Desfluran Piramal: Uses, Dosage & Side Effects
A volatile halogenated inhalational anesthetic agent used for the maintenance of general anesthesia in adult and pediatric patients in hospital settings
Desfluran Piramal (desflurane) is a volatile halogenated inhalational anesthetic used for the maintenance of general anesthesia in adult and pediatric patients undergoing surgery. Desflurane belongs to the fluorinated methyl ethyl ether family and is administered via a specially heated vaporizer in the operating room. It is distinguished by the lowest blood-gas partition coefficient (0.42) among clinically available volatile anesthetics, which translates to exceptionally rapid uptake and elimination, allowing precise moment-to-moment control of anesthetic depth and fast recovery after surgery. Desflurane undergoes minimal hepatic metabolism (less than 0.02%), making it one of the most metabolically stable volatile anesthetics. It is not recommended for induction of anesthesia due to its pungent, airway-irritant properties, particularly in pediatric patients.
Quick Facts: Desfluran Piramal
Key Takeaways
- Desfluran Piramal (desflurane) is a volatile inhalational anesthetic used exclusively in hospital operating rooms for the maintenance of general anesthesia, administered by trained anesthesiologists via a specially heated vaporizer.
- Its exceptionally low blood-gas partition coefficient (0.42) allows the fastest recovery among volatile anesthetics, enabling patients to wake up, follow commands, and be discharged from the recovery room sooner than with other agents.
- Desflurane undergoes minimal hepatic metabolism (less than 0.02% is metabolized), making it one of the safest volatile anesthetics for patients with liver disease and reducing the risk of metabolite-related organ toxicity.
- It is contraindicated in patients with known or suspected susceptibility to malignant hyperthermia, a rare but life-threatening pharmacogenetic reaction, and is not recommended for induction of anesthesia due to airway irritation.
- Desflurane potentiates neuromuscular blocking agents and has a synergistic effect with opioids and nitrous oxide, allowing reduced doses of concomitant anesthetic agents during surgery.
What Is Desfluran Piramal and What Is It Used For?
Desfluran Piramal contains the active substance desflurane, a fluorinated methyl ethyl ether with the chemical formula C3H2F6O (systematic name: 2-(difluoromethoxy)-1,1,1,2-tetrafluoroethane). It is a clear, colorless, volatile liquid with a mildly pungent, ethereal odor. Desflurane is a member of the halogenated volatile anesthetic family, which also includes sevoflurane, isoflurane, and the historically important halothane and enflurane. These agents have been fundamental to modern surgical practice, enabling millions of safe general anesthetics to be administered worldwide each year.
The development of desflurane represented a significant advance in inhalational anesthesia. It was first synthesized in the 1960s but was not introduced into clinical practice until the early 1990s, following extensive preclinical and clinical evaluation. Desflurane was specifically designed to combine the desirable properties of existing volatile anesthetics (potent anesthetic effect, dose-dependent depth control, cardiovascular stability at clinical concentrations) while addressing their limitations (slow onset and offset, hepatotoxicity concerns, prolonged recovery). The key innovation was the substitution of fluorine atoms for chlorine atoms in the molecular structure, which dramatically reduced blood and tissue solubility while maintaining anesthetic potency.
The pharmacological basis for desflurane's clinical advantages lies in its remarkably low blood-gas partition coefficient of 0.42, the lowest among all currently available volatile anesthetics. This coefficient describes how readily the agent dissolves in blood relative to the gas phase: a lower value means less agent needs to dissolve in the blood before the partial pressure in blood (and therefore brain) equilibrates with the inspired concentration. In practical terms, this translates to rapid induction of the desired anesthetic depth when the inspired concentration is increased, and rapid recovery when the concentration is decreased or discontinued. For comparison, the blood-gas partition coefficients of other volatile anesthetics are: sevoflurane 0.65, isoflurane 1.46, and halothane 2.54.
