Desflurane

DEA Class;  Rx

Common Brand Names; Suprane

Sensitivity to halogenated agents

Genetic susceptibility to malignant hyperthermia

Patients in whom general anesthesia is contraindicated

Induction of anesthesia in pediatric patients

History of moderate to severe hepatic dysfunction following anesthesia with desflurane or other halogenated agents

• Cough (3% to 34% adult induction; 26% pediatric maintenance and 72% pediatric induction )
• Apnea (3% to 15% )
• Interrupted breathing (30% adult induction; 3% pediatric maintenance and 68% pediatric induction )
• Laryngeal spasm (3% to 10% adult induction; 13% pediatric maintenance and 50% pediatric induction )
• Nausea (27% )
• Desaturation of blood (3% to 10% adult induction; 2% pediatric maintenance and 26% pediatric induction )
• Vomiting (16% )
• Cardiovascular: Alteration in heart rate (greater than 1% ); hypotension (8% geriatric patients)
• Hypotension (8% geriatric patients)
• Alteration in heart rate (>1% )
• Bradyarrhythmia (>1% )
• Heart failure, Hypertension (>1% )
• Malignant hypertension, Shock, Sinus arrhythmia (>1% )
• Tachycardia (>1% )
• Excessive salivation (>1% )
• Headache (>1% )
• Delirium (>1%)
• Pharyngitis (>1% )
• Cardiac arrest, Cardiac dysrhythmia
• Torsades de pointes
• Hyperkalemia, Perioperative (rare )
• Malignant hyperthermia
• Pancreatitis, acute
• Hepatic necrosis, Hepatitis, Liver failure
• Rhabdomyolysis
• Seizure
• Nephrotoxicity
• Respiratory failure
• Complication of anesthesia, During induction

Volatile liquid; use appropriate vaporizer for inhalation

Not approved for maintenance of anesthesia in nonintubated children due to an increased incidence of respiratory adverse reactions, including coughing (26%), laryngospasm (13%), and secretions (12%)

Decrease in hepatic and renal blood flow reported

Risk of hyperkalemia increased in pediatric patients with underlying neuromuscular disease (eg, Duchenne muscular dystrophy)

Increase in intracranial pressure reported with use

Emergence from anesthesia in children may evoke a brief state of agitation that may hinder cooperation

Should not be used as sole agent of induction in patients with CAD, heart failure, or patients where increase in heart rate or BP are undesirable

Children, particularly if 6 years old or younger, under an anesthetic maintenance of desflurane delivered via laryngeal mask airway (LMA™ mask) are at increased risk for adverse respiratory reactions, including coughing and laryngospasm, especially with removal of the laryngeal mask airway under deep anesthesia; closely monitor these patients for signs and symptoms associated with laryngospasm and treat accordingly

When used for maintenance of anesthesia in children with asthma or history of recent upper airway infection, there is increased risk for airway narrowing and increases in airway resistance; closely monitor these patients for signs and symptoms associated with airway narrowing and treat accordingly

QTc prolongation, associated with torsade de pointes, reported; carefully monitor cardiac rhythm when administering drug to susceptible patients (e.g., patients with congenital Long QT Syndrome or patients taking drugs that can prolong the QT interval)

There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies

It is not known whether drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised when administering therapy to a nursing woman