Desflurane - Transforming Anesthesia Care

Overview

Desflurane is an inhalation medication used to induce anesthesia (loss of sensation or consciousness) in people during or before a surgical or interventional procedure. It is available as an inhalation solution administered by a trained healthcare professional. Desflurane acts by inducing the loss of perception of sensation. Desflurane has several interactions with other drugs. Hence, informing the physician about all the medications and herbal drug supplements taken before the surgical procedure is essential. Also, report to the doctor if any severe side effects are experienced.

Drug Group:

Desflurane belongs to the class of medications called haloalkanes under general anesthetics. The drugs of this class are used to induce anesthesia. Desflurane is a volatile compound that readily enters the gaseous phase and is therefore inhaled for its action. The other drugs belonging to this class include Halothane and Chloroform.

Drug Warnings and Precautions:

Inform the doctor if the patient has any of the following conditions:

• Drug Allergies: If there is a previous history of allergy to the drug or its components.

• Heart Diseases: Desflurane is not recommended for people with heart conditions like coronary artery disease.

• Metabolic: Desflurane use is not recommended in people with a history of malignant hyperthermia.

• High Potassium Levels: Desflurane can cause a rapid increase in potassium levels, especially in children, which can lead to serious adverse events. Hence, use is not recommended for induction of anesthesia.

• Liver Diseases: People with liver necrosis or altered liver function may develop an allergy to the drug. Monitoring is required.

• Lung Diseases: Desflurane can cause respiratory depression, especially in children with asthma. Monitoring and treatment of symptoms are necessary.

• Elderly: The dose will be adjusted in older adults.

• Pregnancy and Breastfeeding: As directed by the doctor.

For Patients:

What Is Desflurane Used For?

Desflurane is used for the induction and maintenance of anesthesia in adults. Anesthesia is a condition in which the state of consciousness is controlled to lose for a short period, mainly for surgical procedures. Desflurane is also used for the maintenance of anesthesia in children.

Never take Desflurane without proper guidance from a healthcare professional.

How Does Desflurane Work?

Desflurane is thought to act on nerve cell membranes to disrupt neuronal transmission in the brain. It has also been shown to bind to and alter membrane proteins, alter cellular calcium ion processes, and augment the activity of the inhibitory neurotransmitter (chemical) gamma-aminobutyric acid (GABA) on nerve signal transmission.

Onset Of Action:

Desflurane is rapidly absorbed from the lungs after inhalation, and the body processes minimal amounts. The major portion of the inhaled drug is excreted back through the lungs. The onset of anesthesia is observed within six minutes after the drug is inhaled.

Habit-Forming:

Desflurane is given under the supervision of a healthcare professional. It is only used for limited indications. Desflurane has not been reported to show any form of habit-forming tendencies in people under anesthesia.

Expiry Date:

For healthcare professionals: Avoid using the drug past its expiration date, which will be provided at the back of the drug packet.

What Is the Dosage of Desflurane?

Desflurane is administered in a clinical setting by a trained professional. The dosing is based on the patient's age, sex, medical conditions, and weight. It is supplied as an inhalation solution under the brands Suprane, and Amerinet Choice Suprane, among others. The general dosing information of Desflurane is as follows:

Indication: Anesthesia.

Adult Dosing (18 to 64 years):

• Induction: Starting with three percent in nitrous oxide or oxygen, which the doctor will further adjust.

• Maintenance: 2.5 to 8.5 percent with or without nitrous oxide.

Child Dosing:

• Maintenance: 5.2 to 10 percent with or without nitrous oxide.

How to Use Desflurane?

To Healthcare Professionals:

• Only administer with a vaporizer specifically designed and designated for use with Desflurane.

• Yellow discoloration of Desflurane, sometimes accompanied by particulates, has been observed through the vaporizer sight glass or after draining the vaporizer; the presence of discoloration or particulates does not alter the quality or efficacy of Desflurane; if observed, refer to the vaporizer instructions.

Overdose:

It is unlikely to overdose, as it is given under medical supervision. However, the healthcare team will proceed with the necessary intervention if an overdose happens.

