DESFLURANE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).

Breastfeeding	Desflurane is minimally excreted into breast milk; M/P ratio is unknown. It is considered compatible with breastfeeding due to rapid elimination from the mother and low oral bioavailability in the infant. However, monitor for neonatal sedation.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Known sensitivity to desflurane or other halogenated anesthetics","History of malignant hyperthermia","Refractory hypovolemia","Increased intracranial pressure (relative)","Concomitant use with adrenergic agents (risk of arrhythmias)"]

Clinical Precautions

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)"]

Clinical Tips & Counseling

Drug interactions

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DESFLURANE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for DESFLURANE (DESFLURANE).

Breastfeeding	Desflurane is minimally excreted into breast milk; M/P ratio is unknown. It is considered compatible with breastfeeding due to rapid elimination from the mother and low oral bioavailability in the infant. However, monitor for neonatal sedation.
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.

Warnings & precautions

■ 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.