Desflurane (1,2,2,2-tetrafluoroethyl difluoromethyl ether), under the brand name Suprane, is ahighly fluorinated methyl ethyl ether used for induction and maintenance ofgeneral anesthesia.[2] 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.[3] Likehalothane,enflurane, andisoflurane, it is aracemic mixture of (R) and (S) optical isomers (enantiomers). It has the most rapid onset and offset of thevolatile anesthetic drugs used forgeneral anesthesia due to its low solubility in blood. It is lipophobic and hydrophobic, and therefore does not easily dissolve in blood.[4]
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[5]). It may causetachycardia 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.[6] Desflurane has a high vapor pressure and a low boiling point, requiring a specific anesthetic vaporizer.[2]Anaesthetic machines are fitted with a specializedanaesthetic vaporizer unit that heats liquid desflurane at a constant temperature and pressure.[7] This enables the agent to be available at a constant vapor pressure and negating the effects of fluctuating ambient temperatures.
Desflurane, along withenflurane and to a lesser extentisoflurane, has been shown to react with thecarbon dioxide absorbent in anesthesia circuits to produce detectable levels ofcarbon monoxide through degradation of the anesthetic agent. The CO2 absorbentBaralyme, when dried, is most culpable for the production of carbon monoxide from Desflurane degradation, although it is also seen withsoda 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.[8]
Desflurane is a volatileinhalational anesthetic primarily used for the maintenance ofgeneral anesthesia in adults and for maintenance in pediatric patients after induction with other agents.[2] Desflurane is administered alongside other anesthetics likemidazolam andpropofol, as well as air and oxygen.[9] 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.[10] 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[2] Additionally, its use has been explored in scenarios like cardiac surgery for potentialmyocardial 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.[11][12]
Desflurane is generally not recommended for inhalation induction, especially in children, due to its pungency and risk of airway irritation andlaryngospasm.[2] Desflurane can cause increased intracranial pressure.[7] In pediatric patients, Desflurane is linked to increased rate ofemergence delirium post operatively.[7] Desflurane decreases blood pressure, but at high concentrations can increase blood pressure and causetachychardia.[7] As of September 2025, Desflurane has been linked to rare cases ofbradycardia, vocal cord deterioration, anddisseminated intravascular coagulation.[13]
It is contraindicated for induction of general anesthesia in the non-intubated pediatric population due to the high risk oflaryngospasm. It should not be used in patients with known or suspected susceptibility tomalignant hyperthermia. It is also contraindicated in patients with elevated intracranial pressure..[7]
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. Likesevoflurane, 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.[2]
Desflurane is administered as an inhalant, and is rapidly eliminated from the lungs. It is not associated withnephrotoxicity and is resistant to defluorination.[2] It is carried byalbumin in the human body and is minimally metabolized by cytochromeCYP2E1 in the liver, which produces a metabolitetrifluoroacetic acid and is eliminated through the urine.[3] Only 0.02% of the metabolite is recovered from urine, the remainder eliminated through the lungs.[3]
Desflurane has a half life of 8.16 ± 3.15 minutes.[3] It has a median volume of distribution of 612 mL/kg.[3] It is produced as a 240ml solution.[2] There is no available data onCmax andTmax for desflurane as it is continuously adjusted by an anesthesiologist in real time during procedures. Instead, inhalant anesthetics are often measured by theirminimal alveolar concentrations, and desflurane's MAC is 6.0% for the 31 to 65 age group and 7.25% for the 18 to 30 age group.[2] Desflurane has a blood-to-gas partition coefficient of 0.42, with a blood-to-gas coefficient of 0.47.[2]
Emergence from desflurane after an hour long procedure is on average 6 minutes.[2] Because desflurane has a short half life it is not considered to affect women who are pregnant or breastfeeding, however, there have been no well-controlled studies specifically on pregnant women.[2]
As Desflurane is a polyfluorinated ether, it is agreenhouse gas.[24] The twenty-yearglobal-warming potential, GWP(20), for desflurane is about 3700, meaning that one tonne of desflurane emitted is equivalent to 3700 tonnes ofcarbon dioxide in the atmosphere, much higher thansevoflurane orisoflurane. Sevoflurane and isoflurane are replacing desflurane globally as hospitals try to minimize their carbon footprint.[25] 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.[26] England, Scotland and parts of Canada have banned desflurane use (except in exceptional circumstances) due to its environmental impact.[27][28]
However unlikenitrous 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 tomethane at 12.4 years. Some argue that GWP is not a suitable metric for suchshort lived climate pollutants, and that due to its negligibleradiative forcing desflurane is not a significant part of greenhouse gas emissions from the healthcare sector.[29]
^abcdefghijklmKhan J, Patel P, Liu M (2025)."Desflurane".StatPearls. Treasure Island (FL): StatPearls Publishing.PMID30725791. Retrieved6 October 2025.
^Miller AL, Theodore D, Widrich J (2025)."Inhalational Anesthetic".StatPearls. Treasure Island (FL): StatPearls Publishing.PMID32119427. Retrieved6 November 2025.
^"Desflurane".PubChem. U.S. National Library of Medicine. Retrieved15 November 2025.
^Qin H, Zhou J (September 2023). "Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical Applications".Journal of Cardiovascular Pharmacology.82 (3):169–179.doi:10.1097/FJC.0000000000001448.PMID37405905.
^Mirsattari SM, Sharpe MD, Young GB (August 2004). "Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane".Archives of Neurology.61 (8):1254–1259.doi:10.1001/archneur.61.8.1254.PMID15313843.
^Barash P, Cullen BF, Stoelting RK, Cahalan M, Stock MC, Ortega R (7 February 2013).Clinical Anesthesia (7th ed.). Lippincott Williams & Wilkins. pp. 470–.ISBN978-1-4698-3027-8.
^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,ISBN978-3-946057-10-9, S. 175.
^Slingo JM, Slingo ME (March 2024). "The science of climate change and the effect of anaesthetic gas emissions".Anaesthesia.79 (3):252–260.doi:10.1111/anae.16189.PMID38205585.
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