Active Ingredient: Desflurane
Desflurane is indicated as an inhalation agent for the maintenance of anaesthesia in infants and children.
For this indication, competent medicine agencies globally authorize below treatments:
Respiratory (Inhalation)
2 - 11 %
From 2 To 11 % once every day
Desflurane should be administered only by healthcare professionals trained in the administration of general anaesthesia using a vaporizer specifically designed and calibrated for use with desflurane.
Equipment for maintenance of a patent airway, artificial ventilation, oxygen enrichment and circulatory resuscitation must be immediately available.
Parameters such as ECG, blood pressure, oxygen saturation, and pCO2 upon exhaling must be monitored during anaesthesia (see section 4.4).
The administration of general anaesthesia must be individualized based on the patient’s response. It is determined depending on the desired effect, taking into consideration of the patient’s age and clinical status.
MAC (minimum alveolar concentration at which 50% of patients show no response to a standardized surgical incision) values for desflurane decreases with increasing patient age. The dose of desflurane should be adjusted accordingly.
The percentage concentration of desflurane corresponding to 1 MAC has been determined within carrier gas as listed in Table 1 below.
Table 1. Percentage concentration of desflurane corresponding to 1 MAC according to patient age and inhalation mixture (Mean ± SD):
| A g | N* | 100% Oxygen | N* | 60% Nitrous Oxide/ |
|---|---|---|---|---|
| 2 | 6 | 9.2 ± 0.0 | - | - |
| 10 | 5 | 9.4 ± 0.4 | - | - |
| 9 | 4 | 10.0 ± 0.7 | 5 | 7.5 ± 0.8 |
| 2 | 3 | 9.1 ± 0.6 | - | - |
| 3 | - | - | 5 | 6.4 ± 0.4 |
| 4 | 4 | 8.6 ± 0.6 | - | - |
| 7 | 5 | 8.1 ± 0.6 | - | - |
| 25 | 4 | 7.3 ± 0.0 | 4 | 4.0 ± 0.3 |
| 45 | 4 | 6.0 ± 0.3 | 6 | 2.8 ± 0.6 |
| 70 | 6 | 5.2 ± 0.6 | 6 | 1.7 |
N* = number of crossover pairs (using up-and-down method of quantal response)
Premedication should be decided after considering the individual requirements of each patient. The use of anticholinergic medicinal products is a matter of choice for the anaesthetist.
Desflurane can be combined with other substances commonly used in anaesthesia, preferably intravenous opioids benzodiazepines and hypnotics. Opioids or benzodiazepines decrease the amount of desflurane required to produce anaesthesia.
The need of Desflurane also decreases with the concomitant use of nitrous oxide (N2O).
Desflurane reduces the recommended dose of neuromuscular inhibitors.
Desflurane should not be used for the induction of general anaesthesia in children because of the high frequency occurrence of coughing, breath holding, apnoea, laryngospasm and increased salivation.
Desflurane is indicated for maintenance of anaesthesia in infants and children. Surgical levels of anaesthesia may be maintained in children with end-tidal concentrations of 5.2 to 10% desflurane with or without the concomitant use of nitrous oxide. Although end-tidal concentrations of up to 18% desflurane have been administered for short periods of time, if high concentrations are used with nitrous oxide it is important to ensure that the inspired mixture contains a minimum of 25% oxygen.
Desflurane should not be used for maintenance of anaesthesia in non- intubated children under the age of 6 years due to an increased incidence of respiratory adverse reactions.
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