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Desflurane is approved by the US Food and Drug Administration (FDA) primarily for use as an anesthetic. The FDA-approved indications of desflurane include the induction or maintenance of anesthesia in adults, as well as the maintenance of anesthesia in pediatric patients after induction with other agents. Desflurane is a racemic mixture of 2 enantiomers resistant to defluorination. It was initially synthesized in the 1970s and is chemically described as 1,2,2,2-tetrafluoroethyl difluoromethyl ether. Unlike other inhalational anesthetic agents, desflurane is not associated with nephrotoxicity as it is exclusively halogenated with fluorine and is resistant to defluorination. Desflurane has the most rapid onset among inhalational anesthetics, yet its higher cost restricts its usage compared to other agents. This activity highlights the significance of interprofessional healthcare teams having a thorough knowledge of the indications, mechanisms of action, administration, adverse event profiles, pharmacology, monitoring, and relevant interactions when treating patients receiving anesthesia. This activity aims to improve patient outcomes by prioritizing early identification of signs and symptoms, such as malignant hyperthermia. This activity further underscores the critical role of effective interprofessional communication and teamwork, particularly involving anesthesiologists and nurse anesthetists within the surgical team. This collaboration is vital for promptly addressing any suspected complications while administering anesthesia to patients, thus aiding in the prevention and management of adverse events. Objectives: Identify the FDA-approved indications for desflurane, including its use in induction or maintenance of anesthesia in adults and pediatric patients following induction with other agents. Screen patients for suitability for desflurane anesthesia, considering factors such as airway sensitivity and cost-effectiveness. Implement appropriate dosing and administration techniques for desflurane anesthesia based on patient characteristics and surgical requirements. Collaborate with interprofessional healthcare team members, particularly anesthesiologists and nurse anesthetists, to ensure coordinated care and treatment of patients receiving desflurane anesthesia. Access free multiple choice questions on this topic.

Desflurane is the most likely inhaled anesthetic to result in CO production, compared with isoflurane and sevoflurane. The production of CO is by the degradation of desflurane by desiccated CO2 absorbent, barium hydroxide lime. The drug can produce clinically significant levels of CO, stressing the importance of replacing dried CO2 absorbents. Although rare, severe hepatic injury can follow anesthesia with desflurane, along with other inhalational agents, and may include massive hepatic necrosis. The mechanism is immunologic. Desflurane undergoes some metabolism by cytochrome P450 to produce trifluoroacetate, which binds to hepatocyte proteins, forming complexes that stimulate antibody formation. Exposures after antibody formation can lead to hepatic necrosis. This is much less common than other agents, such as halothane, but is still possible, given the metabolite. Currently, no specific treatment is available for the hepatic effects of desflurane. Consequently, desflurane or similar inhalational anesthetics should be avoided if hepatic impairment is suspected.[5][18]

Effective interprofessional communication and teamwork are critical in mitigating adverse effects associated with desflurane. Timely identification of signs and symptoms of complications is paramount for improved prognosis and outcomes. In case of suspected complications, the anesthesiologist or nurse anesthetist must notify the surgeon and all other operating room staff promptly. For instance, immediate action is essential for malignant hyperthermia cases due to its high-risk outcome. This involves discontinuing offending agents and prioritizing the implementation of treatment algorithms to restore hemodynamic stability, which takes precedence over continuing the surgical procedure. In such instances, intervention from all clinical staff is necessary.