Desflurane produces general anesthesia through actions on the central nervous system. Like other volatile anesthetics, its exact molecular mechanism of action is not completely understood, but substantial evidence indicates that it acts on multiple targets within the nervous system. Desflurane enhances inhibitory neurotransmission by potentiating the function of gamma-aminobutyric acid type A (GABAA) receptors and glycine receptors, and it inhibits excitatory neurotransmission by blocking N-methyl-D-aspartate (NMDA) glutamate receptors and certain subtypes of nicotinic acetylcholine receptors. It also activates two-pore domain potassium (K2P) channels, particularly TREK-1 and TASK channels, contributing to neuronal hyperpolarization. These combined actions result in dose-dependent depression of consciousness, amnesia, immobility in response to surgical stimulation, and suppression of autonomic reflexes.
The potency of desflurane is measured using the minimum alveolar concentration (MAC), which is the alveolar concentration at steady state that prevents purposeful movement in response to a standard surgical stimulus in 50% of patients. The MAC of desflurane in adults is approximately 6.0–7.3% (in oxygen), depending on age. MAC decreases with increasing age: younger adults typically require higher concentrations than elderly patients. MAC is also reduced by the concomitant administration of opioids, nitrous oxide, benzodiazepines, and other central nervous system depressants, allowing lower concentrations of desflurane to be used during multimodal anesthetic techniques.
Desflurane offers three key clinical advantages over other volatile anesthetics: (1) the fastest recovery profile due to its low blood-gas solubility, allowing earlier emergence, extubation, and discharge from the post-anesthesia care unit; (2) minimal hepatic metabolism (less than 0.02%), making it one of the safest options for patients with liver disease or in prolonged surgical procedures; and (3) precise, real-time control of anesthetic depth, which is particularly valuable in procedures where moment-to-moment titration is important.
Indications
Desfluran Piramal is indicated for the maintenance of general anesthesia in adult and pediatric patients (after induction with another agent). It is used across a broad range of surgical procedures including, but not limited to:
- Inpatient surgery: Major abdominal, thoracic, orthopedic, neurosurgical, and cardiovascular procedures
- Ambulatory (outpatient) surgery: Particularly valued in day-case surgery due to fast recovery, enabling earlier discharge
- Procedures requiring rapid emergence: Such as neurosurgery where early neurological assessment is critical
- Obese patients: Low tissue solubility means less accumulation in adipose tissue, resulting in predictable recovery even in obese patients undergoing prolonged procedures
Desflurane is not recommended for induction of anesthesia by mask in adult patients and is contraindicated for induction in pediatric patients. Its pungent airway-irritant properties can cause coughing, breath-holding, laryngospasm, increased secretions, and bronchospasm when administered to awake or lightly sedated patients, particularly children. Anesthesia is typically induced with an intravenous agent (such as propofol or thiopental) or a non-irritant inhalational agent (such as sevoflurane) before transitioning to desflurane for maintenance.
What Should You Know Before Taking Desfluran Piramal?
Contraindications
Desfluran Piramal must not be used in patients with the following conditions:
- Known or suspected susceptibility to malignant hyperthermia: This is an absolute contraindication. Malignant hyperthermia (MH) is a rare but potentially fatal pharmacogenetic disorder in which exposure to volatile anesthetics (including desflurane) or the depolarizing neuromuscular blocker succinylcholine triggers uncontrolled skeletal muscle metabolism, leading to rapidly rising body temperature, severe metabolic acidosis, hyperkalemia, muscle rigidity, rhabdomyolysis, and multi-organ failure. Susceptibility to MH is typically inherited in an autosomal dominant pattern, most commonly associated with mutations in the ryanodine receptor type 1 (RYR1) gene. Patients with a personal or family history of MH should receive total intravenous anesthesia (TIVA) with agents that do not trigger MH.
