Dosing & Uses
Dosage Forms & Strengths
- 240mL (100%)
Induction: Initial 3% inhaled, increase by 0.5-1% increments q2-3Breaths
Maintenance: 2.5-8.5% with or without nitrous oxide
Dosage Forms & Strengths
- 240mL (100%)
General Anesthesia Maintenance
Indicated for maintenance of anesthesia in infants and children who are tracheally intubated following induction with agents other than desflurane
Maintenance: 5.2-10% with or without nitrous oxide
Contraindicated for induction in pediatric patients
Not indicated for maintenance of anesthesia in nonintubated children due to an increased incidence of moderate to severe respiratory adverse reactions, including coughing, laryngospasm and secretions
Concentration of desflurane used is age dependent
Serious - Use Alternative
Significant - Monitor Closely
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% )
Pharyngitis (>1% )
Cardiac arrest, Cardiac dysrhythmia
Torsades de pointes
Hyperkalemia, Perioperative (rare )
Hepatic necrosis, Hepatitis, Liver failure
Complication of anesthesia, During induction
Post-operative agitation in children
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
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
Malignant hyperthermia may occur in susceptible individuals; fatal outcomes reported
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
General anesthetics and sedation drugs in young children and pregnant women
- Brain development
- Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
- Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
- Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
Pregnancy & Lactation
Pregnancy Category: B
Lactation: excretion in milk unknown; use with caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Volatile liquid inhalation anesthetic; may enhance inhibitory postsynaptic channel activity and may inhibit excitatory synaptic activity
Onset: 1-2 min
Absorption: <0.02% (systemic)
Metabolism: Liver (minimal)
Elimination: Via the lungs (exhaled gases)
Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)
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|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
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|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
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