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desflurane

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Overview

What is Desflurane?

Desflurane, USP, Liquid for Inhalation, a nonflammable liquid administered via vaporizer, is a general inhalation anesthetic. It is (±)1,2,2,2-tetrafluoroethyl difluoromethyl ether:

Some physical constants are:

Partition coefficients at 37°C:

Mean Component/Gas Partition Coefficients:

Desflurane, USP is nonflammable as defined by the requirements of International Electrotechnical Commission 601-2-13.

Desflurane, USP is a colorless, volatile liquid below 22.8°C. Data indicate that desflurane, USP is stable when stored under normal room lighting conditions according to instructions.

Desflurane, USP is chemically stable. The only known degradation reaction is through prolonged direct contact with soda lime producing low levels of fluoroform (CHF ). The amount of CHF obtained is similar to that produced with MAC-equivalent doses of isoflurane. No discernible degradation occurs in the presence of strong acids.

Desflurane, USP does not corrode stainless steel, brass, aluminum, anodized aluminum, nickel plated brass, copper, or beryllium.



What does Desflurane look like?



What are the available doses of Desflurane?

What should I talk to my health care provider before I take Desflurane?

How should I use Desflurane?

Desflurane, USP, Liquid for Inhalation is indicated as an inhalation agent for induction of anesthesia for inpatient and outpatient surgery in adults.

Desflurane, USP, Liquid for Inhalation is contraindicated as an inhalation agent for the induction of anesthesia in pediatric patients because of a high incidence of moderate to severe upper airway adverse events.

Only persons trained in the administration of general anesthesia should administer Desflurane, USP, Liquid for Inhalation. Only a vaporizer specifically designed and designated for use with desflurane should be utilized for its administration. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation must be immediately available.

Desflurane, USP, Liquid for Inhalation is administered by inhalation. The administration of general anesthesia must be individualized based on the patient’s response. Hypotension and respiratory depression increase as anesthesia with Desflurane, USP, Liquid for Inhalation is deepened. The minimum alveolar concentration (MAC) of Desflurane, USP, Liquid for Inhalation decreases with increasing patient age. The MAC for Desflurane, USP, Liquid for Inhalation is also reduced by concomitant N O administration . The dose should be adjusted accordingly. The following table provides mean relative potency based upon age and effect of N O in predominately ASA physical status I or II patients.

Benzodiazepines and opioids decrease the MAC of Desflurane, USP, Liquid for Inhalation . Desflurane, USP, Liquid for Inhalation also decreases the doses of neuromuscular blocking agents required .  The dose should be adjusted accordingly.


What interacts with Desflurane?

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What are the warnings of Desflurane?

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What are the precautions of Desflurane?

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What are the side effects of Desflurane?

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What should I look out for while using Desflurane?

The use of Desflurane, USP, Liquid for Inhalation is contraindicated in the following conditions:


What might happen if I take too much Desflurane?

The symptoms of overdosage of desflurane can present as a deepening of anesthesia, cardiac and/or respiratory depression in spontaneously breathing patients, and cardiac depression in ventilated patients in whom hypercapnia and hypoxia may occur only at a late stage. In the event of overdosage, or suspected overdosage, take the following actions: discontinue administration of desflurane, maintain a patent airway, initiate assisted or controlled ventilation with oxygen, and maintain adequate cardiovascular function.


How should I store and handle Desflurane?

Store at 20º to 25ºC (68º to 77ºF) . Desflurane, USP, Liquid for Inhalation has been demonstrated to be stable for the period defined by the expiration dating on the label. Preserve in tight, light-resistant container. Replace the cap securely after each use. Desflurane, USP, Liquid for Inhalation, NDC 0781-6172-22, is available in amber-colored glass bottle containing 240 mL desflurane, USP. Each individual bottle is supplied in a carton of 6, NDC 0781-6172-86.


