Desflurane

(R)-Desfluran Structural Formula V1

(S)-Desfluran Structural Formula V1

Desflurane is a highly fluorinated methyl ethyl ether used for maintenance of general anesthesia. Chemically, it is a volatile, nonflammable liquid administered through inhalation, often using a vaporizer specifically designed for desflurane. Due to its rapid onset and offset, it is particularly useful in outpatient surgery settings, as it allows for quick adjustment of anesthesia depth and rapid recovery post-operation.

Properties

Desflurane has a boiling point of 22.8°C, which is close to room temperature. This property necessitates the use of a heated vaporizer to control its delivery as a gas. Its low blood/gas partition coefficient of 0.42 makes it one of the fastest-acting inhalational anesthetics available, with minimal accumulation in the body, leading to quick recovery times. However, its physical characteristics also mean that it can be expensive to use due to the specialized equipment required.

Pharmacology

The exact mechanism of action of desflurane, like other general anesthetics, is not fully understood but is thought to involve modulation of GABA receptors, reduction of glutamate receptor activity, and effects on ion channels. It depresses the central nervous system, leading to loss of consciousness, analgesia, and muscle relaxation necessary for surgical procedures.

Clinical Use

Desflurane is indicated for the induction and maintenance of general anesthesia. Its rapid onset and recovery profile make it particularly advantageous for short, outpatient procedures, allowing patients to recover quickly and with fewer post-operative side effects such as nausea and vomiting. However, it can irritate the airways, making it less suitable for patients with reactive airway disease.

Side Effects

The most common side effects of desflurane include cough, airway irritation, and increased salivation. It may also cause dose-dependent depression of the cardiovascular and respiratory systems. Due to its pungency, it is not typically used for induction of anesthesia in children or sensitive patients.

Environmental Impact

Desflurane is a potent greenhouse gas, with a global warming potential significantly higher than that of carbon dioxide. The environmental impact of desflurane has led to increased interest in finding more sustainable alternatives for inhalational anesthesia.

Comparison with Other Agents

Desflurane is often compared with other inhalational anesthetics like isoflurane and sevoflurane. While all three are used for similar purposes, desflurane's quick onset and recovery make it unique. However, this comes at the cost of higher expense and potential for airway irritation.