lSIDE-EFFECTS
▶Common or very commonAgitation.apnoea.arrhythmias.
chills.coagulation disorder.conjunctivitis.cough.
dizziness.drowsiness.fever.headache.hepatic disorders
.hypersalivation.hypertension.hypotension.nausea.
respiratory disorders.temperature regulation disorders.
vomiting
▶UncommonAsthma.atrioventricular block.confusion.
hypoxia.muscle complaints.myocardial infarction.
myocardial ischaemia.vasodilation
▶Frequency not knownAbdominal pain.asthenia.breath
holding.carboxyhaemoglobinaemia.cardiac arrest.chest
discomfort.cognitive impairment.delirium.dyspnoea.
dystonia.electrolyte imbalance.haemorrhage.heart
failure.ileus.intracranial pressure increased.malaise.
metabolic acidosis.mood altered (that can last several
days).myoglobinuria.nephritis tubulointerstitial.
oedema.pancreatitis.QT interval prolongation.
rhabdomyolysis.seizure.shock.skin reactions.
ventricular dysfunction.visual acuity decreased
lALLERGY AND CROSS-SENSITIVITYCan cause
hepatotoxicity in those sensitised to halogenated
anaesthetics.
lDIRECTIONS FOR ADMINISTRATIONVolatile liquid
anaesthetics are administered using calibrated vaporisers,
using air, oxygen, or nitrous oxide-oxygen mixtures as the
carrier gas. To prevent hypoxia, the inspired gas mixture
should contain a minimum of 25 % oxygen at all times.
lPATIENT AND CARER ADVICE
Driving and skilled tasksPatients given sedatives and
analgesics during minor outpatient procedures should be
very carefully warned about the risks of driving or
undertaking skilled tasks afterwards. For a short general
anaesthetic, the risk extendsto at least 24 hoursafter
administration. Responsible persons should be available to
take patients home. The dangers of takingalcoholshould
also be emphasised.
eiiiiF 806
Desflurane
lINDICATIONS AND DOSE
Induction of anaesthesia (but not recommended)
▶BY INHALATION
▶Child 12–17 years: 4 – 11 %, to be inhaled through
specifically calibrated vaporiser
Maintenance of anaesthesia (in nitrous oxide–oxygen)
▶BY INHALATION
▶Neonate: 2 – 6 %, to be inhaled through a specifically
calibrated vaporiser.▶Child: 2 – 6 %, to be inhaled through a specifically
calibrated vaporiser
Maintenance of anaesthesia (in oxygen or oxygen-
enriched air)
▶BY INHALATION
▶Neonate: 2. 5 – 8. 5 %, to be inhaled through a specifically
calibrated vaporiser.▶Child: 2. 5 – 8. 5 %, to be inhaled through a specifically
calibrated vaporiserlINTERACTIONS→Appendix 1 : volatile halogenated
anaesthetics
lPREGNANCYMay depress neonatal respiration if used
during delivery.
lBREAST FEEDINGBreast-feeding can be resumed as soon
as mother has recovered sufficiently from anaesthesia.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation vapour
▶Desflurane (Non-proprietary)
Desflurane 1 ml per 1 mlDesflurane volatile liquid| 240 mlPs
(Hospital only)
eiiiiF 806Isoflurane
lINDICATIONS AND DOSE
Induction of anaesthesia (in oxygen or nitrous oxide–
oxygen) (but indication not recommended in infants and
children of all ages)
▶BY INHALATION
▶Neonate:Initially 0. 5 %, increased to 3 %, adjusted
according to response, administered using specifically
calibrated vaporiser.▶Child:Initially 0. 5 %, increased to 3 %, adjusted
according to response, administered using specifically
calibrated vaporiser
Maintenance of anaesthesia (in nitrous oxide–oxygen)
▶BY INHALATION
▶Neonate: 1 – 2. 5 %, to be administered using specifically
calibrated vaporiser; an additional 0. 5 – 1 % may be
required when given with oxygen alone.▶Child: 1 – 2. 5 %, to be administered using specifically
calibrated vaporiser; an additional 0. 5 – 1 % may be
required when given with oxygen alone
Maintenance of anaesthesia in caesarean section (in
nitrous oxide–oxygen)
▶BY INHALATION
▶Child: 0. 5 – 0. 75 %, to be administered using specifically
calibrated vaporiserIMPORTANT SAFETY INFORMATION
Isoflurane is not recommended for induction of
anaesthesia in infants and children of all ages because of
the occurrence of cough, breath-holding, desaturation,
increased secretions, and laryngospasm.lCAUTIONSChildren under 2 years—limited experience
lINTERACTIONS→Appendix 1 : volatile halogenated
anaesthetics
lPREGNANCYMay depress neonatal respiration if used
during delivery.
lBREAST FEEDINGBreast-feeding can be resumed as soon
as mother has recovered sufficiently from anaesthesia.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation vapour
▶Isoflurane (Non-proprietary)
Isoflurane 1 ml per 1 mlIsoflurane inhalation vapour|
250 mlP£ 35. 29 (Hospital only)
Isoflurane volatile liquid| 250 mlp£ 47. 50 (Hospital only)
▶AErrane(Baxter Healthcare Ltd)
Isoflurane 1 ml per 1 mlAErrane volatile liquid| 250 mlps
(Hospital only)BNFC 2018 – 2019 General anaesthesia 807
Anaesthesia15