Desflurane

Desflurane (1,2,2,2-tetrafluoroethyl difluoromethyl ether), under the brand name Suprane, is a highly fluorinated methyl ethyl ether used for induction and maintenance of general anesthesia.<ref name="Khan_2025">Template:Cite book</ref> Desflurane was developed in the 1980s and approved by the FDA in 1992 as a faster acting and clearing inhalant anesthetic compared to previously used inhalant anesthetics.<ref>Template:Cite web</ref> Like halothane, enflurane, and isoflurane, it is a racemic mixture of (R) and (S) optical isomers (enantiomers). It has the most rapid onset and offset of the volatile anesthetic drugs used for general anesthesia due to its low solubility in blood. It is lipophobic and hydrophobic, and therefore does not easily dissolve in blood.<ref>Template:Cite journal</ref>

Some drawbacks of desflurane are its low potency, its pungency, and its high cost (though at low flow fresh gas rates, the cost difference between desflurane and isoflurane appears to be insignificant<ref>Template:Cite thesis</ref>). It may cause tachycardia and airway irritability when administered at concentrations greater than 10% by volume. Due to this airway irritability, Desflurane is infrequently used to induce anesthesia via inhalation techniques.

Though it vaporizes very readily, it is a liquid at room temperature.<ref>Template:Cite web</ref> Anaesthetic machines are fitted with a specialized anaesthetic vaporiser unit that heats liquid desflurane at a constant temperature and pressure.<ref name="Khan_2022" /> This enables the agent to be available at a constant vapor pressure and negating the effects of fluctuating ambient temperatures.

Desflurane, along with enflurane and to a lesser extent isoflurane, has been shown to react with the carbon dioxide absorbent in anesthesia circuits to produce detectable levels of carbon monoxide through degradation of the anesthetic agent. The Template:CO2 absorbent Baralyme, when dried, is most culpable for the production of carbon monoxide from Desflurane degradation, although it is also seen with soda lime absorbent as well. Dry conditions in the carbon dioxide absorbent are conducive to this phenomenon, such as those resulting from high fresh gas flows.<ref name="Fang_1995">Template:Cite journal</ref>

Medical uses

Desflurane is a volatile inhalational anesthetic primarily used for the maintenance of general anesthesia in adults and for maintenance in pediatric patients after induction with other agents.<ref name="Khan_2025" /> Desflurane is administered alongside other anesthetics like midazolam and propofol, as well as air and oxygen.<ref>Template:Cite book</ref> Unlike intravenous anesthetics, inhalation anesthetics allow for better and more rapid control over the concentration, therefore more control over the depth of anesthesia. In addition, elimination is more rapid, resulting in shorter spans of respiratory depression.<ref>Template:Cite web</ref> Desflurane is favored for its very rapid onset and offset of action, enabling swift induction and particularly fast recovery, which is advantageous for outpatient and day-case surgeries, and in populations where rapid emergence is critical, such as the elderly and obese patients. Desflurane has a low blood solubility because it is hydrophobic and lipophobic, which is why it has a fast onset and elimination<ref name="Khan_2025" /> Additionally, its use has been explored in scenarios like cardiac surgery for potential myocardial protection and in cases of severe seizures in epileptic patients, but primary indications remain tied to its reliable profile for maintaining anesthesia with rapid, predictable recovery.<ref name="Qin_2023">Template:Cite journal</ref><ref>Template:Cite journal</ref>

Adverse effects

Desflurane is generally not recommended for inhalation induction, especially in children, due to its pungency and risk of airway irritation and laryngospasm.<ref name="Khan_2025" /> Desflurane can cause increased intracranial pressure.<ref name="Khan_2022" /> In pediatric patients, Desflurane is linked to increased rate of emergence delirium post operatively.<ref name="Khan_2022" /> Desflurane decreases blood pressure, but at high concentrations can increase blood pressure and cause tachychardia.<ref name="Khan_2022" /> As of September 2025, Desflurane has been linked to rare cases of bradycardia, vocal cord deterioration, and disseminated intravascular coagulation.<ref>Template:Cite journal</ref>

Contraindications

It is contraindicated for induction of general anesthesia in the non-intubated pediatric population due to the high risk of laryngospasm. It should not be used in patients with known or suspected susceptibility to malignant hyperthermia. It is also contraindicated in patients with elevated intracranial pressure..<ref name="Khan_2022">Template:Cite book</ref>

