desflurane

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Author:
cbc115
ID:
71145
Filename:
desflurane
Updated:
2011-03-06 21:37:16
Tags:
desflurane
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Description:
inhaled
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  1. how does desflurane differ from isoflurane
    desflurane substitutes fluorine from chlorine
  2. structure-functure relationship of Desflurane
    blood/gas relationship?
    • blood/gas relationship (low solubility) 0.42
    • results in rapid uptake & elimination
  3. oil/gas partition coefficient of DESFLURANE
    • 18.7
    • solubility in fat (brain)
    • high solubility = high potency
  4. MAC AWAKE for Desflurane
    2.5 (35% of MAC)
  5. MAC BAR for desflurane
    1.3 MAC (in 60% N2O)
  6. 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)
  7. Desflurane Metabolism
    • P450 2E1 oxidation
    • degrades to : 2 fluoride ions ; trifluoroacetic acid; CO2 & H2O
    • 0.02% metabolism
  8. Elimination of Desflurane
    • via lungs
    • WASHOUT most rapid
    • percutaneous loss is small
    • VIsceral losses larger than cutaneous
    • cerebral elimination rapid
  9. How is coronary artery blood flow with Desflurane?
    • unchanged
    • elevation of CVP
    • CO unchanged/slightly depressed
    • HR increased with rapid titration
    • low svr/bp/co
  10. What MAC of desflurane is ICP increased?
    1.1 MAC = increased ICP by 7mmHg
  11. What MAC of desflurnane is learning function lost?
    0.2 MAC
  12. How does Desflurane affect SSEP?
    decreases SSEP in high concentrations
  13. How does desflurane affect EEG?
    • low voltage & increased electrical silent @ higher concentrations
    • iso electric EEG @ 1.5 to 2 MAC
  14. 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
  15. How is hepatic system affected with Desflurane?
    • LFTs unchanged
    • safest of all volatile agents for liver
  16. Advantages of Desflurane?
    • least soluble = rapid recovery
    • most myocardial protection against hypoxic results
    • least metabolized
    • not degraded by normal CO2 absorbents
  17. 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)
    • $$$
  18. How can u decrease the irritant properties of desflurane?
    • premedicate with opiods & benzos
    • NO induction in PEDS (contraindicated)
  19. Which NMBA is potentiated the most?
    Rocuronium

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