Desflurane

Question 1

How many compounds were discovered between 1959-1980?

Answer 1

over 700

Question 2

What compound was Desflurane?

Answer 2

Compound 653, initially discarded, exposive

Question 3

What caused re-evaluation of compound 653?

Answer 3

increased outpatient surgery

Question 4

What is the other name for Desflurane?

Answer 4

Suprane

Question 5

What is the molecular weight of Desflurane?

Answer 5

168

Question 6

What is the vapor pressure of desflurane?

Answer 6

667 mmHg; HIGH, can be hard to manage.

Question 7

how is des stored?

Answer 7

amber glass or aluminum

Question 8

What are some characteristics of des?

Answer 8

stable, doesn’t corrode metals, no known impurities, nonflammable

Question 9

What is the boiling point of des?

Answer 9

23.5C/74.3F; LOW!

Question 10

True/false: Desflurane is not affected by body weight or kidney function.

Answer 10

True, not weight based.

Question 11

True/false: MAC of des is not affected by age

Answer 11

False! Higher the age the lower the MAC.

Question 12

True/false: Des needed a specially constructed/pressurized vaporizer?

Answer 12

True; Tech6; needed to heat Des to 104F and keep it at 2atm to ensure constant delivery. Modern anesthesia has a cassette though, no longer need special vaporizer.

Question 13

What are the cardiovascular effects of Desflurane?

Answer 13

similar to iso, minimal effect on coronary blood flow, CO unchanged or slightly depressed at 1-2 MAC, SVR reduced, MAP reduced (dose dependent/predictable), moderate rise in HR (rapid increase in conc can cause transient increase in catecholamines), CVP, PAP, doesn’t sensitize myocardium (no arrhythmias)

Question 14

What are the respiratory effects of Des?

Answer 14

high incidence of laryngospasm/coughing/increased secretions, decreases tidal volume, increase RR, decrease in alveolar ventilation and increase PaCO2, depress ventilatory response to increasing PaCO2, 1.5 MAC or greater can cause apnea.

Question 15

What are the hepatic effects of des?

Answer 15

close to no metabolism, function tests unaffected, no hepatic injury

Question 16

What are the renal effects of des?

Answer 16

close to no renal metabolism, PO creat and UOP don’t differ significantly

Question 17

What are the neuro effects of des?

Answer 17

decreases CVR, increased CBF, increased ICP, marked decline in CMRO2–cerebral vasoconstriction and moderate increase CBF, dose dependent increase in CSF production, EEG–burst suppression at >1.2 MAC, caution if need high CBF.

Question 18

What are the musculoskeletal effects of des?

Answer 18

dose-dependent decreased muscle tone, decreased response to TOF, synergistic effects with depolarizing and nondepolarizing agents

Question 19

Can you use des for inhalation induction?

Answer 19

Not routinely done, could but would need blunting with narcs. AIRWAY IRRITANT!

Question 20

Are there any drug interactions with Desflurane?

Answer 20

no clinically significant reactions, NDMR synergism, reduces ED95 of succ, can use with benzos to reduce MAC by 16% and opioids by 50%

Question 21

Can des be used in combo with Nitrous Oxide?

Answer 21

Yes, no advantage with induction, Less PONV when used without N2O, N2O may cause increased BP and SVR and decreased HR and CO so you could use it with des.

Question 22

What is the most to least expensive volatile?

Answer 22

Sevo, Des, Iso

Question 23

Is Des bad for the environment?

Answer 23

Yes, 20x more potent of a greenhouse gas than sevo

Question 24

Pros for des:

Answer 24

low B:G/fast onset, skeletal muscle relaxation, lack of toxicity, minimal metabolism

Question 25

Cons of des:

Answer 25

high VP, lower potency so need more, pungent/resp irritant, tachy, decreased SVR, Carbon monoxide degradation.