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how does desflurane differ from isoflurane
desflurane substitutes fluorine from chlorine
structure-functure relationship of Desflurane
- blood/gas relationship (low solubility) 0.42
- results in rapid uptake & elimination
oil/gas partition coefficient of DESFLURANE
- solubility in fat (brain)
- high solubility = high potency
MAC AWAKE for Desflurane
2.5 (35% of MAC)
MAC BAR for desflurane
1.3 MAC (in 60% N2O)
Why does Desflurane work so fast?
- low solubility in blood & tissue = rapid uptake
- rapid elimination
- FA reaches FI more rapidly with the least soluble agents (WASH IN)
- P450 2E1 oxidation
- degrades to : 2 fluoride ions ; trifluoroacetic acid; CO2 & H2O
- 0.02% metabolism
Elimination of Desflurane
- via lungs
- WASHOUT most rapid
- percutaneous loss is small
- VIsceral losses larger than cutaneous
- cerebral elimination rapid
How is coronary artery blood flow with Desflurane?
- elevation of CVP
- CO unchanged/slightly depressed
- HR increased with rapid titration
- low svr/bp/co
What MAC of desflurane is ICP increased?
1.1 MAC = increased ICP by 7mmHg
What MAC of desflurnane is learning function lost?
How does Desflurane affect SSEP?
decreases SSEP in high concentrations
How does desflurane affect EEG?
- low voltage & increased electrical silent @ higher concentrations
- iso electric EEG @ 1.5 to 2 MAC
How is CBF affected by Desflurane?
- high cerebral vasodilation & low resistance
- high CBF
- does NOT alter autoregulation at 1 MAC
- abolishment of autoregulation at 1.5 MAC
How is hepatic system affected with Desflurane?
- LFTs unchanged
- safest of all volatile agents for liver
Advantages of Desflurane?
- least soluble = rapid recovery
- most myocardial protection against hypoxic results
- least metabolized
- not degraded by normal CO2 absorbents
Disadvantages of desflurane
- pungent (irritation at MAC >1)
- transient CV stimulation
- dessicated absorbents can degrade into CO
- can cause post op agitation in PEDS (like sevo)
How can u decrease the irritant properties of desflurane?
- premedicate with opiods & benzos
- NO induction in PEDS (contraindicated)
Which NMBA is potentiated the most?
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