Storage:

Store the medication at room temperature, preferably between 15 to 30 degrees Celsius.

What Are the Contraindications of Desflurane?

Desflurane is not recommended under the following conditions:

• Allergy to the active or inactive ingredients of the drug or any other haloalkane anesthetics.

• Known history or genetic susceptibility for malignant hyperthermia (severe adverse reaction to anesthetic drugs).

• If presented with a high fever.

• History of moderate to severe liver dysfunction (with no other known cause) after use of previous general anesthetics of haloalkane class.

• For the induction of anesthesia in children.

What Are the Side Effects of Desflurane?

The common side effects of Desflurane include:

• Nausea.

• Vomiting.

• Cough.

• Increased salivation.

• Eye inflammation.

• Interrupted breathing.

The symptoms will be managed by the healthcare professionals promptly.

The serious side effects include:

• Desaturation of blood (sudden decline in hemoglobin levels in the blood).

• High potassium levels.

• Malignant hyperthermia.

• Severe shortness of breath.

• Spasm of the larynx (in the throat area).

• Decreased oxygen supply to the heart.

These symptoms will require serious medical intervention.

The drug can cause drowsiness or dizziness. Here, activities requiring mental attention, like driving or operating heavy machinery, are not recommended within 24 hours.

What Are the Interactions of Desflurane?

Drugs often interact with other drugs, supplements, food, or beverages, leading to unwanted side effects. Hence, the chances for interaction have been reduced. The common interactions of Desflurane are as follows:

1. With Other Drugs: Talk with the pharmacist or doctor to check for drug-drug interactions of Desflurane.

2. With Alcohol: Alcohol use should be strictly avoided before the procedure due to the potential risk of higher adverse events associated.

3. With Food: There is no data regarding Desflurane's food-drug interactions. Check with the doctor.

For Doctors:

Indications:

Desflurane shows certain favorable pharmacokinetic and pharmacodynamic properties. However, it is not considered an ideal inhalational general anesthetic agent. It possesses the advantage of accurate control over the depth of anesthesia without implementing the use of an overpressure technique along with a predictable, rapid, and clear recovery. It also has minimum postoperative sequelae that make it a valuable anesthetic agent for maintenance in pediatric and adult patients during surgeries of varying durations.

Mechanism of Action:

The mechanism of action of the inhalational agents is still not very clear. It is believed that Inhalational anesthetics work through interaction with various ion channels present throughout the central and peripheral nervous system and block the excitatory channels and enhance the activity of inhibitory channels. Other mechanisms that might be possible are that these agents act by affecting the membrane bilayer.

Pharmacoeconomics

Pharmacoeconomics involves the cost-effective analyses of both direct and indirect costs of novel drugs and therapeutic agents. It is highly challenging to provide good quality anesthetic care at the minimum cost. It is recommended that low-flow anesthesia should be used for economic reasons and to decrease pollution.

However, clinical practice procedures like low-flow anesthesia require scientific skills and modern monitoring. The need of the hour is daycare surgery with fast-tracking and ambulatory anesthesia. The usage of Desflurane, a relatively new inhalational anesthetic helps to address some of these issues. However, its use might help to improve the direct costs of providing anesthetic care. Therefore, the methods or techniques to reduce the overall effective cost must be considered along with imposing minimum effects on the environment.

Physicochemical Properties

Desflurane is an inhalational general anesthetic agent that contains ether. It is a clear, nonflammable liquid and possesses a strong odor at room temperature. Desflurane is structurally the same as isoflurane with only one exception, that is, a fluorine atom is present instead of a chlorine atom on the alpha-ethyl carbon.

It is extremely volatile with a low boiling point of 23.5 degrees Celsius. Full vapor saturation cannot be reached if a conventional vaporizer is used since this temperature is close to the ambient temperature in the operating theater. Therefore, a vaporizer that heats the agent to 39 degrees Celsius at a pressure of two atmospheres. This helps to reach full vapor saturation.

