An overview of induction and emergence characteristics of desflurane in pediatric, adult, and geriatric patients.
A major advantage of desflurane over currently available agents is that the blood-gas partition coefficient of desflurane is 0.42, lower than all available volatile anesthetics, and slightly lower than nitrous oxide. This property predicts rapid induction of and recovery from general anesthesia with desflurane. This review will summarize and compare results of studies that have examined various clinical characteristics of induction and emergence with desflurane in a variety of patient populations. Studies in pediatric patients, and in adults, have confirmed that inhalation induction with desflurane is rapid. However, there has been a high incidence of airway irritation and/or reactivity, including breath holding, coughing, excessive secretions, and laryngospasm. This incidence is significantly higher than that seen with halothane, making it unlikely that desflurane will supplant halothane for inhalation inductions. The hemodynamic effects of desflurane induction and maintenance with or without intravenous adjuvants appear similar to those seen with isoflurane. Several studies have compared emergence from anesthesia with desflurane with that from isoflurane-based anesthetics, and have demonstrated that initial emergence from a given depth of anesthesia, e.g., time to eye opening or response to verbal commands, is about twice as fast with desflurane. Similar results have been obtained in pediatric patients where emergence from desflurane is faster than that seen from halothane. Emergence from desflurane anesthesia appears similar in time-course to that from propofol-based anesthetics.(ABSTRACT TRUNCATED AT 250 WORDS)
Smiley
R M
RM
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York 10032.
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000777:Anesthetics; D002648:Child; D000077335:Desflurane; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*
D000777:Anesthetics; D000077335:Desflurane; D007530:Isoflurane