Desflurane

Registered South African indications:

• Induction and maintenance of general anaesthesia

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Patients in whom general anaesthesia is contraindicated
• Patients with known or genetic susceptibility to malignant hyperthermia
• Coronary artery disease
• Patients where increases in heart rate or blood pressure are undesirable

Cautions

• Pregnancy
• Breastfeeding
• Hepatic impairment
• Latent or overt neuromuscular disease, particularly Duchenne muscular dystrophy
• Induction of anaesthesia in children
• Maintenance of anaesthesia in non-intubated children < 6 years 
• Maintenance anaesthesia with laryngeal mask airway or face mask in children < 6 years
• Obstetric procedures
• Repeated anaesthesia in short duration of time
• Hypovolaemic patients
• Hypotensive patients
• Debilitated patients 
• Patients with space occupying lesions
• Glucose intolerance

Forms avail. in SA and covered in this monograph: liq

Induction of general anaesthesia

• Inhaled (liq): Initial: 3% concentration; Titrate by 0.5-1% increments at intervals of 2-3 breaths; Max: 15% concentration: MAC: 0.5-1%
• Age dependent MAC concentrations

AGE (Years)	100% oxygen	60% nitrous oxide/ 40% oxygen
18-30	6.35-7.25%	3.75-4.25%
30-65	5.75-6.25%	1.75-3.25%
> 65	5.17+/- 0.6%	1.67+/- 0.4%

Maintenance of general anaesthesia

• Inhaled (liq): 2-6% concentration with nitrous oxide OR 2.5-8.5% with oxygen

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If high concentrations are used with nitrous oxide, it is important to ensure that the inspired mixture contains a minimum of 30% oxygen

Paed. forms avail. in SA and covered in this monograph: liq

Maintenance of general anaesthesia

• Inhaled (liq): 5.2-10% concentration with or without nitrous oxide
• Age dependent MAC concentrations

AGE (Years)	100% oxygen	60% nitrous oxide/ 40% oxygen
0-1	8.95-10.65%	5.75-7.75%
1-12	7.2-9.4%	5.75-7%

Not recommended for induction of general anaesthesia via mask in children because of the high incidence of laryngospasm, increase in secretions, breath holding and coughing

Pregnancy

• Caution; not recommended
• Due to the limited number of patients studied, the safety of desflurane has not been established for use in obstetric procedures. Desflurane is a uterine relaxant and reduces the uterine-placental blood-flow. Studies in animals have shown reproductive toxicity
• There are no adequate data from the use of desflurane in pregnant women, therefore desflurane is not indicated for use during pregnancy

Breastfeeding

• Caution
• There are no adequate data from the use of desflurane in breastfeeding women, therefore desflurane is not indicated for use during breastfeeding

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warning

Central Nervous System Disorders

• Breath holding
• Agitation
• Headache
• Dizziness
• Convulsions
• Malaise
• Migraine
• Encephalopathy

Cardiovascular Disorders

• Nodal arrhythmia
• Bradycardia
• Tachycardia
• Hypertension
• Myocardial infarction
• Myocardial ischemia
• Arrthymia
• Cardiac arrest
• Torsade de pointes
• Ventricular failure
• Ventricular hypokinesia
• Vasodilation
• Malignant hypertension
• Hemorrhage
• Hypotension
• Shock
• Electrocardiogram ST-T change
• Electrocardiogram T wave inversion
• Palpitations

Respiratory Disorders

• Apnea
• Cough
• Laryngospasm
• Hypoxia
• Respiratory arrest
• Respiratory failure
• Respiratory distress
• Bronchospasm
• Hemoptysis
• Pharyngitis

Gastrointestinal Disorders

• Nausea and vomiting
• Salivary
• Hypersecretion
• Pancreatitis acute
• Abdominal pain

Hepatobiliary Disorders

• Hepatic necrosis
• Cytolytic hepatitis
• Cholestasis
• Jaundice
• Abnormal hepatic function 
• Hepatic disorder
• Increased alanine aminotransferase 
• Increased aspartate aminotransferase 

Genitourinary Disorders

• Increased creatinine phosphokinase

Endocrine and Metabolic Disorders

• Hyperkalemia
• Hypokalemia
• Metabolic acidosis
• Malignant hypothermia
• Increased ammonia 

Musculoskeletal Disorders

• Myalgia
• Rhabdomyolysis

Skin and Subcutaneous Tissue Disorders

• Urticaria
• Erythema
• Skin burning sensation

Immune, Blood and Lymphatic System Disorders

• Coagulopathy
• Abnormal coagulation test 

Sensory Disorders

• Conjunctivitis
• Ocular icterus
• Transient blindness
• Eye burns
• Ulcerative keratitis
• Ocular hyperemia
• Reduced visual acuity
• Eye irritation
• Eye pain

• Muscle relaxants
• Nitrous oxide
• Fentanyl
• Midazolam

• Oxygen concentration
• Desflurane concentration

Desflurane is a volatile halogenated anaesthetic with a chemical structure similar to isoflurane, except for substitution of a fluorine atom for chlorine at the alpha-ethyl carbon. It produces a dose related, reversible loss of consciousness, modification of autonomic reflexes and depression of respiration and the cardiovascular system. Desflurane has low solubility in blood and tissues and is relatively resistant to degradation which minimise the risk of nephrotoxicity.

Liquid 240ml

• Suprane (Baxter) originator

Liquid 250ml

• Torrance (Safeline)