- Known hypersensitivity to desflurane or to other halogenated anesthetic agents. Although extremely rare, cross-sensitivity between halogenated agents has been reported.
- Patients in whom general anesthesia is contraindicated: As with any general anesthetic, desflurane should not be used in situations where general anesthesia itself is inadvisable.
Malignant hyperthermia is a life-threatening emergency. If signs of MH develop during anesthesia (unexplained rise in end-tidal CO2, tachycardia, muscle rigidity, rapidly increasing body temperature, metabolic acidosis), desflurane must be discontinued immediately, the anesthesia machine must be flushed with high-flow oxygen, and dantrolene sodium must be administered intravenously without delay. Operating rooms where volatile anesthetics are used must have dantrolene immediately available.
Warnings and Precautions
Before undergoing anesthesia with desflurane, your anesthesiologist should be informed about the following conditions and factors, which may influence the choice of anesthetic technique or require special monitoring:
- Coronary artery disease or cardiovascular disease: Rapid increases in the inspired concentration of desflurane can cause transient sympathetic nervous system activation, resulting in tachycardia (rapid heart rate) and hypertension (elevated blood pressure). These hemodynamic effects are generally self-limiting but can be clinically significant in patients with coronary artery disease, heart failure, or other cardiovascular conditions. Gradual titration of the inspired concentration is recommended.
- Raised intracranial pressure: At concentrations exceeding 1 MAC, desflurane may increase cerebral blood flow and intracranial pressure, particularly in patients with impaired intracranial compliance. In neurosurgical patients, hypocapnia (controlled hyperventilation) should be established before introducing desflurane, and concentrations should be carefully controlled.
- Respiratory conditions: Desflurane's airway-irritant properties can provoke bronchospasm, coughing, and laryngospasm, particularly in patients with reactive airway disease (asthma, chronic obstructive pulmonary disease). Other volatile anesthetics such as sevoflurane may be preferred for patients with significant respiratory disease.
- Hepatic disease: Although desflurane undergoes minimal hepatic metabolism and is generally considered safe in patients with liver disease, rare cases of hepatitis following exposure to halogenated anesthetics have been reported. Patients with a history of unexplained hepatitis or jaundice after previous exposure to any halogenated anesthetic should be evaluated carefully, and an alternative anesthetic technique should be considered.
- Renal disease: Desflurane does not produce clinically significant levels of inorganic fluoride (unlike methoxyflurane and, to a lesser extent, sevoflurane), and renal toxicity is not expected. No dose adjustment is required in patients with renal impairment.
- Neuromuscular disorders: Patients with neuromuscular diseases (such as myasthenia gravis, muscular dystrophies, or myotonic conditions) may have increased sensitivity to volatile anesthetics and neuromuscular blocking agents. Special care and appropriate monitoring are required.
Pregnancy and Breastfeeding
Desflurane, like other volatile anesthetics, should only be used during pregnancy when the benefit clearly outweighs the potential risk. There are no adequate and well-controlled studies of desflurane in pregnant women. Animal reproductive studies have not demonstrated teratogenic effects at clinically relevant concentrations, but animal data are not always predictive of human outcomes. Volatile anesthetics cross the placenta and can affect the fetus; neonatal depression is possible if high concentrations are used close to delivery.
Desflurane is sometimes used as part of general anesthesia for cesarean section, typically at lower concentrations (sub-MAC) in combination with other agents to minimize fetal exposure while maintaining maternal unconsciousness. The decision to use desflurane in obstetric anesthesia is made by the anesthesiologist based on the clinical situation, weighing the benefits of general anesthesia against the risks of fetal exposure.
It is not known whether desflurane or its metabolites are excreted in human breast milk. However, given the extremely rapid elimination of desflurane through the lungs (due to its low blood-gas solubility) and its minimal metabolism, clinically significant exposure of the breastfed infant is considered unlikely. Most guidelines suggest that breastfeeding may be resumed as soon as the mother is sufficiently recovered from anesthesia to safely care for and feed the infant.
