Desflurane: Biological Mechanisms, Surgical Applications and Side Effects

Desflurane is an inhalational anesthetic drug used for induction and maintenance of anesthesia in adults and maintenance of anesthesia in children.¹ It was first created in the 1970s, and when it was first introduced to the market, it was difficult to synthesize and expensive.¹ However, it has the most rapid onset of all inhalational anesthetic drugs, which allowed it to become popular despite cost and other difficulties.¹ Additionally, the delivery method of the drug can improve its cost-effectiveness, reducing the prohibitive cost.² Today, Suprane is the well-known brand name for desflurane.³ Given the widespread use of desflurane and its advantages, anesthesia providers should understand its biochemical mechanisms, surgical applications and side effects.

The chemical name for desflurane is 1,2,2,2-tetrafluoroethyl difluoromethyl ether.¹ Like many other inhalational anesthetics, desflurane is a halogenated ether.⁴ However, desflurane is only halogenated by fluorine, and it is very resistant to defluorination.¹ Because of this stability and the fact that it undergoes almost no metabolism, it is associated with less hepatotoxicity (i.e., liver damage) than inhalational anesthetics like halothane.^5,6 To a small degree, though, desflurane is metabolized by the enzyme CYP2E1 to a trifluoroacetic acid, which leads to the body’s production of antibodies.⁵ Although the mechanism of action of inhalational anesthetics remains unclear,¹ volatile agents such as desflurane may activate gamma aminobutyric acid (GABA) channels and hyperpolarize cell membranes.⁷ In addition, it may inhibit certain calcium channels, thereby preventing the release of neurotransmitters and inhibiting glutamate channels.⁷ Other proposals state that these anesthetics work by affecting the membrane bilayer of cells.¹ Its actions occur throughout the central and peripheral nervous systems, and it has an overall inhibitory effect.¹

Desflurane has a variety of surgical and anesthetic applications.¹ Because it has a pungent odor, it is less often used for anesthetic induction than for anesthetic maintenance.¹ That is, it is usually applied after initial administration of another intravenous or inhalational anesthetic drug.¹ Desflurane has a low blood-gas solubility similar to that of nitrous oxide, which makes it a potent inhalational anesthetic with a quick induction and fast recovery time.^6,8 During surgery, desflurane has numerous effects on various body systems. The cardiovascular effects of desflurane entail vasodilation, which results in dose-dependent reductions in vascular resistance and arterial blood pressure.⁹ Desflurane is better than other inhaled anesthetics in maintaining blood pressure control.⁹ The neuromuscular effects of desflurane contribute to its use as an anesthetic, as it causes dose-dependent depression of brain activity, muscle relaxation and potentiation of neuromuscular blocking agents.⁹ Desflurane can be used for Cesarean section¹⁰ or for pain control during vaginal delivery.¹¹ Though desflurane is not approved for induction in children, its rapid recovery profile is helpful for geriatric, obese and other adult populations.⁹

Like any general anesthetic, desflurane is associated with several side effects. It can cause moderate to severe upper airway events in children,¹ and should be avoided in patients with liver disease or history of malignant hyperthermia.¹² As desflurane is a strong-smelling airway irritant, it can cause coughing, breath holding, laryngospasm (constriction of the laryngeal muscles) and sialorrhea (hypersalivation).⁶ Rapid increases in the concentration of desflurane can cause elevation in heart rate and blood pressure.¹ Common postoperative side effects include bluish lips or skin, body aches, congestion, fever, trouble breathing or swallowing and voice changes.¹² Patients should seek medical attention if they experience any distressing side effects.

Desflurane has advantages over other anesthetics, such as rapid induction and recovery times and lack of liver damage. It can be used to lower blood pressure, brain activity and muscle movement during general anesthesia. Given its pungent odor, desflurane’s most common side effects include coughing, breath holding and other respiratory issues. Though desflurane is not risky for most patients, patients should give their anesthesia providers a full medical history to avoid complications.

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