Anesthetic Considerations Using Potent Inhaled Anesthetics: Desflurane Rapid Emergence & Economic Advantages Ann Briggs, MS, CRNA Loyola University Medical Center Department of Anesthesia Maywood, IL. Inhalation Anesthesia. Depth of anesthesia determined by concentration of anesthetic in CNS
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Anesthetic Considerations Using Potent Inhaled Anesthetics: Desflurane Rapid Emergence & Economic AdvantagesAnn Briggs, MS, CRNALoyola University Medical CenterDepartment of AnesthesiaMaywood, IL
of anesthetic from lungs to arterial
blood is solubility
Desflurane vs Isoflurane, Propofol, and
Eger EI II, Schafer SL Anesth Analg 2005; 101: 688-696
The most common problems encountered with insertion or tolerance of the LMA are due directly to inadequate depth of anesthesia – regardless of the anesthetic agent in use.
* The incidence of coughing during anesthetic maintenance while using a LMA is minimal and does not differ among the anesthetics commonly used for anesthesia, including propofol.
Figure 1. The incidence of coughing during anesthetic maintenance during use of an LMA is minimal and does not differ among the anesthetics commonly used for anesthesia.
% of Patients Coughing During Anesthesia
While Breathing Through a Laryngeal Mask Airway
(differences not significant)
Data for desflurane and isoflurane are from Ashworth and Smith. Data for sevoflurane are from Tang et al. Both of these references supplied the data for propofol.
Airway Responses During Desflurane Versus Sevoflurane Administration via a LMA in Smokers.
McKay RE et al. Anesthesia and Analgesia, Nov. 2006
Study tested whether the use of a more pungent anesthetic (desflurane) would result in a higher rate of coughing, breath holding, laryngospasm or desaturation among patients who smoke.
Average pack years smoked: 25 years
↓ renal reserve
1 week + 3 mos.
Silverstein et al. Anesthesiology March 2007
Monk et al. Anesthesiology, Jan. 2008
Heavner et al. Br J Anesthesia 2003; 91: 502-6
Iannuzzi et al. Minerva Anesthesiol 2005; 71:147-55
“Desflurane Anesthesia After Sevoflurane Inhaled Induction Reduces Severity of Emergence Agitation in Children Undergoing Minor Ear-Nose-Throat Surgery Compared with Sevoflurane Induction and Maintenance”
Mayer, et al, Klinikum Ludwigshafen, Germany
Anesthesia & Analgesia, February 2006
To evaluate the influence of desflurane maintenance after sevo induction versus sevo induction and maintenance on emergence agitation in pediatrics undergoing ear, nose, and throat surgery.
Maintenance of anesthesia with desflurane after mask induction with sevoflurane resulted in less severe agitation with faster emergence times.
Although time of PACU stay did not differ significantly, a more rapid immediate recovery from anesthesia could be an additional benefit in a busy operating room.
-13-14% between 1970’s to 1990’s &
increased hospital costs to $127M/year.
- 15% between 1999 to 2000.
↑ gastric volume (up to 75% greater), delayed gastric emptying
Renal and Endocrine
Strum et al, Anesth Analg 2004; 99: 1848 -53
Emergence and Immediate Recovery Times After Discontinuation of Volatile Anesthetics in the Two Anesthetic Groups
The present study demonstrates that morbidly obese patients anesthetized for more than three hours recover significantly more rapidly after desflurane anesthesia than after sevoflurane anesthesia.
Rachel Eshima McKay, M.D. and
Warren R. McKay, M.D.
Department of Anesthesia and Perioperative Care
University of California, San Francisco
Juvin et al. Postoperative recovery after desflurane, propofol or isoflurane anaesthesia among morbidly obese patients. Anesth Analg. 2000; 91:714-719.
Mahmoud et al. Desflurane or sevoflurane for gynaecological day-case anaesthesia with spontaneous respiration? Anaesthesia. 2001; 56:171