Desflurane in modern anaesthetic practice : walking on thin ice(caps)?

Shelton, C.L. and Sutton, R. and White, S.M. (2020) Desflurane in modern anaesthetic practice : walking on thin ice(caps)? British Journal of Anaesthesia, 125 (6). pp. 852-856. ISSN 0007-0912

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Abstract

The third-generation volatile anaesthetic agents desflurane and sevoflurane were introduced into clinical practice in the 1990s in response to the perceived need for rapid return of consciousness after ambulatory surgery. Initially marketed by two competing pharmaceutical companies, their relative merits have been debated for three decades. Of the two, desflurane has a lower solubility in blood and therefore the fastest offset, providing a rapid emergence, which is more notable in obese patients and after prolonged anaesthesia. Furthermore, some authorities (including the US Food and Drug Administration [FDA]) have deemed desflurane to be more suitable than sevoflurane for low-flow anaesthesia, as it undergoes only negligible metabolism and minimal reaction with soda lime. However, desflurane has several well-known disadvantages, including a pungent odour (making it a respiratory irritant), lower potency, and environmental impacts related to its manufacture, administration, and discharge into the atmosphere, calling into question its continued use as a general anaesthetic agent.