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Changes in the clinical effects of desflurane rapidly follow changes in the inspired concentration. The duration of anesthesia and selected recovery measures for desflurane are given in the following tables:

In 178 female outpatients undergoing laparoscopy, premedicated with fentanyl (1.5 mcg/kg to 2 mcg/kg), anesthesia was initiated with propofol 2.5 mg/kg, desflurane/N O 60% in O or desflurane/O alone. Anesthesia was maintained with either propofol 1.5 mg/kg/hr to 9 mg/kg/hr, desflurane 2.6% to 8.4% in N O 60% in O , or desflurane 3.1% to 8.9% in O .

In 88 unpremedicated outpatients, anesthesia was initiated with thiopental 3mg/kg to 9 mg/kg or desflurane in O . Anesthesia was maintained with isoflurane 0.7% to 1.4% in N O 60%, desflurane 1.8% to 7.7% in N O 60%, or desflurane 4.4% to 11.9% in O .

Recovery from anesthesia was assessed at 30 minutes, 60 minutes, and 90 minutes following 0.5 MAC desflurane (3%) or isoflurane (0.6%) in N O 60% using subjective and objective tests. At 30 minutes after anesthesia, only 43% of patients in the isoflurane group were able to perform the psychometric tests compared to 76% in the desflurane group (p
Desflurane was studied in twelve volunteers receiving no other drugs. Hemodynamic effects during controlled ventilation (PaCO 38 mmHg) were:

When the same volunteers breathed spontaneously during desflurane anesthesia, systemic vascular resistance and mean arterial blood pressure decreased; cardiac index, heart rate, stroke volume, and central venous pressure (CVP) increased compared to values when the volunteers were conscious. Cardiac index, stroke volume, and CVP were greater during spontaneous ventilation than during controlled ventilation.

During spontaneous ventilation in the same volunteers, increasing the concentration of desflurane from 3% to 12% decreased tidal volume and increased arterial carbon dioxide tension and respiratory rate. The combination of N O 60% with a given concentration of desflurane gave results similar to those with desflurane alone. Respiratory depression produced by desflurane is similar to that produced by other potent inhalation agents.

The use of desflurane concentrations higher than 1.5 MAC may produce apnea.

Figure 1. PaCO2 During Spontaneous Ventilation in Unstimulated Volunteers

Non-Clinical Toxicology
The use of Desflurane, USP, Liquid for Inhalation is contraindicated in the following conditions:

Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with atenolol plus a catecholamine depletor should therefore be closely observed for evidence of hypotension and/or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.

Calcium channel blockers may also have an additive effect when given with atenolol (see

Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart failure when administered with beta blockers.

Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta blockers.

Beta blockers may exacerbate the rebound hypertension, which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped.

Concomitant use of prostaglandin synthase inhibiting drugs, e.g., indomethacin, may decrease the hypotensive effects of beta blockers.

Information on concurrent usage of atenolol and aspirin is limited. Data from several studies, i.e., TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta blockers in the acute myocardial infarction setting.

While taking beta blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Both digitalis glycosides and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.

In susceptible individuals, potent inhalation anesthetic agents may trigger a skeletal muscle hypermetabolic state leading to high oxygen demand and the clinical syndrome known as malignant hyperthermia. In genetically susceptible pigs, desflurane induced malignant hyperthermia. The clinical syndrome is signaled by hypercapnia, and may include muscle rigidity, tachycardia, tachypnea, cyanosis, arrhythmias, and/or unstable blood pressure. Some of these nonspecific signs may also appear during light anesthesia: acute hypoxia, hypercapnia, and hypovolemia.

Treatment of malignant hyperthermia includes discontinuation of triggering agents, administration of intravenous dantrolene sodium, and application of supportive therapy. (Consult prescribing information for dantrolene sodium intravenous for additional information on patient management.) Renal failure may appear later, and urine flow should be monitored and sustained if possible.

Fatal outcome of malignant hyperthermia has been reported with desflurane.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).