Anesthesia

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Desflurane

Sun, 11/04/2007 - 13:20 — oxygen
Your Ad Here Desflurane Listen to Audio physical properties effects on organ system biotransformation and toxicity contraindications drug interactions physical properties -MAC value: 6.0% -vapor pressure: 681 mmHg at 20 degrees celcius -substitution of isoflurane's chlorine atom for flourine creates desflurane -boils at room temperature when located at high altitudes (ex. Denver, Colardo) -requires a special vaporizer -low solubility promotes rapid induction and emergence -tighter control of anesthetic level due to alveolar concentration close to inspired concentrations -blood-gas partition coefficient 0.42 Central Nervous System -decreases CMR02 -increases CBF -increases ICP Cardiovascular System -decreased systemic vascular resistance leads to decreased arterial blood pressure -decreased arterial blood pressure which stimulates baroreceptors relex increase in heart rate -maintained cardiac output with decreased arterial pressure and increased heart rate -rapid increases in desflurane concentrations may lead to increased arterial blood pressure and heart rate -increased cardiac parameters due to sudden increase in desflurane levels can be attenuated with: fentanyl, esmolol or clonidine Respiratory System -increased respiratory rate -decreased tidal volume -resultant decreased alveolar ventilation -elevated resting PaC02 -decreased hypoxic drive -blunted/decreased ventilatory response to elevated PaC02 -airway irritation associated with: salivation, breathe holding, coughing, and laryngospasm Hepatic System -no evidence of hepatic injury -normal post-operative liver function test Renal System -no evidence of nephrotoxic injury Neuromuscular System -dose dependant decrease in train-of-four peripheral nerve stimulation response -dose dependant decrease in tetanic peripheral nerve stimulation response biotransformation and toxicity -minimal metabolism of desflurane in humans -degraded by dissicated carbon dioxide absorbents into clinically insignificant levels of carbon monoxide contraindications -general contraindications shared with other volatile anesthetics -avoid in malignant hyperthermia, severe hypovolemia and patients with increased intracranial hypertension drug interactions -desflurane emergence in some pediatric patients has been assoicated delirium -prolongs duration of nondepolarizing muscle relaxants (NDMR) -epinephrine can be used safely in doses upto 4.5 ug/L

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