Anaes · Volatile & inhalational agents
Desflurane
Also known as 2-(difluoromethoxy)-1,1,1,2-tetrafluoroethane · Fluorinated methyl ethyl ether · Suprane · Most rapid-onset volatile · Heated vaporiser agent · Most pungent volatile
Desflurane is a fluorinated methyl ethyl ether and the most pharmacokinetically extreme of the modern volatile anaesthetics, defined by four exam-critical ideas. Its blood-gas partition coefficient of 0.42 is the LOWEST of any volatile agent, giving the fastest induction and the fastest, clearest emergence of the inhaled agents and making it the agent of choice for day-case surgery, neuroanaesthesia and the obese patient. Its boiling point of 23.5 degrees Celsius means it BOILS at room temperature and cannot be delivered by a standard variable-bypass vaporiser, demanding a special electronically heated pressurised vaporiser (the Tec 6) that holds the liquid at 39 degrees Celsius and 2 atm. It is EXTREMELY PUNGENT, provoking coughing, breath-holding and laryngospasm, so it is NEVER used for inhalational induction and is avoided in severe reactive airway disease. And it is the most environmentally damaging anaesthetic in clinical use, with a global-warming potential of 2540 times that of carbon dioxide and an atmospheric lifetime of 14 years, a cost that has led some institutions to ban or restrict it. Built on the delayed malignant-hyperthermia case report (Seki 2026), the environmental-and-clinical-rationale review (Tamura 2026), the desflurane-versus-propofol neurocognitive trial in the elderly (Somnuke 2026), the environmental-impact commentary (Jayaswal 2026), the banning-desflurane analysis (Mizutani 2026), the desflurane-versus-sevoflurane inflammatory-response study (Adamowitsch 2026), the anaesthetic-depth-methods review (Altinoluk 2026), and the isoflurane-versus-desflurane optic-nerve study (Rajmohan 2026).
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Desflurane is EXTREMELY PUNGENT and provokes coughing, breath-holding, laryngospasm and bronchospasm in the awake patient — it must NEVER be used for inhalational induction; induce intravenously and switch to desflurane only after the airway is secured.
- Desflurane produces marked SYMPATHETIC ACTIVATION at concentrations above 1 MAC and with rapid concentration increases — transient tachycardia, hypertension and a catecholamine surge that can be dangerous in coronary disease; increase the dialled concentration slowly and blunt the response with an opioid or benzodiazepine.
- Desflurane's boiling point of 23.5 degrees Celsius means it BOILS at room temperature and CANNOT be used in a standard variable-bypass vaporiser — it requires the special electronically heated, pressurised Tec 6 vaporiser (39 degrees Celsius, 2 atm).
- Desflurane IS a trigger of malignant hyperthermia, like every volatile agent — never give it to the known or suspected MH-susceptible patient; case reports include delayed onset, so maintain vigilance well into the recovery period.
- Desflurane produces the MOST carbon monoxide of all volatiles when it passes through desiccated baralyme or strongly desiccated soda lime — change absorbent regularly and turn the vaporiser off when the machine stands.
- Desflurane is the WORST greenhouse gas of all anaesthetics (GWP 2540, atmospheric lifetime 14 years) — some institutions have banned or restricted it; use low-flow techniques, avoid it in routine cases, and consider sevoflurane or TIVA where the rapid-recovery benefit is not needed.
Meet the patient
A 52-year-old, BMI 41, is listed for a laparoscopic cholecystectomy on a busy day-surgery list. The team wants a rapid, clear wake-up to turn the room over, and the patient's high body mass would slow recovery from a more soluble agent. The charge nurse asks which volatile you will use — and whether you will use it at all.[2]
Hold two questions and the whole topic resolves: how fast can I wake this patient? (solubility answers it) and what does that speed cost? (pungency, sympathetic surge, hardware, the planet). Desflurane is the agent where both answers hit their extremes.[2]
References8ShowHide
- [1]Seki H, et al. Desflurane-Induced Delayed Onset of Malignant Hyperthermia: A Case Report Anesth Prog, 2026.PMID 42307544
- [2]Tamura T, et al. Environmental and clinical rationale for the use of desflurane: a review of the literature J Anesth, 2026.PMID 42081124
- [3]Somnuke P, et al. Effect of desflurane versus propofol on perioperative neurocognitive disorders in older adults undergoing major urological surgery: a randomized trial BMC Geriatr, 2026.PMID 42321629
- [4]Jayaswal RP, et al. Comments on: Environmental and clinical rationale for the use of desflurane: a review of the literature J Anesth, 2026.PMID 42319477
- [5]Mizutani K, et al. Banning desflurane: Comments on the article, Environmental and clinical rationale for the use of desflurane: a review of the literature by Tamura et al J Anesth, 2026.PMID 42319476
- [6]Adamowitsch N, et al. Desflurane versus sevoflurane and postoperative inflammatory biomarkers in older adults undergoing minor- to moderate-risk noncardiac surgery Sci Rep, 2026.PMID 42218321
- [7]Altınoluk T, Kazdağlı H General anesthesia and depth of anesthesia (DoA) evaluation methods in laboratory animals: a comprehensive review Vet Res Commun, 2026.PMID 41843253
- [8]Rajmohan N, et al. Comparison of the effects of isoflurane and desflurane on the optic nerve sheath diameter in elderly patients undergoing robotic-assisted laparoscopic radical prostatectomies in steep Trendelenburg position - A randomised controlled trial J Minim Access Surg, 2026.PMID 42085065