Rights statement: This is the author’s version of a work that was accepted for publication in British Journal of Anaesthesia. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in British Journal of Anaesthesia, 125, 6, 2020 DOI: 10.1016/j.bja.2020.09.013
Accepted author manuscript, 245 KB, PDF document
Final published version
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Desflurane in modern anaesthetic practice
T2 - walking on thin ice(caps)?
AU - Shelton, C.L.
AU - Sutton, R.
AU - White, S.M.
N1 - This is the author’s version of a work that was accepted for publication in British Journal of Anaesthesia. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in British Journal of Anaesthesia, 125, 6, 2020 DOI: 10.1016/j.bja.2020.09.013
PY - 2020/12/1
Y1 - 2020/12/1
N2 - The third-generation volatile anaesthetic agents desflurane and sevoflurane were introduced into clinical practice in the 1990s in response to the perceived need for rapid return of consciousness after ambulatory surgery. Initially marketed by two competing pharmaceutical companies, their relative merits have been debated for three decades. Of the two, desflurane has a lower solubility in blood and therefore the fastest offset, providing a rapid emergence, which is more notable in obese patients and after prolonged anaesthesia. Furthermore, some authorities (including the US Food and Drug Administration [FDA]) have deemed desflurane to be more suitable than sevoflurane for low-flow anaesthesia, as it undergoes only negligible metabolism and minimal reaction with soda lime. However, desflurane has several well-known disadvantages, including a pungent odour (making it a respiratory irritant), lower potency, and environmental impacts related to its manufacture, administration, and discharge into the atmosphere, calling into question its continued use as a general anaesthetic agent.
AB - The third-generation volatile anaesthetic agents desflurane and sevoflurane were introduced into clinical practice in the 1990s in response to the perceived need for rapid return of consciousness after ambulatory surgery. Initially marketed by two competing pharmaceutical companies, their relative merits have been debated for three decades. Of the two, desflurane has a lower solubility in blood and therefore the fastest offset, providing a rapid emergence, which is more notable in obese patients and after prolonged anaesthesia. Furthermore, some authorities (including the US Food and Drug Administration [FDA]) have deemed desflurane to be more suitable than sevoflurane for low-flow anaesthesia, as it undergoes only negligible metabolism and minimal reaction with soda lime. However, desflurane has several well-known disadvantages, including a pungent odour (making it a respiratory irritant), lower potency, and environmental impacts related to its manufacture, administration, and discharge into the atmosphere, calling into question its continued use as a general anaesthetic agent.
KW - environmental impact
KW - hypotension
KW - intraoperative complications
KW - perioperative medicine
KW - public health
KW - sustainability
KW - volatile anaesthetics
U2 - 10.1016/j.bja.2020.09.013
DO - 10.1016/j.bja.2020.09.013
M3 - Journal article
VL - 125
SP - 852
EP - 856
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 6
ER -