Use in Children
Desflurane may be used for the maintenance of anesthesia in pediatric patients of all ages, but must not be used for induction of anesthesia in children. The pungent airway-irritant properties of desflurane cause a high incidence of laryngospasm (spasm of the vocal cords causing airway obstruction), coughing, breath-holding, bronchospasm, and excessive salivation when administered to awake or lightly sedated children by face mask. These events can lead to desaturation and, in rare cases, complete airway obstruction requiring emergency intervention.
For pediatric anesthesia, induction is typically performed with sevoflurane (which is non-irritant and pleasant-smelling) or with an intravenous agent, followed by transition to desflurane for maintenance once the airway is secured. The MAC of desflurane is higher in children than in adults (approximately 8–10% in infants and young children), reflecting the generally higher anesthetic requirements of the pediatric population.
The U.S. FDA and EMA have issued warnings that prolonged or repeated exposure to general anesthetics, including volatile agents, in children under 3 years of age or in pregnant women during the third trimester may affect brain development. Current evidence comes primarily from animal studies, and the clinical significance in humans remains under investigation. For necessary surgical procedures, this concern should not delay or prevent appropriate medical care. Discuss the timing and duration of surgery with your child's medical team.
Elderly Patients
The MAC of desflurane decreases with advancing age. In patients aged 70–80 years, the MAC is approximately 5.2%, compared with 7.3% in patients aged 25–30 years. This age-related decrease is consistent across all volatile anesthetics and reflects changes in brain sensitivity, not pharmacokinetics. Elderly patients also tend to have slower circulatory times, which can slightly delay the rate of wash-in and wash-out. Despite these considerations, the low blood-gas solubility of desflurane still confers faster recovery compared with other volatile agents in the elderly population. Careful titration to effect, guided by clinical signs and end-tidal concentration monitoring, is recommended.
How Does Desfluran Piramal Interact with Other Drugs?
Drug interactions with desflurane are primarily pharmacodynamic rather than pharmacokinetic, as desflurane undergoes negligible hepatic metabolism and does not interact with cytochrome P450 enzymes. The most clinically significant interactions occur with drugs routinely used during anesthesia and surgery. Understanding these interactions is essential for the anesthesiologist to optimize dosing and maintain patient safety.
| Drug / Drug Class | Type of Interaction | Clinical Significance |
|---|---|---|
| Neuromuscular blocking agents (e.g., rocuronium, cisatracurium, vecuronium) | Potentiation – desflurane enhances and prolongs neuromuscular blockade | Reduce initial dose by approximately 30–50% and extend dosing intervals; use neuromuscular monitoring |
| Opioids (e.g., fentanyl, remifentanil, morphine, sufentanil) | Synergistic CNS depression; opioids reduce the MAC of desflurane by 50–70% | Commonly used together; lower desflurane concentrations required in opioid-supplemented anesthesia |
| Nitrous oxide (N2O) | Additive CNS depression; 60% N2O reduces the MAC of desflurane by approximately 50% | Often co-administered; lower desflurane concentrations needed |
| Benzodiazepines (e.g., midazolam, diazepam) | Synergistic sedation and amnesia; reduce MAC of desflurane | Used as premedicants; lower desflurane concentrations may suffice |
| Beta-blockers and calcium channel blockers | Additive cardiovascular depression (bradycardia, hypotension) | Monitor hemodynamics closely; titrate desflurane carefully |
| Sympathomimetic agents (e.g., epinephrine, norepinephrine) | Desflurane sensitizes the myocardium to catecholamines less than halothane but caution is still advised | Risk of arrhythmias with exogenous catecholamines; use standard doses and monitor ECG |
| MAO inhibitors | Potential for hemodynamic instability | Discontinuation timing should be discussed with the surgical team; monitor blood pressure and heart rate |
In addition to the interactions listed above, desflurane may interact with desiccated carbon dioxide absorbents (such as dry soda lime or barium hydroxide lime) in the anesthesia breathing circuit. When the absorbent is severely desiccated, degradation of desflurane can produce carbon monoxide (CO), potentially leading to carboxyhemoglobinemia. This risk is greatest after periods when the anesthesia machine has been left idle with fresh gas flowing through the circuit, drying out the absorbent. Standard precautions include turning off fresh gas flow when the machine is not in use and regularly replacing the absorbent according to manufacturer guidelines.
