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|Suprane |
| Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home SupraneGeneric Name: desflurane Dosage Form: Volatile liquid for inhalation Rx only Volatile Liquid for Inhalation Suprane DescriptionSuprane (desflurane, USP), a nonflammable liquid administered via vaporizer, is a general inhalation anesthetic. It is (±)1,2,2,2-tetrafluoroethyl difluoromethyl ether:  Some physical constants are:
Partition coefficients at 37°C:
Mean Component/Gas Partition Coefficients:
Desflurane is nonflammable as defined by the requirements of International Electrotechnical Commission 601-2-13. Desflurane is a colorless, volatile liquid below 22.8°C. Data indicate that desflurane is stable when stored under normal room lighting conditions according to instructions. Desflurane is chemically stable. The only known degradation reaction is through prolonged direct contact with soda lime producing low levels of fluoroform (CHF3). The amount of CHF3 obtained is similar to that produced with MAC-equivalent doses of isoflurane. No discernible degradation occurs in the presence of strong acids. Desflurane does not corrode stainless steel, brass, aluminum, anodized aluminum, nickel plated brass, copper, or beryllium. Suprane - Clinical PharmacologySuprane (desflurane, USP) is a volatile liquid inhalation anesthetic minimally biotransformed in the liver in humans. Less than 0.02% of the Suprane absorbed can be recovered as urinary metabolites (compared to 0.2% for isoflurane). Minimum alveolar concentration (MAC) of desflurane in oxygen for a 25 year-old adult is 7.3%. The MAC of Suprane (desflurane, USP) decreases with increasing age and with addition of depressants such as opioids or benzodiazepines (see DOSAGE AND ADMINISTRATION for details). PharmacokineticsDue to the volatile nature of desflurane in plasma samples, the washin-washout profile of desflurane was used as a surrogate of plasma pharmacokinetics. Eight healthy male volunteers first breathed 70% N2O/30% O2 for 30 minutes and then a mixture of Suprane (desflurane, USP) 2.0%, isoflurane 0.4%, and halothane 0.2% for another 30 minutes. During this time, inspired and end-tidal concentrations (FI and FA) were measured. The FA/FI (washin) value at 30 minutes for desflurane was 0.91, compared to 1.00 for N2O, 0.74 for isoflurane, and 0.58 for halothane (See Figure 1). The washin rates for halothane and isoflurane were similar to literature values. The washin was faster for desflurane than for isoflurane and halothane at all time points. The FA/FAO (washout) value at 5 minutes was 0.12 for desflurane, 0.22 for isoflurane, and 0.25 for halothane (See Figure 2). The washout for Suprane was more rapid than that for isoflurane and halothane at all elimination time points. By 5 days, the FA/FAO for desflurane is 1/20th of that for halothane or isoflurane.   PharmacodynamicsChanges in the clinical effects of Suprane (desflurane, USP) rapidly follow changes in the inspired concentration. The duration of anesthesia and selected recovery measures for Suprane are given in the following tables: In 178 female outpatients undergoing laparoscopy, premedicated with fentanyl (1.5-2.0 µg/kg), anesthesia was initiated with propofol 2.5 mg/kg, desflurane/N2O 60% in O2 or desflurane/O2 alone. Anesthesia was maintained with either propofol 1.5-9.0 mg/kg/hr, desflurane 2.6-8.4% in N2O 60% in O2, or desflurane 3.1-8.9% in O2.
In 88 unpremedicated outpatients, anesthesia was initiated with thiopental 3-9 mg/kg or desflurane in O2. Anesthesia was maintained with isoflurane 0.7-1.4% in N2O 60%, desflurane 1.8-7.7% in N2O 60%, or desflurane 4.4-11.9% in O2.
Recovery from anesthesia was assessed at 30, 60, and 90 minutes following 0.5 MAC desflurane (3%) or isoflurane (0.6%) in N2O 60% using subjective and objective tests. At 30 minutes after anesthesia, only 43% of the isoflurane group were able to perform the psychometric tests compared to 76% in the desflurane group (p < 0.05).
