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Inhalational Anesthetic Agents

Desflurane, CF3-CFH-O-CF2H

Introduced in 1992.

Physical Properties

 vapor pressure = 681 mmHg at 20 degrees C so

 boils at room temperature at high altitudes (eg, Denver, Colorado), and

 requires special vaporizer

 low solubility permits rapid changes in pA and thus pBrain

 pungent and irritating to the airway

Organ System Effects

Cardiovascular
 similar to isoflurane (but does NOT increase coronary artery blood flow)
 cardiac output no more than slightly depressed at 1-2 MAC

 rapid increases in pa may -> pronounced tachycardia and hypertension

Respiratory
 fast, shallow breathing with incresased p aCO2
 airway irritation

o salivation

o breath-holding

o coughing
 2

o laryngospasm

CNS
 general anesthesia, MAC = 6.0
 cerebral vasodilator, increases CBF and ICP

 marked decrease in CMRO2 tends to cause compensatory vasoconstriction

 EEG effects similar to isoflurane

Biotransformation and Toxicity

 minimal metabolism in vivo

 degraded (more than other agents) to potentially harmful levels of carbon
monoxide by desiccated carbon dioxide absorbent

o especially by barium hydroxide lime, but also by sodium and potassium

hydroxide

o use of calcium hydroxide minimizes this degradation problem

Contraindications

 malignant hyperthermia susceptibility

 hypovolemia

 intracranial hypertension