Compound A, a nephrotoxic degradation product associated with sevoflurane and certain CO2 absorbents, is not produced by desflurane, which is one of desflurane's safety advantages over sevoflurane in this regard.
All drug interactions with desflurane are managed by the anesthesiologist as part of standard anesthetic practice. Before your surgery, inform your anesthesiologist about all medications you are taking, including prescription drugs, over-the-counter medicines, herbal supplements, and recreational substances. This information is critical for planning a safe anesthetic and is kept strictly confidential.
What Is the Correct Dosage of Desfluran Piramal?
Unlike oral medications with fixed doses, volatile inhalational anesthetics such as desflurane are titrated continuously by the anesthesiologist during surgery. The concentration delivered is adjusted moment to moment based on the patient's physiological responses (heart rate, blood pressure, movement), the end-tidal concentration measured by the anesthesia gas analyzer, the type of surgery, and the degree of surgical stimulation. This real-time titration is one of the fundamental advantages of inhalational anesthesia.
Adults
| Age Group | MAC (% in O2) | Typical Maintenance Range |
|---|---|---|
| 18–30 years | 7.3% | 5.0–8.5% |
| 31–65 years | 6.0–7.0% | 4.0–7.5% |
| Over 65 years | 5.2–6.0% | 2.5–6.0% |
In clinical practice, desflurane is almost always used in combination with other agents (opioids, nitrous oxide, regional anesthesia techniques) that reduce the MAC, so the actual concentration of desflurane used is typically lower than the MAC value. For example, when combined with 60% nitrous oxide, the MAC of desflurane is reduced by approximately 50%, so a concentration of 3–4% may be sufficient for surgical anesthesia. When combined with a remifentanil infusion, MAC may be reduced by 60–70%, requiring even lower concentrations.
Children
| Age Group | MAC (% in O2) | Notes |
|---|---|---|
| Neonates (0–30 days) | 9.2% | Limited data; use with particular caution |
| Infants (1–12 months) | 9.4–10.0% | Highest MAC values; maintenance only |
| Children (1–5 years) | 8.6–9.1% | Not for induction; maintenance only |
| Children (6–12 years) | 7.5–8.0% | Approaching adult values; maintenance only |
| Adolescents (13–17 years) | 7.0–7.5% | Similar to young adults |
As noted above, desflurane is not used for induction in pediatric patients. Anesthesia is induced with sevoflurane or an intravenous agent before switching to desflurane for maintenance. The switch is typically made after the airway is secured (e.g., with an endotracheal tube or supraglottic airway device), and the vaporizer is turned on at a low concentration that is gradually increased to the target level.
Elderly Patients
Elderly patients require lower concentrations of desflurane for surgical anesthesia, reflecting the age-related decline in MAC. The maintenance concentration should be titrated carefully using end-tidal monitoring and clinical assessment. Elderly patients may also be more susceptible to cardiovascular depression (hypotension, bradycardia) at any given concentration. Slow, incremental changes in the inspired concentration are advisable to avoid hemodynamic instability.
The Desflurane Vaporizer
Desflurane has a boiling point of 22.8°C, which is near room temperature. At standard operating room temperatures (20–24°C), desflurane exists near its boiling point and would produce unpredictable vapor output in a conventional variable-bypass vaporizer. For this reason, desflurane requires a specially designed electrically heated and pressurized vaporizer, such as the Datex-Ohmeda TEC 6, the Drager D-Vapor, or equivalent devices. These vaporizers heat desflurane to approximately 39°C (well above its boiling point), pressurize it, and then inject a precisely metered amount of desflurane vapor into the fresh gas flow. This ensures accurate and consistent delivery regardless of ambient temperature variations in the operating room.