Solubility

Desflurane possesses the lowest blood or gas solubility of 0.42 as compared to other common anesthetic agents like:

• Diethyl-ether: 12.0.

• Halothane: 2.3.

• Enflurane: 1.9.

• Isoflurane: 1.3.

• Sevoflurane: 0.67.

• Nitrous oxide: 0.47.

The lower blood or gas solubility helps anesthetic alveolar concentration to remain near the inspired concentration which allows a rapid and huge change along with controlling the anesthetic depth and causes early awakening.

Clinical Effects of Desflurane

Desflurane shows different effects on different systems:

1. Cardiovascular System: The effect on the cardiovascular system is of two types.

• Firstly, the direct effects of the anesthetic.

• Secondly, a transient response causes sympathetic nervous system (SNS) activation.

2. Pulmonary System: The respiratory system might be severely affected by inhalational anesthetic agents leading to the following conditions:

• Respiratory depression.

• Airway irritation.

• Bronchospasm.

Desflurane might cause irritation of the airway when administered to patients in high concentrations above the threshold for respiratory irritation. End-tidal concentration of 5.4 percent or less does not cause irritation of the airway, coughing, breath-holding, or laryngospasm. Administration of a small dose, that is, 1 mcg/kg of Fentanyl can decrease coughing by 80 percent along with a decrease in airway irritation.

3. Neurological System: The effects of Desflurane on cerebral function and physiology are considered similar to those of isoflurane as both of them reduce cerebral vascular resistance and lead to an increase in intracranial pressure. The production of cerebrospinal fluid (CSF) is increased slightly more with Desflurane than isoflurane. In humans, central respiratory depression (ventilatory response to CO2) produced by Desflurane is comparable with Enflurane and more than that seen with Isoflurane. Increased attention is being given to the subanesthetic concentration of inhaled anesthetic that depresses the response to hypoxia.

4. Hepatic and Renal Effects: Human studies have proven to cause hepatic injury after anesthesia with Desflurane. In a recent study in rats, it was documented that, unlike halothane, biodegradation of Desflurane does not produce covalently-bound fluorine that is responsible for hepatic damage. Therefore, the potential for hepatotoxicity is usually low. This low hepatotoxic potential has also been documented in human volunteers and patients with postanesthetic renal function tests who showed no change after Desflurane anesthesia.

5. Neuromuscular Effects: Desflurane causes dose-related muscle relaxation that is similar to that seen with isoflurane. Further, it increases the action of non-depolarizing neuromuscular blocking agents to a higher degree than that seen with Isoflurane.

6. Obstetrics: Desflurane is also used during cesarean section without any maternal complications. It shows a slightly longer neonatal time to sustained respiration compared to Enflurane and nitrous oxide. Desflurane has also been used for controlling labor pain.

7. Malignant Hyperthermia: Desflurane also proved to act as a trigger for malignant hyperthermia. However, the onset of Desflurane might be delayed compared to that of Halothane.

Use in Specific Population:

• Elderly population: The advantage of Desflurane in elderly patients is rapid recovery from prolonged anesthesia in the elderly with decreased hepatic and renal function and cognitive impairment like delirium and confusion. Any pre-existing hepatic or renal injury is not increased by Desflurane and has minimal effect on the metabolism of other drugs. Various studies have revealed Desflurane has a faster and more predictable recovery in elderly patients as compared to Sevoflurane.

• Obese Population: Obese patients are at a higher risk of hypoventilation, aspiration, desaturation, and airway obstruction while early recovery from anesthesia as compared to non-obese patients. Desflurane has become popular for bariatric surgery because of favorable profiles of emergence and recovery.

• Pediatric Population: Desflurane is not approved for usage as an induction and maintenance dose in non-intubated pediatric patients due to an increased incidence of respiratory adverse reactions like laryngospasm, coughing, and secretions.

Desflurane is mainly used as a maintenance dose for intubated children during pediatric anesthesia. A maintenance dose must be used with caution with laryngeal mask airway (LMA) in children six years or younger because of the risk of increased adverse respiratory events like coughing and laryngospasm.