 1st trimester | Desflurane is generally avoided in the first trimester due to potential teratogenicity based on animal studies; use only if clearly needed. |
| 2nd trimester | May be used if necessary; consider risk-benefit as anesthetic agents can affect fetal development. No well-controlled human studies. |
| 3rd trimester | May cause uterine relaxation and fetal depression; use with caution, especially near term. Risk of neonatal respiratory depression. |
Clinical note
Comprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).
| Placental transfer | Rapidly crosses the placenta; fetal concentrations reach approximately 70% of maternal levels within minutes. |
| Breastfeeding | Desflurane is rapidly eliminated via exhalation; levels in breast milk are low and unlikely to affect a nursing infant. Resume breastfeeding after recovery from anesthesia. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Desflurane is not associated with major congenital malformations in the first trimester, but use in the second and third trimesters may cause fetal depression, decreased fetal heart rate variability, and neonatal respiratory depression. It is pregnancy category B, but caution is advised. |
| Fetal Monitoring | Monitor maternal vital signs (heart rate, blood pressure, oxygen saturation), depth of anesthesia, end-tidal CO2, and inhalational agent concentration. For fetus, use continuous fetal heart rate monitoring if applicable. Assess uterine tone if used for obstetric procedures. |
| Fertility Effects | No direct evidence of impaired fertility in humans. Occupational exposure to inhalational anesthetics may be associated with reduced fertility, but desflurane has not been specifically implicated. |
■ FDA Black Box Warning
Desflurane is not indicated for induction of general anesthesia in pediatric patients due to a high incidence of laryngospasm and upper airway adverse events.
| Serious Effects |
Known hypersensitivity to desflurane or other halogenated anestheticsHistory of malignant hyperthermiaKnown or suspected susceptibility to malignant hyperthermia
| Precautions | Malignant hyperthermia, Respiratory depression and airway complications, Cardiovascular depression (hypotension, bradycardia), QT prolongation, Hepatotoxicity (rare), Rising carbon monoxide levels with dry absorbents, Neurotoxicity in pediatric patients, Renal toxicity (rare) |
| Food/Dietary | No known food interactions. However, patients should follow preoperative fasting guidelines (nil per os for at least 2 hours for clear liquids and 6-8 hours for solid foods) to reduce the risk of pulmonary aspiration during anesthesia. |
| Clinical Pearls | Desflurane has the lowest blood-gas partition coefficient among volatile anesthetics, resulting in the fastest onset and emergence. Its pungent odor limits use for inhalation induction, especially in children. Due to its high vapor pressure, a specialized heated vaporizer is required. Desflurane can cause sympathetic nervous system activation at high concentrations, leading to tachycardia and hypertension. It is metabolized minimally (0.02%), but can produce carbon monoxide when exposed to dried CO2 absorbents; desiccated absorbents should be avoided. Malignant hyperthermia risk is present, so dantrolene should be available. |
| Patient Advice | You will receive desflurane gas through a mask or breathing tube to keep you asleep during surgery. · Desflurane has a strong smell; you may notice an odor as you fall asleep. · You will wake up quickly after the anesthetic is stopped, but you may feel drowsy or confused initially. · Potential side effects include nausea, vomiting, shivering, and a temporary increase in heart rate or blood pressure. · Inform your doctor if you have a personal or family history of malignant hyperthermia (a severe reaction to anesthesia). · Do not eat or drink before surgery as instructed to prevent aspiration. |
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