Drugs List

Therapeutic Indications

Uses

Anaesthesia - general - inhalation

Adults
Induction and/or maintenance of general anaesthesia for inpatient and outpatient surgery

Children
Maintenance of general anaesthesia for inpatient and outpatient surgery

Administration

For inhalation via a specifically calibrated vaporiser.

Contraindications

Induction in children
Predisposition to malignant hyperthermia
Breastfeeding
Pregnancy

Precautions and Warnings

Debilitation
Hepatic impairment
Hypotension
Hypovolaemia
Ischaemic heart disease
Neuromuscular disorder
Raised intracranial pressure
Structural central nervous system lesion

Advise patient not to drive/operate machinery within 24 hours of treatment
A patent airway and adequate oxygenation must be maintained
May interact with dry carbon dioxide absorbents - do not allow to dry out
Resuscitation facilities must be immediately available
To be administered by anaesthetist or a doctor trained in intensive care
Monitor blood pressure
Monitor for malignant hyperthermia
Monitor heart rate

In patients with coronary artery disease, it is important to maintain normal haemodynamics so that myocardial ischaemia is avoided.

Desflurane may increase cerebrospinal fluid or intracranial pressure in patients with space occupying lesions. In these patients, desflurane should be administered at a minimum alveolar concentration of 0.8 or less and in conjunction with a barbiturate induction and hyperventilation in the period before intracranial compression. Cerebral perfusion pressure should be maintained.

Caution should be exercised when desflurane is used for maintenance anaesthesia with laryngeal mask airway (LMA) or face mask in children 6 years old or younger because of the increased potential for adverse respiratory events, e.g. coughing and laryngospasm, especially with removal of the LMA under deep anaesthesia.

Pregnancy and Lactation

Pregnancy

Desflurane is contraindicated during pregnancy.

There are no adequate or well controlled studies with desflurane during human pregnancy. Desflurane has been reported to cause neonatal respiratory depression when used during the third trimester of pregnancy. Animal studies have shown possible foetotoxic effects and reduced offspring weight. However, these effects were restricted to groups where maternal toxicity was observed.

The low molecular weight (about 168) and the presence of desflurane in the brain suggests that it will cross the placenta to the foetus. Desflurane is not teratogenic in two animal species, but as there are limited reports of its use during early pregnancy, the estimation of risk is not possible. All anaesthetic agents can cause depression in the newborn that may last for longer than 24 hours.

Schaefer concludes that halogenated anaesthetics can be used at any time during pregnancy. When used during labour, there is a need for careful monitoring and the newborn should be observed for possible respiratory and circulatory effects and possibly hyperbilirubinaemia.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Desflurane contraindicated in breastfeeding mothers.

It is not known if desflurane is secreted in human milk.

Desflurane is probably secreted into colostrum and milk, as suggested by its presence in the maternal blood and its low molecular weight (about 168), but the effect on the infant is unknown.

There is limited published experience with desflurane during breastfeeding. Because the serum half-life of desflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered from general anaesthesia to nurse.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Abnormal liver function
Agitation
Alanine aminotransferase increased
Apnoea
Aspartate aminotransferase increased
Asthenia
Blindness
Bradycardia
Breath holding
Bronchospasm
Burning sensation
Cardiac arrest
Cardiac arrhythmias
Cardio-respiratory depression
Cholestasis
Coagulation disorders
Conjunctivitis
Convulsions
Cough
Cytolytic hepatitis
Dizziness
ECG changes
Encephalopathy
Erythema
Eye irritation
Eye pain
Fatigue
Haemoptysis
Haemorrhage
Headache
Hepatic necrosis
Hepatitis
Hyperkalaemia
Hypersensitivity reactions
Hypertension
Hypokalaemia
Hypokinesia
Hypotension
Hypoxia
Increase in creatinine
Increase in serum glucose
Increased cerebrospinal fluid pressure
Jaundice
Laryngospasm
Malaise
Malignant hyperthermia
Metabolic acidosis
Migraine
Myalgia
Myocardial infarction
Myocardial ischaemia
Nausea
Ocular hyperaemia
Palpitations
Pancreatitis
Pharyngitis
Reduced visual acuity
Respiratory arrest
Respiratory distress
Respiratory failure
Rhabdomyolysis
Salivation
Scleral icterus
Shock
T-wave changes
Tachyarrhythmia
Tachycardia
Torsades de pointes
Ulcerative keratitis
Urticaria
Vasodilatation
Vomiting

Presentation

Volatile liquid for inhalation of vapours containing desflurane.

Drugs List

Therapeutic Indications

Uses

Anaesthesia - general - inhalation

Adults
Induction and/or maintenance of general anaesthesia for inpatient and outpatient surgery

Children
Maintenance of general anaesthesia for inpatient and outpatient surgery

Dosage

Due to the complexity and specialist nature of using anaesthesia, specific dosing information on this agent is not included.

