2. Desflurane ®

3. 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

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

5. Key Areas of Differences: SOLUBILITY Agent Blood/Gas BrainFat Muscle Partition BloodBloodBlood Coefficient Halothane 2.54 1.9 51 3.4 Enflurane 1.8 1.3 36 1.7 Isoflurane 1.46 1.6 45 4.0 Desflurane 0.42 1.3 27 2.0 Sevoflurane 0.69 1.7 48 3.1

6. 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%

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

8. Inhalation Anesthetics Characteristics

9. 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

10. INDUCTION (WASH-IN) Premed with fentanyl (1.5 - 2 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

11. 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.

12. 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

13. 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.

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

15. 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)

16. 시간별 기준약가 비교

17. 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 )

18. 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