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Desflurane – Effects, Uses & Side Effects
Desflurane is an inhaled general anesthetic used to maintain and induce general anesthesia. It acts rapidly and allows for precise control of anesthetic depth.
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Desflurane is an inhaled general anesthetic used to maintain and induce general anesthesia. It acts rapidly and allows for precise control of anesthetic depth.
What is Desflurane?
Desflurane (chemical name: Desfluranum) is a volatile inhalation anesthetic belonging to the group of halogenated ethers. It is used in anesthesiology to induce and, most commonly, to maintain general anesthesia during surgical procedures. Desflurane is characterized by its very low blood-gas partition coefficient, which allows for rapid onset and offset of anesthesia.
Mechanism of Action
Desflurane exerts its anesthetic effects primarily by inhibiting excitatory neurotransmitters (particularly NMDA receptors) and enhancing inhibitory neurotransmitters (particularly GABA-A receptors) within the central nervous system. This results in:
- Loss of consciousness (hypnosis)
- Pain suppression (analgesia)
- Muscle relaxation
- Suppression of reflexes to surgical stimuli
The very low blood-gas partition coefficient of approximately 0.42 explains the rapid induction and recovery: patients are quickly brought into anesthesia and wake up swiftly after the agent is discontinued.
Indications and Usage
Desflurane is primarily used for the maintenance of general anesthesia in adults and older children. Due to its pungent odor, it is less suitable for inhalation induction, as it can cause airway irritation, coughing, and laryngospasm. Anesthesia is therefore typically induced intravenously, for example with propofol.
Common areas of application include:
- Short to medium-length surgical procedures
- Outpatient and ambulatory surgery where rapid recovery is desired
- Procedures in patients who benefit from a fast emergence from anesthesia
Dosage
Desflurane is administered via a specially heated vaporizer, as it has a very high vapor pressure at room temperature. The required concentration is expressed as volume percent and is guided by the minimum alveolar concentration (MAC), which is approximately 6–7 vol.% for adults. The precise dosage is adjusted individually by the anesthesia team.
Side Effects
Like all inhalation anesthetics, desflurane can cause side effects. Common and well-known adverse effects include:
- Airway irritation: coughing, laryngospasm, and increased secretions during inhalation induction
- Cardiovascular effects: transient increases in heart rate and blood pressure with rapid concentration increases
- Nausea and vomiting after surgery (PONV – Postoperative Nausea and Vomiting)
- Hypotension at high concentrations
- Malignant hyperthermia: a rare but life-threatening genetic reaction to inhalation anesthetics
Contraindications
Desflurane should not be used in patients with:
- Known susceptibility to malignant hyperthermia
- Known hypersensitivity to halogenated ether anesthetics
- Severe hepatic dysfunction caused by prior exposure to halogenated anesthetics
Environmental Considerations
Desflurane has a significant global warming potential (GWP) and contributes substantially more to climate change compared to other inhalation anesthetics such as sevoflurane or isoflurane. As a result, many hospitals and medical societies have recommended reducing or eliminating the use of desflurane. In several countries, its use has been heavily restricted or it has been withdrawn from the market due to its unfavorable environmental footprint.
References
- Patel, S.S. & Goa, K.L. (1995): Desflurane – A Review of its Pharmacodynamic and Pharmacokinetic Properties and its Efficacy and Safety in General Anaesthesia. In: Drugs, 50(4), pp. 742–767.
- Butterworth, J.F. et al. (2022): Morgan & Mikhail's Clinical Anesthesiology, 7th edition. McGraw-Hill Education.
- European Medicines Agency (EMA): Product Information for Suprane (Desflurane). Available at: www.ema.europa.eu
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