An overview of induction and emergence characteristics of desflurane in pediatric, adult, and geriatric patients

A major advantage of desflurane over currently available agents is that the blood-gas partition coefficient of desflurane is 0.42, lower than all available volatile anesthetics, and slightly lower than nitrous oxide. This property predicts rapid induction of and recovery from general anesthesia with desflurane. This review will summarize and compare results of studies that have examined various clinical characteristics of induction and emergence with desflurane in a variety of patient populations. Studies in pediatric patients, and in adults, have confirmed that inhalation induction with desflurane is rapid. However, there has been a high incidence of airway irritation and/or reactivity, including breath holding, coughing, excessive secretions, and laryngospasm. This incidence is significantly higher than that seen with halothane, making it unlikely that desflurane will supplant halothane for inhalation inductions. The hemodynamic effects of desflurane induction and maintenance with or without intravenous adjuvants appear similar to those seen with isoflurane. Several studies have compared emergence from anesthesia with desflurane with that from isoflurane-based anesthetics, and have demonstrated that initial emergence from a given depth of anesthesia, e.g., time to eye opening or response to verbal commands, is about twice as fast with desflurane. Similar results have been obtained in pediatric patients where emergence from desflurane is faster than that seen from halothane. Emergence from desflurane anesthesia appears similar in time-course to that from propofol-based anesthetics. Psychometric testing has also confirmed more rapid emergence with desflurane than isoflurane, and the clinical impression has been that patients are more 'awake' in the postanesthesia care unit, although studies have not demonstrated earlier discharge times from the postanesthesia care unit or from the hospital for ambulatory patients. Initial studies in elderly (>age 65 yr) patients have confirmed the safety of desflurane and generally confirmed the emergence and hemodynamic profiles demonstrated in younger age groups. Desflurane appears to offer some advantages over currently available anesthetics; the specific indications and potential for desflurane should become clearer over the next (first) few years of clinical use.