Suprane (desflurane, USP) was studied in twelve volunteers receiving no other drugs. Hemodynamic effects during controlled ventilation (PaCO2 38mm Hg) were:
When the same volunteers breathed spontaneously during desflurane anesthesia, systemic vascular resistance and mean arterial blood pressure decreased; cardiac index, heart rate, stroke volume, and central venous pressure (CVP) increased compared to values when the volunteers were conscious. Cardiac index, stroke volume, and CVP were greater during spontaneous ventilation than during controlled ventilation. During spontaneous ventilation in the same volunteers, increasing the concentration of Suprane (desflurane, USP) from 3% to 12% decreased tidal volume and increased arterial carbon dioxide tension and respiratory rate. The combination of N2O 60% with a given concentration of desflurane gave results similar to those with desflurane alone. Respiratory depression produced by desflurane is similar to that produced by other potent inhalation agents. The use of desflurane concentrations higher than 1.5 MAC may produce apnea.  CLINICAL TRIALSSuprane (desflurane, USP) was evaluated in 1,843 patients including ambulatory (N=1,061), cardiovascular (N=277), geriatric (N=103), neurosurgical (N=40), and pediatric (N=235) patients. Clinical experience with these patients and with 1,087 control patients in these studies not receiving desflurane are described below. Although desflurane can be used in adults for the inhalation induction of anesthesia via mask, it produces a high incidence of respiratory irritation (coughing, breathholding, apnea, increased secretions, laryngospasm). For incidence, see ADVERSE REACTIONS. Oxyhemoglobin saturation below 90% occurred in 6% of patients (from pooled data, N = 370 adults). Ambulatory SurgerySuprane (desflurane, USP) plus N2O was compared to isoflurane plus N2O in multicenter studies (21 sites) of 792 ASA physical status I, II, or III patients aged 18-76 years (median 32). InductionAnesthetic induction begun with thiopental and continued with desflurane was associated with a 7% incidence of oxyhemoglobin saturation of 90% or less (from pooled data, N = 307) compared with 5% in patients in whom anesthesia was induced with thiopental and isoflurane (from pooled data, N = 152). Maintenance & RecoverySuprane (desflurane, USP) with or without N2O or other anesthetics was generally well tolerated. There were no differences between desflurane and the other anesthetics studied in the times that patients were judged fit for discharge. In one outpatient study, patients received a standardized anesthetic consisting of thiopental 4.2-4.4 mg/kg, fentanyl 3.5-4.0 µg/kg, vecuronium 0.05-0.07 mg/kg, and N2O 60% in oxygen with either desflurane 3% or isoflurane 0.6%. Emergence times were significantly different; but times to sit up and discharge were not different (see Table).
Desflurane was compared to isoflurane, sufentanil or fentanyl for the anesthetic management of coronary artery bypass graft (CABG), abdominal aortic aneurysm, peripheral vascular and carotid endarterectomy surgery in 7 studies at 15 centers involving a total of 558 patients. In all patients except the desflurane vs sufentanil study, the volatile anesthetics were supplemented with intravenous opioids, usually fentanyl. Blood pressure and heart rate were controlled by changes in concentration of the volatile anesthetics or opioids and cardiovascular drugs if necessary. Oxygen (100%) was the carrier gas in 253 of 277 desflurane cases (24 of 277 received N2O/O2).
