Desflurane

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.