Desfluranes

Desfluranes are volatile inhalational anesthetic agents belonging to the halogenated ether class, with desflurane being the principal member used in clinical practice (brand name Suprane). They are designed for inhalational anesthesia and are typically delivered with oxygen or air through a calibrated vaporizer integrated into anesthesia machines. Desflurane and related compounds are characterized by their fluorinated ether structure and largely inert pharmacology.

Desflurane is notable for an exceptionally low blood-gas partition coefficient, which yields very rapid induction and emergence from anesthesia as the agent equilibrates quickly between alveoli and blood. Most of the agent is exhaled unchanged, with only a small portion metabolized by the liver (minimal metabolism). This leads to predictable control of anesthetic depth and quick recovery, but it also means there is relatively little production of metabolites that would require further organ processing.

Clinical use centers on maintenance of general anesthesia after induction, often following initial sedation with intravenous agents and neuromuscular blockade. Desflurane has a pungent, irritant odor that can provoke airway irritation, coughing, or laryngospasm, particularly during inhalational induction in spontaneously breathing patients. As a result, it is usually avoided for inhalational induction and used more commonly for maintenance in patients under controlled ventilation. It can cause dose-dependent hemodynamic changes, such as tachycardia or hypertension at high concentrations, and bears the general risks associated with volatile anesthetics, including the rare risk of malignant hyperthermia in susceptible individuals.

Environmental considerations include a relatively high global warming potential compared with some other anesthetic gases, prompting emphasis on gas scavenging and strategies to minimize waste anesthetic emissions.