When using this agent, specialist literature, national guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of all relevant patient factors.

Additional Dosage Information

Administration

For inhalation via a specifically calibrated vaporiser.

Contraindications

Induction in children
Predisposition to malignant hyperthermia
Breastfeeding
Pregnancy

Precautions and Warnings

Debilitation
Hepatic impairment
Hypotension
Hypovolaemia
Ischaemic heart disease
Neuromuscular disorder
Raised intracranial pressure
Structural central nervous system lesion

Advise patient not to drive/operate machinery within 24 hours of treatment
A patent airway and adequate oxygenation must be maintained
May interact with dry carbon dioxide absorbents - do not allow to dry out
Resuscitation facilities must be immediately available
To be administered by anaesthetist or a doctor trained in intensive care
Monitor blood pressure
Monitor for malignant hyperthermia
Monitor heart rate

In patients with coronary artery disease, it is important to maintain normal haemodynamics so that myocardial ischaemia is avoided.

Desflurane may increase cerebrospinal fluid or intracranial pressure in patients with space occupying lesions. In these patients, desflurane should be administered at a minimum alveolar concentration of 0.8 or less and in conjunction with a barbiturate induction and hyperventilation in the period before intracranial compression. Cerebral perfusion pressure should be maintained.

Caution should be exercised when desflurane is used for maintenance anaesthesia with laryngeal mask airway (LMA) or face mask in children 6 years old or younger because of the increased potential for adverse respiratory events, e.g. coughing and laryngospasm, especially with removal of the LMA under deep anaesthesia.

Pregnancy and Lactation

Pregnancy

Desflurane is contraindicated during pregnancy.

There are no adequate or well controlled studies with desflurane during human pregnancy. Desflurane has been reported to cause neonatal respiratory depression when used during the third trimester of pregnancy. Animal studies have shown possible foetotoxic effects and reduced offspring weight. However, these effects were restricted to groups where maternal toxicity was observed.

The low molecular weight (about 168) and the presence of desflurane in the brain suggests that it will cross the placenta to the foetus. Desflurane is not teratogenic in two animal species, but as there are limited reports of its use during early pregnancy, the estimation of risk is not possible. All anaesthetic agents can cause depression in the newborn that may last for longer than 24 hours.

Schaefer concludes that halogenated anaesthetics can be used at any time during pregnancy. When used during labour, there is a need for careful monitoring and the newborn should be observed for possible respiratory and circulatory effects and possibly hyperbilirubinaemia.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Desflurane contraindicated in breastfeeding mothers.

It is not known if desflurane is secreted in human milk.

Desflurane is probably secreted into colostrum and milk, as suggested by its presence in the maternal blood and its low molecular weight (about 168), but the effect on the infant is unknown.

There is limited published experience with desflurane during breastfeeding. Because the serum half-life of desflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered from general anaesthesia to nurse.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Abnormal liver function
Agitation
Alanine aminotransferase increased
Apnoea
Aspartate aminotransferase increased
Asthenia
Blindness
Bradycardia
Breath holding
Bronchospasm
Burning sensation
Cardiac arrest
Cardiac arrhythmias
Cardio-respiratory depression
Cholestasis
Coagulation disorders
Conjunctivitis
Convulsions
Cough
Cytolytic hepatitis
Dizziness
ECG changes
Encephalopathy
Erythema
Eye irritation
Eye pain
Fatigue
Haemoptysis
Haemorrhage
Headache
Hepatic necrosis
Hepatitis
Hyperkalaemia
Hypersensitivity reactions
Hypertension
Hypokalaemia
Hypokinesia
Hypotension
Hypoxia
Increase in creatinine
Increase in serum glucose
Increased cerebrospinal fluid pressure
Jaundice
Laryngospasm
Malaise
Malignant hyperthermia
Metabolic acidosis
Migraine
Myalgia
Myocardial infarction
Myocardial ischaemia
Nausea
Ocular hyperaemia
Palpitations
Pancreatitis
Pharyngitis
Reduced visual acuity
Respiratory arrest
Respiratory distress
Respiratory failure
Rhabdomyolysis
Salivation
Scleral icterus
Shock
T-wave changes
Tachyarrhythmia
Tachycardia
Torsades de pointes
Ulcerative keratitis
Urticaria
Vasodilatation
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2013

Reference Sources

BNF for Children (2012-2013) Pharmaceutical Press, London.

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Desflurane 100% v/v Inhalation vapour, liquid. Baxter Healthcare Ltd. Revised October 2015.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Desflurane Last revised: April 1, 2008
Last accessed: June 10, 2013.