Desflurane
Desflurane
physical properties
effects on organ system
biotransformation and toxicity
contraindications
drug interactions
-MAC value: 6.0%
-vapor pressure: 681 mmHg at 20 degrees celcius
-substitution of isoflurane's chlorine atom for flourine creates desflurane
-boils at room temperature when located at high altitudes (ex. Denver, Colardo)
-requires a special vaporizer
-low solubility promotes rapid induction and emergence
-tighter control of anesthetic level due to alveolar concentration close to inspired concentrations
-blood-gas partition coefficient 0.42
Central Nervous System
-decreases CMR02
-increases CBF
-increases ICP
Cardiovascular System
-decreased systemic vascular resistance leads to decreased arterial blood pressure
-decreased arterial blood pressure which stimulates baroreceptors relex increase in heart rate
-maintained cardiac output with decreased arterial pressure and increased heart rate
-rapid increases in desflurane concentrations may lead to increased arterial blood pressure and heart rate
-increased cardiac parameters due to sudden increase in desflurane levels can be attenuated with: fentanyl, esmolol or clonidine
Respiratory System
-increased respiratory rate
-decreased tidal volume
-resultant decreased alveolar ventilation
-elevated resting PaC02
-decreased hypoxic drive
-blunted/decreased ventilatory response to elevated PaC02
-airway irritation associated with: salivation, breathe holding, coughing, and laryngospasm
Hepatic System
-no evidence of hepatic injury
-normal post-operative liver function test
Renal System
-no evidence of nephrotoxic injury
Neuromuscular System
-dose dependant decrease in train-of-four peripheral nerve stimulation response
-dose dependant decrease in tetanic peripheral nerve stimulation response
biotransformation and toxicity
-minimal metabolism of desflurane in humans
-degraded by dissicated carbon dioxide absorbents into clinically insignificant levels of carbon monoxide
-general contraindications shared with other volatile anesthetics
-avoid in malignant hyperthermia, severe hypovolemia and patients with increased intracranial hypertension
drug interactions
-desflurane emergence in some pediatric patients has been assoicated delirium
-prolongs duration of nondepolarizing muscle relaxants (NDMR)
-epinephrine can be used safely in doses upto 4.5 ug/L
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