Desflurane is indicated as an inhalation agent for induction and maintenance of general anaesthesia for inpatient and outpatient surgery in adults.
For this indication, competent medicine agencies globally authorize below treatments:
Respiratory (Inhalation)
1.67 - 11 %
From 1.67 To 11 % once every day
Desflurane should be administered only by healthcare professionals trained in the administration of general anaesthesia using a vaporizer specifically designed and calibrated for use with desflurane.
Equipment for maintenance of a patent airway, artificial ventilation, oxygen enrichment and circulatory resuscitation must be immediately available.
Parameters such as ECG, blood pressure, oxygen saturation, and pCO2 upon exhaling must be monitored during anaesthesia.
The administration of general anaesthesia must be individualized based on the patient’s response. It is determined depending on the desired effect, taking into consideration of the patient’s age and clinical status.
MAC (minimum alveolar concentration at which 50% of patients show no response to a standardized surgical incision) values for desflurane decreases with increasing patient age. The dose of desflurane should be adjusted accordingly.
The percentage concentration of desflurane corresponding to 1 MAC has been determined within carrier gas as listed in the table below.
Percentage concentration of desflurane corresponding to 1 MAC according to patient age and inhalation mixture (Mean ± SD):
| A g | N* | 100% Oxygen | N* | 60% Nitrous Oxide/ |
|---|---|---|---|---|
| 2 | 6 | 9.2 ± 0.0 | - | - |
| 10 | 5 | 9.4 ± 0.4 | - | - |
| 9 | 4 | 10.0 ± 0.7 | 5 | 7.5 ± 0.8 |
| 2 | 3 | 9.1 ± 0.6 | - | - |
| 3 | - | - | 5 | 6.4 ± 0.4 |
| 4 | 4 | 8.6 ± 0.6 | - | - |
| 7 | 5 | 8.1 ± 0.6 | - | - |
| 25 | 4 | 7.3 ± 0.0 | 4 | 4.0 ± 0.3 |
| 45 | 4 | 6.0 ± 0.3 | 6 | 2.8 ± 0.6 |
| 70 | 6 | 5.2 ± 0.6 | 6 | 1.7 |
N* = number of crossover pairs (using up-and-down method of quantal response)
Premedication should be decided after considering the individual requirements of each patient. The use of anticholinergic medicinal products is a matter of choice for the anaesthetist.
Desflurane can be combined with other substances commonly used in anaesthesia, preferably intravenous opioids benzodiazepines and hypnotics. Opioids or benzodiazepines decrease the amount of desflurane required to produce anaesthesia.
The need of Desflurane also decreases with the concomitant use of nitrous oxide (N2O).
Desflurane reduces the recommended dose of neuromuscular inhibitors.
Taking into account the poor tolerability of breathing desflurane in awake patient, the benefit risk ratio of such a procedure must be analysed on case by case basis.
In adults, a starting concentration of 3% is recommended, increased in 0.5- 1.0% increments every 2 to 3 breaths. Inspired concentrations of 4- 11% of desflurane usually produce surgical anaesthesia in 2-4 minutes.
Higher concentrations up to 15% may be used. Such concentrations of desflurane will proportionately dilute the concentration of oxygen and commencing administration of oxygen should be 30% or above.
During induction in adults, the overall incidence of oxyhemoglobin desaturation (SpO2 <90%) was 6%. High concentrations of desflurane may induce upper airway adverse events.After induction in adults with an intravenous medicinal product such as thiopental or propofol, desflurane can be started at approximately 3.0% (0.5 MAC) - 6.0% (1 MAC), whether the carrier gas is O2 or N2O/O2.
Continuous, short-lived excitement may appear during the induction of anaesthesia with desflurane.
Desflurane at 2.5-8.5% may be required when administered using oxygen or oxygen enriched air. In adults, surgical levels of anaesthesia may be sustained at a reduced concentration of desflurane (2-6%) when nitrous oxide is used concomitantly.
If high concentrations are used with nitrous oxide, it is important to ensure that the inhaled gaseous mixture contains a minimum of 25% oxygen.
Lower doses of desflurane are needed when using opioids, benzodiazepines or other sedatives.
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