desflurane (Rx)

Brand and Other Names:Suprane
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

inhalation solution

  • 240mL (100%)
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General Anesthesia

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

inhalation solution

  • 240mL (100%)
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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

Dosing Considerations

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

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Interactions

Interaction Checker

and desflurane

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            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)

            1-10%

            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% )

            <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

            Postmarketing reports

            Atrial fibrillation

            Post-operative agitation in children

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            Warnings

            Contraindications

            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

            Cautions

            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
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women; in animal reproduction studies, embryo-fetal toxicity (reduced viable fetuses and/or increased post-implantation loss) was noted in pregnant rats and rabbits administered 1 MAC desflurane for 4 hours a day (4 MAC-hours/day) during organogenesis; there are no data on pregnancy exposures in primates corresponding to periods prior to the third trimester in humans

            Lactation

            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

            Pregnancy Categories

            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.

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            Pharmacology

            Mechanism of Action

            Volatile liquid inhalation anesthetic; may enhance inhibitory postsynaptic channel activity and may inhibit excitatory synaptic activity

            Pharmacokinetics

            Onset: 1-2 min

            Absorption: <0.02% (systemic)

            Metabolism: Liver (minimal)

            Elimination: Via the lungs (exhaled gases)

            Pharmacogenomics

            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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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 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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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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