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 remarkably high vapour pressure means it cannot be delivered by a standard variable-bypass vaporiser, demanding the special electrically heated pressurised Tec 6 vaporiser. 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, 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 Tamura-commentaries (Jayaswal 2026; Mizutani 2026), the isoflurane-versus-desflurane optic-nerve-sheath trial (Rajmohan 2026), the desflurane kinetics/safety/MAC review (Eger 1992), the neurocirculatory-activation volunteer study (Muzi 1996), the Baralyme-CO rehydration study (Baxter 1997), and the Tec-6 vaporiser papers (Andrews 1993; Miller 1994).
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 NEUROCIRCULATORY ACTIVATION with rapid concentration increases — transient tachycardia, hypertension and sympathetic-nerve activation with no consistent threshold (generally below 1 MAC in volunteers); increase the dialled concentration slowly and blunt the response with an opioid or benzodiazepine, especially in coronary disease.
- Desflurane's remarkably high vapour pressure means it CANNOT be used in a standard variable-bypass vaporiser — it requires the special electrically heated, pressurised Tec 6 vaporiser.
- Desflurane IS a trigger of malignant hyperthermia, like every volatile agent — never give it to the known or suspected MH-susceptible patient; a 26-year-old man developed fulminant MH during emergence after desflurane-rocuronium despite prior uneventful anaesthetics, so maintain vigilance well into recovery.
- Desflurane produces the MOST carbon monoxide of all volatiles through desiccated absorbent (greater with Baralyme than soda lime, inversely related to water content) — change absorbent regularly per local protocol.
- Desflurane is the WORST greenhouse gas of all anaesthetics — 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]
References11ShowHide
- [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
- [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
- [9]Eger EI 2nd. Desflurane animal and human pharmacology: aspects of kinetics, safety, and MAC. Anesthesia and Analgesia, 1992.PMID 1524237
- [10]Muzi M, et al. Desflurane-mediated neurocirculatory activation in humans. Effects of concentration and rate of change. Anesthesiology, 1996.PMID 8623996
- [11]Baxter PJ, Kharasch ED. Rehydration of desiccated Baralyme prevents carbon monoxide formation from desflurane. Anesthesiology, 1997.PMID 9158355
- [12]Andrews JJ. The new Tec6 desflurane vaporizer. Anesthesia and Analgesia, 1993.PMID 8498675
- [13]Miller D. The Tec 6 vaporizer: why desflurane needs to be heated. AANA Journal, 1994.PMID 7879584