INDICATIONS AND USAGE
SUPRANE (desflurane, USP) is indicated as an inhalation agent for induction and/or maintenance of anesthesia for inpatient and outpatient surgery in adults (see PRECAUTIONS).
SUPRANE (desflurane, USP) is not recommended for induction of anesthesia in pediatric patients because of a high incidence of moderate to severe upper airway adverse events (see WARNINGS). After induction of anesthesia with agents other than SUPRANE, and tracheal intubation, SUPRANE is indicated for maintenance of anesthesia in infants and children.
DOSAGE AND ADMINISTRATION
Deliver SUPRANE (desflurane, USP) from a vaporizer specifically designed and designated for use with desflurane.
The administration of general anesthesia must be individualized based on the patient’s response (see INDIVIDUALIZATION OF DOSE). The following two tables provide mean relative potency based upon age and drug interaction studies in predominately ASA physical status I or II patients.
EFFECT OF AGE ON MAC OF DESFLURANE MEAN ± SD (percent atmospheres)
| Age || N || O2 100% || N || N2O 60% |
|2 weeks||6||9.2 ± 0.0||-||-|
|10 weeks||5||9.4 ± 0.4||-||-|
|9 months||4||10.0 ± 0.7||5||7.5 ± 0.8|
|2 years||3||9.1 ± 0.6||-||-|
|3 years||-||-||5||6.4 ± 0.4|
|4 years||4||8.6 ± 0.6||-||-|
|7 years||5||8.1 ± 0.6||-||-|
|25 years||4||7.3 ± 0.0||4||4.0 ± 0.3|
|45 years||4||6.0 ± 0.3||6||2.8 ± 0.6|
|70 years||6||5.2 ± 0.6||6||1.7 ± 0.4|
N = number of crossover pairs (using up-and-down method of quantal response)
Opioids or benzodiazepines decrease the amounts of SUPRANE (desflurane, USP) required to produce anesthesia. The following table is based on studies of drug interaction (MAC reduction).
SUPRANE (desflurane, USP) MAC WITH FENTANYL OR MIDAZOLAM MEAN ± SD (percent reduction)
| Dose || 18-30 years || 31-65 years |
|No fentanyl||6.4 ± 0.0||6.3 ± 0.4|
|3 µg/kg fentanyl||3.5 ± 1.9 (46%)||3.1 ± 0.6 (51%)|
|6 µg/kg fentanyl||3.0 ± 1.2 (53%)||2.3 ± 1.0 (64%)|
|No midazolam||6.9 ± 0.1||5.9 ± 0.6|
|25 µg/kg midazolam||-||4.9 ± 0.9 (16%)|
|50 µg/kg midazolam||-||4.9 ± 0.5 (17%)|
SUPRANE (desflurane, USP) decreases the doses of neuromuscular blocking agents required (see PRECAUTIONS, Drug Interactions).
During the maintenance of anesthesia with inflow rates of 2 L/min or more, the alveolar concentration of desflurane will usually be within 10% of the inspired concentration. (FA/FI, see Figure 1 in Pharmacokinetics section.)
SUPRANE (desflurane, USP), NDC 10019-641-24, is packaged in amber-colored bottles containing 240 mL desflurane.
Safety and Handling
There is no specific work exposure limit established for SUPRANE (desflurane, USP). However, the National Institute for Occupational Safety and Health Administration (NIOSH) recommends that no worker should be exposed at ceiling concentrations greater than 2 ppm of any halogenated anesthetic agent over a sampling period not to exceed one hour.
The predicted effects of acute overexposure by inhalation of SUPRANE (desflurane, USP) include headache, dizziness or (in extreme cases) unconsciousness.
There are no documented adverse effects of chronic exposure to halogenated anesthetic vapors (W aste A nesthetic G ases or WAGs) in the workplace. Although results of some epidemiological studies suggest a link between exposure to halogenated anesthetics and increased health problems (particularly spontaneous abortion), the relationship is not conclusive. Since exposure to WAGs is one possible factor in the findings for these studies, operating room personnel, and pregnant women in particular, should minimize exposure. Precautions include adequate general ventilation in the operating room, the use of a well-designed and well-maintained scavenging system, work practices to minimize leaks and spills while the anesthetic agent is in use, and routine equipment maintenance to minimize leaks.