Pharmacology

Template:As of the exact mechanism of the action of general anaesthetics has not been delineated.<ref>Template:Cite web</ref> Inhalant anesthetics work on the central and peripheral nervous systems by blocking excitatory ion channels and enhancing the activity of inhibitory ion channels.<ref name="Khan_2025" /> Desflurane is known to act as a positive allosteric modulator of the inhibitory GABA_A and an agonist of the inhibitory glycine receptors.<ref name="Hemmings_2006">Template:Cite book</ref><ref name="Miller_2014">Template:Cite book</ref><ref>Template:Cite journal</ref> In addition, Desflurane acts as an antagonist on excitatory glutamate receptors,<ref>Template:Cite journal</ref> as a negative allosteric modulator of the nicotinic acetylcholine receptor,<ref name="Reed_2013">Template:Cite book</ref><ref name="Barash_2013">Template:Cite book</ref> as well as affecting other ligand-gated ion channels.<ref name="Cote_2013">Template:Cite book</ref><ref name="AglioLekowski2015">Template:Cite book</ref>

Desflurane induces a dose dependent reduction in blood pressure due to reduced systemic vascular resistance. However, rapid increases in desflurane may induce a transient sympathetic response secondary to catecholamine release. Even though it is highly pungent, it is still a bronchodilator. It reduces the ventilatory response to hypoxia and hypercapnia. Like sevoflurane, desflurane vasodilatory properties also cause it to increase intracranial pressure and cerebral blood flow. However, it reduces cerebral metabolic rate. It also promotes muscle relaxation and potentiate neuromuscular blockade at a greater level than sevoflurane.<ref name="Khan_2025" />

Chemistry

Stereochemistry

Desflurane medications are a racemate of two enantiomers.<ref name="Rote Liste">Rote Liste Service GmbH (Hrsg.): Rote Liste 2017 - Arzneimittelverzeichnis für Deutschland (einschließlich EU-Zulassungen und bestimmter Medizinprodukte). Rote Liste Service GmbH, Frankfurt/Main, 2017, Aufl. 57, Template:ISBN, S. 175.</ref>

Enantiomeres of desflurane
Structural Formula of (R)-Desfluran (R)-Enantiomer	Structural Formula of (S)-Desfluran (S)-Enantiomer

Physical properties

Boiling point :	23.5 °C or 74.3 °F	(at 1 atm)
Density :	1.465 g/cm3	(at 20 °C)
Molecular Weight :	168 Daltons
Vapor pressure:	88.5 kPa	672 mmHg	(at 20 °C)
	107 kPa	804 mmHg	(at 24 °C)
Blood:Gas partition coefficient:	0.42
Oil:Gas partition coefficient :	19
MAC :	6 vol %

Global-warming potential

As Desflurane is a polyfluorinated ether, it is a greenhouse gas.<ref>Template:Cite web</ref> The twenty-year global-warming potential, GWP(20), for desflurane is about 3700, meaning that one tonne of desflurane emitted is equivalent to 3700 tonnes of carbon dioxide in the atmosphere, much higher than sevoflurane or isoflurane. Sevoflurane and isoflurane are replacing desflurane globally as hospitals try to minimize their carbon footprint.<ref>Template:Cite web</ref> It has been estimated that halogenated anaesthetic agents used by health systems covering 80% of global population in 2023 emitted about 2 million tonnes CO2eq, just over half from desflurane.<ref>Template:Cite journal</ref> England, Scotland and parts of Canada have banned desflurane use (except in exceptional circumstances) due to its environmental impact.<ref>Template:Cite web</ref><ref>Template:Cite web</ref>

However unlike nitrous oxide, which is also used as an anaesthetic and remains in the atmosphere for over a century, the atmospheric lifetime of desflurane at 14.1 years is similar to methane at 12.4 years. Some argue that GWP is not a suitable metric for such short lived climate pollutants, and that due to its negligible radiative forcing desflurane is not a significant part of greenhouse gas emissions from the healthcare sector.<ref name="Slingo_2024">Template:Cite journal</ref>

Further reading

• Template:Cite book
• Template:Cite book
• Template:Cite thesis
• Template:Cite thesis)
• Template:Cite journal