desflurane: clinical use

Prescribing considerations

• Administration requires a desflurane-specific vaporiser, a trained anaesthetic professional and immediate access to airway, ventilation, oxygenation and resuscitation equipment.
• Avoid paediatric inhalational induction. Use particular caution with reactive airways, recent upper-respiratory infection, coronary disease, long-QT risk, raised intracranial pressure, hypovolaemia, hypotension, debility, neuromuscular disease and repeated exposure to halogenated anaesthetics.
• Rapid emergence requires anticipatory postoperative analgesia and planning for possible emergence agitation in children.
• Replace potentially desiccated carbon-dioxide absorbent before use because desflurane can generate carbon monoxide in dry absorbent.

Contraindications and cautions

• Known hypersensitivity to halogenated anaesthetic agents
• Known or suspected genetic susceptibility to malignant hyperthermia
• Previous confirmed hepatitis caused by a halogenated inhalational anaesthetic
• Previous unexplained moderate-to-severe hepatic dysfunction after a halogenated inhalational anaesthetic
• Use as an inhalational induction agent in paediatric patients
• Any situation in which general anaesthesia is contraindicated

Monitoring

• Continuous ECG, blood pressure, oxygen saturation, ventilation and end-tidal carbon dioxide monitoring
• Airway resistance and respiratory events, especially in children or people with bronchial hyperreactivity
• Anaesthetic depth and haemodynamic changes; rapid increases can cause sympathetic tachycardia and hypertension
• Neuromuscular function when muscle relaxants are used
• Temperature, carbon dioxide, potassium and signs of muscle injury if malignant hyperthermia or perioperative hyperkalaemia is suspected
• Postoperative pain, nausea, vomiting, agitation and respiratory recovery

Clinical pharmacology

A fluorinated volatile anaesthetic producing concentration-related central nervous system and cardiorespiratory depression. Its low blood–gas partition coefficient supports rapid equilibration and emergence. It is eliminated mainly unchanged through the lungs, with minimal metabolism.

Formulation and product differences

• The selected product is pure desflurane supplied as a clear inhalation-vapour liquid with no listed excipients.
• It is supplied in glass or internally coated aluminium bottles with a valve compatible with a desflurane vaporiser.
• It must only be used with a vaporiser specifically designed and designated for desflurane.