Volatile Inhalational Anaesthetic
Pregnancy: Caution — sevoflurane preferred
Desflurane
Brand names: Suprane
Adult dose
Dose: MAC 6–7%; maintenance 2.5–8.5% in O2/air
Route: Inhalational
Frequency: Continuous during anaesthesia
Max: Titrated to clinical effect
Fastest offset of all volatiles (blood:gas coefficient 0.42). NOT suitable for inhalational induction — pungent, causes laryngospasm. Requires heated pressurised vaporiser (boils at 22.8°C). RCoA recommends phasing out — GWP ~2,500× CO₂.
Paediatric dose
Route:
Not recommended for paediatric induction — pungent. Seek specialist opinion if required in paediatric setting.
Dose adjustments
Renal
No specific renal adjustment required.
Hepatic
Caution if previous volatile-associated hepatitis.
Clinical pearls
- Fastest emergence of all volatiles — benefit in day-case/bariatric surgery where rapid emergence is critical
- RCoA Net Zero initiative: many UK hospitals have now banned desflurane use — replaced with sevoflurane or TIVA
- Antidote for MH: dantrolene as per sevoflurane entry
Contraindications
- Known or suspected MH susceptibility
- Inhalational induction (pungent)
- Previous volatile anaesthetic-associated hepatitis
Side effects
- Laryngospasm/coughing if used for gas induction
- MH
- Cardiovascular depression
- Sympathetic stimulation at >1 MAC
- Significant greenhouse gas emissions
Interactions
- NMB agents (potentiate block)
- Opioids (reduce MAC requirement)
Monitoring
- End-tidal agent concentration
- Haemodynamics
- Temperature monitoring
Reference: BNFc; BNF 90; RCoA GPAS 2023; RCoA Sustainability Report 2022; AAGBI MH Guidelines 2020. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators