Adult Dosing
Induction of anesthesia
- Individualize dosage
- Initial: 3%, then increase 0.5-1% q2-3 breaths or as tolerated (up to 11%), until loss of consciousness
Maintenance of anesthesia
- Individualize dosage
- Titrate inhalation to effect; typical range 2.5-8.5%
Note:
- Dosing can be started at ~0.5-1 minimum alveolar concentration
- Concentrations > 1 minimum alveolar concentration may increase heart rate
Pediatric Dosing
Maintenance of anesthesia
- Individualize dosage by age
- Typical range 5.2-10%; titrate inhalation to effect
Note:
- Dosing can be started at ~0.5-1 minimum alveolar concentration
- Concentrations > 1 minimum alveolar concentration may increase heart rate
[Outline]
- May cause malignant hyperthermia in susceptible patients. Immediately suspend therapy if incidences of malignant hyperthermia occur
- Desflurane has been associated with perioperative hyperkalemia resulting in cardiac arrhythmias and death in pediatric patients. The risk is increased in patients with latent or overt neuromuscular disease, particularly with Duchenne muscular dystrophy
- In patients sensitized by previous exposure to halogenated anesthetics, therapy may cause sensitivity hepatitis
- As therapy is associated with high incidences of moderate to severe respiratory adverse reactions, including coughing, laryngospasm and secretions, it is not indicated in children as an anesthesia induction agent or for maintenance of anesthesia in non-intubated children
- Therapy may result in elevated levels of carboxyhemoglobin in some patients, as desflurane can react with desiccated carbon dioxide (CO2) absorbents to produce carbon monoxide
- Transient elevations in glucose and white blood cell count may occur
Cautions: Use cautiously in
- Increased ICP
- CAD
- HTN
- Tachycardia
- Neuromuscular disorder
- Muscular dystrophy
- Perioperative hyperkalemia
Pregnancy Category:B
Breastfeeding: Safety unknown. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia because the serum half-life of desflurane in the mother is short and the drug is not expected to be absorbed by the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 May 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
