Desflurane ®

O Desflurane Chemistry Desflurane: fluorine atom replaces chlorine atom on the alpha ethyl carbon of isoflurane Isoflurane F F F F Cl H CCCOHF Desflurane H F F F F F H CCCF BrF 3

Distinguishing Characteristics of Desflurane   Solubility   Potency   Stability   Vapor pressure The differences in the chemical structure of desflurane result in several distinguishing characteristics:

Key Areas of Differences: SOLUBILITY Agent Blood/Gas BrainFat Muscle Partition BloodBloodBlood Coefficient Halothane Enflurane Isoflurane Desflurane Sevoflurane

Key Areas of Differences: PHYSICAL PROPERTIES MAC AGENT MAC-(45 yr old) CONCENTRATION Halothane 0.77% Enflurane 1.7% Isoflurane 1.15% Desflurane 6% Sevoflurane 2.1%

Key Areas of Differences: METABOLISM AGENT %METABOLIZED Halothane15-20% Enflurane2% Isoflurane0.17% Desflurane0.02% Sevoflurane5%

Inhalation Anesthetics Characteristics

SUPRANE  TECHNIQUE Solubility equal to N 2 O Turn on and off like N 2 O No need to overpressure No need to titrate down for fast wake-up Low flow = low cost

INDUCTION (WASH-IN) Premed with fentanyl ( ug/kg) IV induction (propofol) Turn on Suprane  at 3-6% 3-5 liter flow for 5-10 minutes Reduce flows to 1-2 liters Adjust Suprane  conc. 1-2% as needed

CHANGING DEPTH Do not need to overpressure Increase conc. in 1-2% increments To hasten change, increase flow rate to 3-5 liters for 2-3 minutes.

Emergence Maintain required depth to the end of the case. (3-6%). Consider reversing relaxant prior to shutting off the Suprane  Provide for post-op analgesia Perform airway manipulation and suctioning under adequate level of anesthesia Use small dose of opioid, propofol, or lidocaine

WAKE - UP Turn off the Suprane  at end of surgery Flush the circuit Increase oxygen flow to 8-10 liters Patient will awaken and be alert in 3-5 min.

Recovery Time and Fast-Tracking * P<.05 * * * Song and White. Anesthesiology. 1997;87:A33

Desflurane 사용량 마취제 사용량 = 마취제농도 (%) Ⅹ산소유량 (ml) Ⅹ마취시간 ( 분 ) 액체 1ml 당 발생되는 증기량 (210)  6% 농도사용시 4L/min → 68,5ml/h 2L/min → 34.2ml/h (7.0h/BTL)  8% 농도사용시 4L/min → 91.4ml/h 2L/min → 45.7ml/h (5.2h/BTL)  보험인정 초회량 15ml/15min, 유지량 10.7ml/15min 1 시간 사용시 = 47.1ml 2 시간 사용시 = 89.9ml (5.6h/BTL)

시간별 기준약가 비교

성분 : Desflurane 허가년월일 : 1996 년 2 월 3 일 발매년월일 : 1996 년 8 월 수입처 : Baxter 함량 : 100ml 당 데스프루란 (U.S.P) 100ml 제형 : 240ml 보험수가 : 374 원 /ml (1Bottle 당 89,760 원 )

뇌질환 (Brain) 심장질환 (Heart) 신장질환 (Kidney) 장기이식 (Organ Transplantation) 신생아 수술 (Neonate) 2 시간 이내의 수술환자 (Within 2hours Surgery) 간질환 및 간질환의 기왕력이 있는 환자 (Liver disease or a case history of liver disease) Desflurane 의 보험영역