Dosing and uses of Suprane (desflurane)
Adult dosage forms and strengths
inhalation solution
- 240mL (100%)
General Anesthesia
Induction: Initial 3% inhaled, increase by 0.5-1% increments q2-3Breaths
Maintenance: 2.5-8.5% with or without nitrous oxide
Pediatric dosage forms and strengths
inhalation solution
- 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
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
Suprane (desflurane) adverse (side) 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
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
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
Pregnancy and lactation
Pregnancy category: B
Lactation: excretion in milk unknown; use with caution
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.
Pharmacology of Suprane (desflurane)
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)