Overdose
Overdose with desflurane manifests as an extension of its pharmacological effects: deep unconsciousness, severe cardiovascular depression (profound hypotension, bradycardia), respiratory depression or apnea, and in extreme cases, cardiac arrest. In the event of an overdose (excessively deep anesthesia), the management is straightforward: immediately discontinue or reduce the inspired concentration of desflurane, increase fresh gas flow to accelerate elimination, provide mechanical ventilation with 100% oxygen, and administer cardiovascular support (fluids, vasopressors) as needed. Due to desflurane's low blood-gas solubility, recovery from overexposure is rapid once the agent is discontinued.
What Are the Side Effects of Desfluran Piramal?
Like all general anesthetics, desflurane can cause side effects. Many of these are expected consequences of general anesthesia rather than specific adverse reactions to desflurane. The frequency and severity of side effects depend on the concentration used, the speed of concentration changes, the duration of anesthesia, and individual patient factors. The anesthesia team is specifically trained to anticipate, recognize, and manage these effects.
Side effects are categorized below by frequency according to the standard medical convention:
Very Common (affects more than 1 in 10 patients)
Frequency: > 10%
- Nausea (postoperative)
- Vomiting (postoperative)
- Coughing during airway management
- Breath-holding (especially during induction or concentration changes)
Common (affects 1 to 10 in every 100 patients)
Frequency: 1–10%
- Tachycardia (rapid heart rate), especially with rapid concentration increases
- Hypertension (elevated blood pressure), especially with rapid concentration increases
- Increased salivation and airway secretions
- Pharyngitis (sore throat)
- Laryngospasm (spasm of the vocal cords)
- Shivering during emergence
- Headache (postoperative)
- Dizziness or lightheadedness during recovery
- Conjunctivitis (eye irritation)
- Agitation during emergence (especially in children)
Uncommon (affects 1 to 10 in every 1,000 patients)
Frequency: 0.1–1%
- Bronchospasm (constriction of the airways)
- Apnea (temporary cessation of breathing)
- Hypotension (low blood pressure), especially at higher concentrations
- Bradycardia (slow heart rate)
- Cardiac arrhythmias (irregular heartbeat)
- Elevated creatine kinase (CK) levels
- Hypoxia (low blood oxygen) secondary to airway events
Rare (affects fewer than 1 in 1,000 patients)
Frequency: < 0.1%
- Malignant hyperthermia (life-threatening; see Contraindications)
- Hepatitis or hepatic dysfunction (post-exposure liver injury)
- Cardiac arrest (in the context of deep overdose or underlying cardiac disease)
- Rhabdomyolysis (skeletal muscle breakdown)
- Hyperkalemia (elevated potassium, often associated with MH or rhabdomyolysis)
- Seizures (reported very rarely, usually during emergence)
- Anaphylactic or anaphylactoid reactions
Not Known (frequency cannot be estimated)
From post-marketing reports
- Pancreatitis (reported in post-marketing surveillance; causal relationship uncertain)
- Coagulation disorders (abnormal bleeding; relationship to desflurane uncertain)
Postoperative Nausea and Vomiting (PONV)
Postoperative nausea and vomiting is one of the most common adverse effects of general anesthesia with volatile agents, including desflurane. The incidence varies widely depending on patient risk factors (female sex, history of motion sickness, non-smoking status, and use of postoperative opioids are well-established risk factors), the type and duration of surgery, and whether prophylactic antiemetics are administered. Meta-analyses suggest that the overall incidence of PONV with volatile anesthetics is approximately 30–40% without prophylaxis, which can be reduced to 10–15% with appropriate antiemetic prophylaxis. When avoiding PONV is a high priority (e.g., in patients with multiple risk factors), total intravenous anesthesia (TIVA) with propofol may be preferred.
