Volatile Inhalational Anaesthetic Pregnancy: Safety not established for obstetric procedures; desflurane is a uterine relaxant and reduces utero-placental blood flow; animal studies showed reproductive toxicity. Use in pregnancy only when absolutely necessary. Avoid breastfeeding until desflurane has been eliminated (around 24 hours after anaesthesia).

Desflurane

Brand names: Suprane

Desflurane is a volatile halogenated inhalational anaesthetic agent used for the maintenance of general anaesthesia, delivered via a calibrated vaporiser.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Individualised, concentration-based (percent inspired vapour). Induction in adults: start at 3%, increased in 0.5 to 1.0% increments every 2 to 3 breaths; inspired concentrations of 4 to 11% usually produce surgical anaesthesia in 2 to 4 minutes (up to 15% may be used). After IV induction with e.g. thiopental or propofol, desflurane can be started at approximately 3.0% (0.5 MAC) to 6.0% (1 MAC).

Route: Inhalation via a vaporizer specifically designed and calibrated for desflurane

Frequency: Continuous administration during anaesthesia; titrated to the desired depth of anaesthesia and individual response

Maintenance of anaesthesia in adults: 2.5 to 8.5% with oxygen or oxygen-enriched air, or 2 to 6% when nitrous oxide is used concomitantly (ensure at least 25% oxygen when high concentrations are used with nitrous oxide). MAC decreases with increasing patient age and is reduced by concomitant nitrous oxide, opioids and benzodiazepines - adjust dose accordingly. Lower concentration recommended in hypovolaemic, hypotensive, debilitated and elderly patients. Neurosurgery: 0.8 MAC or less with barbiturate induction and hyperventilation. CHILDREN: must NOT be used for induction of anaesthesia (high frequency of coughing, breath-holding, apnoea, laryngospasm, increased salivation); for maintenance in intubated infants/children, end-tidal concentrations of 5.2 to 10% (up to 18% for short periods) - NOT for maintenance in non-intubated children under 6 years. Administered only by professionals trained in general anaesthesia. When high concentrations are used with nitrous oxide, keep inspired oxygen at least 25%.

Dose adjustments

Renal

No dose adjustment necessary in renal (or hepatic) impairment due to low metabolism; concentrations of 1 to 4% with nitrous oxide or oxygen have been administered successfully.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Patients for whom general anaesthesia is contraindicated
Known hypersensitivity to halogenated anaesthetics or other halogenated hydrocarbon compounds
Known or suspected propensity to malignant hyperthermia (or hereditary disposition to it)
Induction of anaesthesia in children
Maintenance of anaesthesia in non-intubated children under 6 years
Sole anaesthetic in patients at risk of coronary artery disease, or where increases in heart rate or blood pressure are undesirable
History of confirmed hepatitis or unexplained moderate to severe liver dysfunction after previous halogenated anaesthetic
Dental procedures outside a hospital or day-care unit

Side effects

Nausea and vomiting (very common)
Cough and breath-holding
Apnoea and hypoxia
Laryngospasm
Bradycardia, tachycardia or nodal arrhythmia
Headache

Interactions

Nitrous oxide, benzodiazepines and opioids: decrease the amount (MAC) of desflurane required to produce anaesthesia - reduce desflurane dose accordingly
Neuromuscular blocking agents (muscle relaxants): desflurane reduces the dose required
May react with desiccated CO2 absorbents to produce carbon monoxide (US labelling): replace desiccated absorbent before administration

Clinical monograph

How it works

Like other volatile agents it produces dose-dependent general anaesthesia through actions on multiple CNS targets, including enhancement of inhibitory GABA-A receptor activity.

Prescribing in practice

It is a recognised trigger for malignant hyperthermia and must be avoided in susceptible patients, with dantrolene and an MH management plan available wherever it is used.
Its low blood-gas solubility gives rapid onset and recovery, but its pungency makes it unsuitable for gas induction owing to airway irritation, coughing and laryngospasm.
Rapid increases in inspired concentration can cause sympathetic stimulation with tachycardia and hypertension.

Monitoring

Monitor depth of anaesthesia, end-tidal agent concentration, oxygenation, capnography and cardiovascular parameters throughout administration.

Counselling the patient

Reassure the patient that emergence is usually rapid once the agent is discontinued.
Document and communicate any personal or family history suggesting malignant hyperthermia risk.

Evidence & guidelines

Its use is supported by product information and established anaesthetic practice; environmental considerations of volatile agents are increasingly emphasised in professional guidance.

Reference: RCoA GPAS 2023; RCoA Sustainability Report 2022; AAGBI MH Guidelines 2020; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways