Understanding Anesthesiology - The Global Regional Anesthesia ...

DESFLURANE
Class
Volatile inhaled anesthetic. Used for maintenance of anesthesia.
Mechanism of Action
Uncertain
Dose
Titrated to effect; MAC (age 40) = 6.0%
Onset
Low solubility allows rapid uptake and equilibration.
Onset of effect is hastened by using higher flows of carrier
gases and by using higher concentrations of volatile
agent.
Duration
Clinical recovery in less than 10 minutes (2-2.5 x faster
washout than Isoflurane)
Elimination
Pulmonary (major); negligible hepatic (0.02%)
Effects
CNS
Desflurane produces an additive central nervous system
(CNS) depressant effect along with other sedative/
hypnotics and analgesics. Sympatho-excitation can occur
with rapid increase in concentration of desflurane.
Has the potential to increase intracranial pressure
which can be mitigated with hyperventilation. May
cause headache, agitation, dizziness.
CVS
Dose-related hypotension (vasodilation). Tachycardia
and hypertension may be seen due to sympathetic nervous
system activation.
Respiratory
Respiratory depression with a rapid, shallow respiratory
pattern. Loss of intercostal muscle function creates
a rocking boat appearance. Desflurane is irritating to
the airways and can cause breath-holding, cough, laryngospasm
or bronchospasm in susceptible individuals,
especially if used as sole agent for induction.
GI
Potential immune-mediated hepatotoxicity. Nausea,
vomiting.
MSK
Potentiates neuromuscular blockade; malignant hyperthermia
trigger.
Misc.
Significant carbon monoxide production occurs on exposure
to dessicated CO 2 absorbing agents therefore
must not be used with low-flow anesthesia. Rapid
elimination requires initiation of post-operative analgesia
prior to emergence.
Contraindications
Malignant hyperthermia susceptibility
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