No differences were found in cardiovascular outcome (death, myocardial infarction, ventricular tachycardia or fibrillation, heart failure) among desflurane and the other anesthetics. InductionDesflurane should not be used as the sole agent for anesthetic induction in patients with coronary artery disease or any patients where increases in heart rate or blood pressure are undesirable. In the desflurane vs sufentanil study, anesthetic induction with desflurane without opioids was associated with new transient ischemia in 14 patients vs 0 in the sufentanil group. In the desflurane group, mean heart rate, arterial pressure, and pulmonary blood pressure increased and stroke volume decreased in contrast to no change in the sufentanil group. Cardiovascular drugs were used frequently in both groups: especially esmolol in the desflurane group (56% vs 0%) and phenylephrine in the sufentanil group (43% vs 27%). When 10 µg/kg of fentanyl was used to supplement induction of anesthesia at one other center, continuous 2-lead ECG analysis showed a low incidence of myocardial ischemia and no difference between desflurane and isoflurane. If desflurane is to be used in patients with coronary artery disease, it should be used in combination with other medications for induction of anesthesia, preferably intravenous opioids and hypnotics. Maintenance & RecoveryIn studies where desflurane or isoflurane anesthesia was supplemented with fentanyl, there were no differences in hemodynamic variables or the incidence of myocardial ischemia in the patients anesthetized with desflurane compared to those anesthetized with isoflurane. During the precardiopulmonary bypass period, in the desflurane vs sufentanil study where the desflurane patients received no intravenous opioid, more desflurane patients required cardiovascular adjuvants to control hemodynamics than the sufentanil patients. During this period, the incidence of ischemia detected by ECG or echocardiography was not statistically different between desflurane (18 of 99) and sufentanil (9 of 98) groups. However, the duration and severity of ECG-detected myocardial ischemia was significantly less in the desflurane group. The incidence of myocardial ischemia after cardiopulmonary bypass and in the ICU did not differ between groups. Geriatric SurgerySuprane (desflurane, USP) plus N2O was compared to isoflurane plus N2O in a multicenter study (6 sites) of 203 ASA physical status II or III elderly patients, aged 57-91 years (median 71). InductionMost patients were premedicated with fentanyl (mean 2 µg/kg), preoxygenated, and received thiopental (mean 4.3 mg/kg IV) or thiamylal (mean 4 mg/kg IV) followed by succinylcholine (mean 1.4 mg/kg IV) for intubation. Maintenance & RecoveryHeart rate and arterial blood pressure remained within 20% of preinduction baseline values during administration of Suprane (desflurane, USP) 0.5-7.7% (average 3.6%) with 50-60% N2O. Induction, maintenance, and recovery cardiovascular measurements did not differ from those during isoflurane/N2O administration nor did the postoperative incidence of nausea and vomiting differ. The most common cardiovascular adverse event was hypotension occurring in 8% of the Suprane patients and 6% of the isoflurane patients. NeurosurgerySuprane (desflurane, USP) was studied in 38 patients aged 26-76 years (median 48 years), ASA physical status II or III undergoing neurosurgical procedures for intracranial lesions. InductionInduction consisted of standard neuroanesthetic techniques including hyperventilation and thiopental. MaintenanceNo change in cerebrospinal fluid pressure (CSFP) was observed in 8 patients who had intracranial tumors when the dose of desflurane was 0.5 MAC in N2O 50%. In another study of 9 patients with intracranial tumors, 0.8 MAC desflurane/air/O2 did not increase CSFP above postinduction baseline values. In a different study of 10 patients receiving 1.1 MAC desflurane/air/O2, CSFP increased 7 mm Hg (range 3-13 mm Hg increase, with final values of 11-26 mm Hg) above the predrug values. All volatile anesthetics may increase intracranial pressure in patients with intracranial space occupying lesions. In such patients, desflurane should be administered at 0.8 MAC or less, and in conjunction with a barbiturate induction and hyperventilation (hypocapnia) in the period before cranial decompression. Appropriate attention must be paid to maintain cerebral perfusion pressure. The use of a lower dose of desflurane and the administration of a barbiturate and mannitol would be predicted to lessen the effect of desflurane on CSFP. Under hypocapnic conditions (PaCO2 27 mm Hg) desflurane 1 and 1.5 MAC did not increase cerebral blood flow (CBF) in 9 patients undergoing craniotomies. CBF reactivity to increasing PaCO2 from 27 to 35 mm Hg was also maintained at 1.25 MAC desflurane/air/O2. Pediatric SurgerySuprane (desflurane, USP) is not recommended for induction of anesthesia in pediatric patients because of the high incidence of moderate to severe upper airway adverse reactions, including laryngospasm, coughing, breathholding, and secretions, seen in studies of induction of anesthesia in pediatric patients. (see WARNINGS and PRECAUTIONS – Pediatric Use). Suprane is not approved for maintenance of anesthesia in non-intubated pediatric patients due to an increased incidence of respiratory adverse reactions, including coughing, laryngospasm and secretions, seen in one study of maintenance of anesthesia in non-intubated pediatric patients. (see WARNINGS and PRECAUTIONS – Pediatric Use). Maintenance & Recovery in Intubated Pediatric PatientsSuprane (desflurane, USP) is approved for maintenance of anesthesia in infants and children after induction of anesthesia with agents other than Suprane, and tracheal intubation. Suprane, with or without N2O, and halothane, with or without N2O were studied in three clinical trials of pediatric patients aged 2 weeks to 12 years (median 2 years) and ASA physical status I or II. The concentration of Suprane (desflurane, USP) required for maintenance of general anesthesia is age-dependent (see INDIVIDUALIZATION OF DOSE). Changes in blood pressure during maintenance of and recovery from anesthesia with desflurane/N2O/O2 are similar to those observed with halothane/N2O/O2. Heart rate during maintenance of anesthesia is approximately 10 beats per minute faster with desflurane than with halothane. Patients were judged fit for discharge from post-anesthesia care units within one hour with both desflurane and halothane. There were no differences in the incidence of nausea and vomiting between patients receiving desflurane or halothane. INDIVIDUALIZATION OF DOSE(Also see DOSAGE AND ADMINISTRATION) Preanesthetic MedicationIssues such as whether or not to premedicate and the choice of premedicant(s) must be individualized. In clinical trials, patients scheduled to be anesthetized with desflurane frequently received IV pre-anesthetic medication, such as opioid and/or benzodiazepine. InductionIn adults, some premedicated with opioid, a frequent starting concentration was 3% desflurane, increased in 0.5-1.0% increments every 2 to 3 breaths. End-tidal concentrations of 4-11% Suprane (desflurane, USP) with and without N2O, produced anesthesia within 2 to 4 minutes. When desflurane was tested as the primary anesthetic induction agent, the incidence of upper airway irritation (apnea, breathholding, laryngospasm, coughing and secretions) was high (see ADVERSE REACTIONS). During induction in adults, the overall incidence of oxyhemoglobin desaturation (SpO2< 90%) was 6%. After induction in adults with an intravenous drug such as thiopental or propofol, desflurane can be started at approximately 0.5-1 MAC, whether the carrier gas is O2 or N2O/O2. MaintenanceSurgical levels of anesthesia in adults may be maintained with concentrations of 2.5-8.5% Suprane (desflurane, USP) with or without the concomitant use of nitrous oxide. In children, surgical levels of anesthesia may be maintained with concentrations of 5.2-10% Suprane with or without the concomitant use of nitrous oxide. During the maintenance of anesthesia, increasing concentrations of Suprane (desflurane, USP) produce dose-dependent decreases in blood pressure. Excessive decreases in blood pressure may be due to depth of anesthesia and in such instances may be corrected by decreasing the inspired concentration of Suprane. Concentrations of desflurane exceeding 1 MAC may increase heart rate. Thus with this drug, an increased heart rate may not serve reliably as a sign of inadequate anesthesia. Suprane (desflurane, USP) decreases the doses of neuromuscular blocking agents required (see PRECAUTIONS, Drug Interactions). Indications and Usage for SupraneSuprane (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)
Typical mistypes for Suprane auprane, zuprane, xuprane, duprane, euprane, wuprane, syprane, shprane, sjprane, siprane, s8prane, s7prane, suorane, sulrane, su-rane, su0rane, supeane, supdane, supfane, suptane, sup5ane, sup4ane, suprzne, suprsne, suprwne, suprqne, suprabe, suprame, supraje, suprahe, supranw, suprans, suprand, supranr, supran4, supran3, uprane, sprane, surane, supane, suprne, suprae, supran, usprane, spurane, surpane, suparne, suprnae, supraen, ssuprane, suuprane, supprane, suprrane, supraane, supranne, supranee, etc.
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