Sympathetic Activation
A distinctive pharmacological feature of desflurane is its tendency to cause sympathetic nervous system activation when the inspired concentration is rapidly increased, particularly above 1 MAC or when sudden large increases (more than 1 MAC increment) are made. This manifests as transient tachycardia and hypertension, which typically resolve within 5–10 minutes. The mechanism involves stimulation of tracheobronchial C-fiber receptors and sympathetic efferent pathways. This effect is unique among modern volatile anesthetics (sevoflurane does not produce comparable sympathetic activation) and requires the anesthesiologist to increase the concentration gradually. Pre-treatment with opioids (such as fentanyl) or clonidine can attenuate this response.
Most side effects of desflurane occur during or immediately after anesthesia and are managed by the anesthesia and surgical team. However, if you experience persistent symptoms after discharge from hospital — such as unexplained fever, jaundice (yellowing of skin or eyes), dark urine, severe abdominal pain, or muscle weakness — contact your healthcare provider promptly, as these may indicate rare delayed adverse effects such as hepatitis or rhabdomyolysis.
How Should You Store Desfluran Piramal?
Desfluran Piramal is supplied in sealed aluminum bottles containing 240 mL of liquid desflurane. The product is designed for hospital use only and is stored, handled, and dispensed by hospital pharmacy staff and anesthesia professionals. Patients do not need to store or handle this medication at any point.
The following storage conditions must be observed to maintain the quality, purity, and safety of the product:
- Temperature: Store at controlled room temperature, between 15°C and 30°C (59°F to 86°F). Desflurane has a boiling point of 22.8°C, but the sealed bottle maintains the liquid under pressure at room temperature. Do not store near heat sources, open flames, or in direct sunlight.
- Position: Store upright in the original bottle with the cap tightly closed. Proper sealing prevents evaporation and contamination.
- Light: Protect from prolonged exposure to direct sunlight or intense artificial light, as photodegradation may occur over extended periods.
- Shelf life: Use before the expiration date printed on the bottle. Do not use desflurane after the expiration date. Opened bottles should be used within the timeframe specified by the manufacturer and local hospital policy.
- Disposal: Unused desflurane should be disposed of in accordance with local hospital waste management policies and environmental regulations. Desflurane is a potent greenhouse gas with a global warming potential (GWP) approximately 2,540 times that of carbon dioxide over a 100-year time horizon, and an atmospheric lifetime of approximately 14 years. Responsible use and proper waste management are important environmental considerations.
Keep all medicines out of the sight and reach of children. Do not dispose of medicines via household waste or wastewater. The hospital pharmacy can advise on proper disposal of pharmaceutical products.
What Does Desfluran Piramal Contain?
Desfluran Piramal is a remarkably simple formulation from a pharmaceutical perspective. The product consists entirely of the active substance desflurane at 100% concentration, with no added excipients, preservatives, or stabilizers. This purity is characteristic of volatile inhalational anesthetics, which are delivered as vapours and do not require the formulation additives used in oral or injectable medications.
Active Substance
- Desflurane (2-(difluoromethoxy)-1,1,1,2-tetrafluoroethane) – 100%
- Chemical formula: C3H2F6O
- Molecular weight: 168.04 g/mol
- CAS number: 57041-67-5
- Appearance: Clear, colorless, volatile liquid with a mildly pungent, ethereal odor
- Boiling point: 22.8°C at sea level (760 mmHg)
- Vapor pressure: 88.5 kPa (664 mmHg) at 20°C
- Blood-gas partition coefficient: 0.42 at 37°C
Packaging
Desfluran Piramal is supplied in sealed amber-tinted aluminum bottles with a capacity of 240 mL, fitted with a Quik-Fil™ filling system (or equivalent) designed for direct connection to the TEC 6 or compatible heated vaporizer. The filling system is designed to prevent spillage and minimize environmental release during transfer from the bottle to the vaporizer. The bottles are packed individually in cardboard cartons with a patient information leaflet (for healthcare professional reference).
