DrugLib.com — Drug Information Portal

Rx drug information, pharmaceutical research, clinical trials, news, and more

Suprane (Desflurane) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

No clinically significant adverse interactions with commonly used preanesthetic drugs, or drugs used during anesthesia (muscle relaxants, intravenous agents, and local anesthetic agents) were reported in clinical trials. The effect of SUPRANE (desflurane, USP) on the disposition of other drugs has not been determined. Similar to isoflurane, SUPRANE (desflurane, USP) does not predispose to premature ventricular arrhythmias in the presence of exogenously infused epinephrine in swine.

Benzodiazepines and Opioids (MAC Reduction)

Benzodiazepines and opioids decrease the amount of desflurane (MAC) needed to produce anesthesia. This effect is shown in Table 3 for intravenous midazolam (25-50 µg/kg) and intravenous fentanyl (3-6 µg/kg) in patients of two different age groups.

Table 3

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%)

Neuromuscular Blocking Agents

Anesthetic concentrations of desflurane at equilibrium (administered for 15 or more minutes before testing) reduced the ED95 of succinylcholine by approximately 30% and that of atracurium and pancuronium by approximately 50% compared to N2O/opioid anesthesia (see Table 4). The effect of desflurane on duration of nondepolarizing neuromuscular blockade has not been studied.

Table 4
Dosage of Muscle Relaxant Causing 95% Depression
in Neuromuscular Blockade
Desflurane Concentration Mean ED95 (µg/kg)
Pancuronium Atracurium Succinylcholine Vecuronium
0.65 MAC 60%
N2O/O2
26 133 - -
1.25 MAC 60%
N2O/O2
18 119 - -
1.25 MAC O2 22 120 360 19

Dosage reduction of neuromuscular blocking agents during induction of anesthesia may result in delayed onset of conditions suitable for endotracheal intubation or inadequate muscle relaxation, because potentiation of neuromuscular blocking agents requires equilibration of muscle with the delivered partial pressure of SUPRANE (desflurane, USP).

Among nondepolarizing drugs, pancuronium, atracurium, and vecuronium interactions have been studied. In the absence of specific guidelines:

  • For endotracheal intubation, do not reduce the dose of nondepolarizing muscle relaxants or succinylcholine.
  • During maintenance of anesthesia, the dose of nondepolarizing muscle relaxants is likely to be reduced compared to that during N2O/opioid anesthesia. Administration of supplemental doses of muscle relaxants should be guided by the response to nerve stimulation.

Concomitant use with NO

Concomitant administration of N2O reduces the MAC of SUPRANE (desflurane, USP) [see Dosage and Administration (2), Table 1 ].

Beta Blockers

Concomitant use of beta blockers may exaggerate the cardiovascular effects of inhalational anesthetics, including hypotension and negative inotropic effects.

Monoamine Oxidase Inhibitors (MAO)

Concomitant use of MAO inhibitors and inhalational anesthetics may increase the risk of hemodynamic instability during surgery or medical procedures.

OVERDOSAGE

The symptoms of overdosage of SUPRANE (desflurane, USP) can present as a deepening of anesthesia, cardiac and/or respiratory depression in spontaneously breathing patients, and cardiac depression in ventilated patients in whom hypercapnia and hypoxia may occur only at a late stage. In the event of overdosage, or suspected overdosage, take the following actions: discontinue administration of SUPRANE (desflurane, USP), maintain a patent airway, initiate assisted or controlled ventilation with oxygen, and maintain adequate cardiovascular function.

CONTRAINDICATIONS

The use of SUPRANE (desflurane, USP) is contraindicated in the following conditions:

  • Known or suspected genetic susceptibility to malignant hyperthermia.
  • Patients in whom general anesthesia is contraindicated.
  • Induction of anesthesia in pediatric patients.
  • Patients with known sensitivity to SUPRANE (desflurane, USP) or to other halogenated agents [see Warnings and Precautions].
  • Patients with a history of confirmed hepatitis or with a history of unexplained moderate to severe hepatic dysfunction (e.g., jaundice associated with fever and/or eosinophilia) after anesthesia with SUPRANE (desflurane, USP) or other halogenated agents [see Warnings and Precautions].

-- advertisement -- The American Red Cross
 
Home | About Us | Contact Us | Site usage policy | Privacy policy

All Rights reserved - Copyright DrugLib.com, 2006-2017