Desflurane is an anesthetic that belongs to the flurane class of drugs. The inhalation anesthetic is widely used because of its very good hypnotic properties as well as its easy controllability. In Germany, Austria, and Switzerland, desflurane is marketed by the American pharmaceutical company Baxter under the trade name Suprane.
What is desflurane?
Desflurane is a well-established and widely used anesthetic. It is inhaled and therefore called an inhalation anesthetic. Its pharmacologic properties make desflurane a member of the flurane class of agents, the most prominent group of anesthetics, which also includes the related drugs sevoflurane and isoflurane. Desflurane is one of the few anesthetics that have good circulatory stability and at the same time are easy to control. The controllability of the substance can be explained by a particularly rapid onset and release of blood. Desflurane is also characterized by a strong hypnotic effect, i.e. patients can be rapidly put into a deep sleep (Greek: ὕπνος hypnos), which allows surgery to be performed without interference. However, the analgesic and muscle relaxant effects of desflurane are very minimal, which is why additional preparations may need to be administered to ensure the safe performance of medical procedures. The inhalation anesthetic is described in chemistry by the molecular formula C 3 – H 2 – F 6 – O, which corresponds to a moral mass of approximately 168.0g/mol. The drug is subject to very strict pharmacy and prescription requirements.
Pharmacological effects on body and organs
The exact mechanism of action of desflurane is not entirely clear, but is controversial in detail. Various theories or approaches are advocated in the literature. Nevertheless, there is basic agreement that the effect is achieved by a complex interaction of lipids, water, and proteins. Interactions are supposed to lead to influences on the nerve membranes. The efficacy and safety of desflurane is undisputed based on many years of experience with the drug. Numerous studies have shown that the anesthetic has a so-called blood-gas partition coefficient of 0.42. Accordingly, the concentration of the active ingredient is 0.5. Accordingly, the concentration of the active substance in the blood is 0.42 %-vol. Desflurane is only slightly soluble, which causes rapid flooding and draining. This allows the rapid fall asleep and awakening phases typical of the drug. With a minimum alveolar concentration (anesthetic potency) of 6%, desfluan lags behind the related active ingredients sevoflurane and isoflurane. The metabolization rate of the inhalation anesthetic is also pharmacologically relevant. This is set at approx. 0.1 %, which makes damage to the liver unlikely. For patients with liver damage, therefore, there is not necessarily a contraindication to desfluan. In some cases, it can be used without concern despite organ damage.
Medical use and use for treatment and prevention.
Desflurane has primarily hypnotic effects, so patients can be put into a deep sleep state. The anesthetic is therefore used to induce or perform anesthesia. Only in this case is there a justifiable indication. Because of its hypnotic effects or its property as an anesthetic, desflurane is subject to prescription and pharmacy requirements in all countries where it is available. As a rule, it is not issued to patients, but only to the attending physician. This is because only an experienced anesthesiologist is authorized to dispense it. He or she will vaporize the drug, which is supplied as a liquid, in a special anesthesia device and give it to the patient for inhalation. Independent ingestion by the patient is thus ruled out because of the multitude of hazards under consideration.
Risks and side effects
Desflurane must be administered only under medical supervision. Therefore, it must be administered by or under the supervision of an anesthesiologist. Otherwise, a loss of control is to be feared, which massively increases the probability of risks and side effects and triggers unpredictable dangers.The most common side effects of desflurane include coughing fits, mild or severe headache, and gastrointestinal discomfort that may manifest as nausea or vomiting. Also common are hypertension or hypotension (blood pressure that is too low or too high) and cardiac rhythm disturbances. These can manifest as bradycardia (falling below the usual heart rate) or tachycardia (medically relevant exceeding of the typical heart rate). In addition, the development of pharyngitis (inflammation of the pharyngeal mucosa) is also within the realm of possibility. Desflurane must not be administered if there is a contraindication. This is the case if there is a known hypersensitivity or allergy to it or its related agents. A diagnosed risk of coronary artery disease is also a circumstance contraindicating its use. This also applies to existing malignant hyperthermia.