Desflurane is non-flammable and non-explosive at clinical concentrations in air or oxygen, unlike the older anesthetic diethyl ether. However, like all halogenated compounds, it should not be exposed to open flames or high-energy ignition sources in the presence of concentrated oxidizing agents.
Frequently Asked Questions About Desfluran Piramal
Desflurane (sold as Desfluran Piramal) is a volatile inhalational anesthetic used for the maintenance of general anesthesia during surgical procedures. It is administered as a vapour through a breathing circuit by a trained anesthesiologist in a hospital operating room. Desflurane is not used for induction of anesthesia due to its airway-irritant properties. It is valued for its rapid onset, precise control of anesthetic depth, and fast recovery after surgery.
Desflurane has a boiling point of 22.8°C, which is close to room temperature. A conventional vaporizer cannot accurately control the delivery of an agent that is near its boiling point. The TEC 6 vaporizer (or equivalent) is electrically heated to approximately 39°C and pressurized, keeping desflurane in liquid form and precisely metering the vapor into the fresh gas flow. This ensures safe, accurate, and consistent delivery to the patient.
Desflurane provides the fastest recovery among all volatile anesthetics due to its very low blood-gas partition coefficient (0.42). When desflurane is discontinued, it is rapidly eliminated through the lungs. Patients typically open their eyes and follow commands within 5–10 minutes of stopping desflurane, and orientation and fitness for discharge from the recovery room are achieved sooner than with sevoflurane or isoflurane. This fast recovery is particularly advantageous in ambulatory (day-case) surgery.
Desflurane undergoes less than 0.02% hepatic metabolism, making it one of the safest volatile anesthetics for patients with liver disease. Unlike halothane and, to a lesser extent, isoflurane and sevoflurane, desflurane produces negligible quantities of potentially hepatotoxic metabolites. However, very rare cases of hepatitis following halogenated anesthetic exposure have been reported with all agents in this class. Patients with a history of unexplained hepatitis after previous halogenated anesthetic exposure should be carefully evaluated.
Desflurane can be used for the maintenance of anesthesia in children after induction with another agent (typically sevoflurane or an intravenous drug). However, desflurane must not be used for induction of anesthesia in pediatric patients because its pungent airway-irritant properties cause a high incidence of coughing, laryngospasm, breath-holding, and bronchospasm. Children also require higher concentrations (MAC 8–10%) than adults for equivalent anesthetic depth.
Malignant hyperthermia (MH) is a rare, inherited, life-threatening condition that can be triggered by volatile anesthetics including desflurane. In susceptible individuals, exposure to these agents causes uncontrolled skeletal muscle metabolism, leading to rapidly rising temperature, muscle rigidity, metabolic acidosis, and potentially organ failure and death. It is treated with immediate discontinuation of the triggering agent and administration of dantrolene. If you have a family history of malignant hyperthermia, inform your medical team before any surgery.
References
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- Miller RD, Eriksson LI, Fleisher LA, et al. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020. Chapter 26: Inhaled Anesthetics.
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- De Hert S, Moerman A. Sevoflurane vs. desflurane: clinically relevant differences. Best Practice & Research Clinical Anaesthesiology. 2015;29(4):473-484.
- Rosenberg H, Pollock N, Schiemann A, et al. Malignant hyperthermia: a review. Orphanet Journal of Rare Diseases. 2015;10:93.
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd List, 2023. Geneva: WHO; 2023.
- European Society of Anaesthesiology and Intensive Care (ESAIC). Guidelines on Perioperative Care. 2023. Available from: www.esaic.org
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