Suprane Dosage

Generic name: desflurane
Dosage form: volatile liquid for inhalation

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Only persons trained in the administration of general anesthesia should administer SUPRANE (desflurane, USP). Only a vaporizer specifically designed and designated for use with desflurane should be utilized for its administration. Facilities for maintenance of a patent airway, artificial ventilation, oxygen enrichment, and circulatory resuscitation must be immediately available.

SUPRANE (desflurane, USP) is administered by inhalation. The administration of general anesthesia must be individualized based on the patient’s response. Hypotension and respiratory depression increase as anesthesia with SUPRANE (desflurane, USP) is deepened. The minimum alveolar concentration (MAC) of SUPRANE (desflurane, USP) decreases with increasing patient age. The MAC for SUPRANE (desflurane, USP) is also reduced by concomitant N2O administration (see Table 1). The dose should be adjusted accordingly. The following table provides mean relative potency based upon age and effect of N2O in predominately ASA physical status I or II patients.

Benzodiazepines and opioids decrease the MAC of SUPRANE (desflurane, USP) [see Drug Interactions (7.1, Table 3)]. SUPRANE (desflurane, USP) also decreases the doses of neuromuscular blocking agents required [see Drug Interactions (7.2, Table 4)].  The dose should be adjusted accordingly.

Table 1
N = number of crossover pairs (using up-and-down method of quantal response)
Effect of Age on Minimum Alveolar Concentration of Desflurane
Mean ± SD (percent atmospheres)
Age N O2 100% N N2O 60%/40% O2
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

Preanesthetic Medication

Issues such as whether or not to premedicate and the choice of premedication(s) must be individualized. In clinical studies, patients scheduled to be anesthetized with SUPRANE (desflurane, USP) frequently received IV preanesthetic medication, such as opioid and/or benzodiazepine.

Induction

In adults, some premedicated with opioid, a frequent starting concentration was 3% SUPRANE (desflurane, USP), 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 SUPRANE (desflurane, USP) was tested as the primary anesthetic induction agent, the incidence of upper airway irritation (apnea, breathholding, laryngospasm, coughing and secretions) was high. During induction in adults, the overall incidence of oxyhemoglobin desaturation (SpO2 < 90%) was 6% [see Adverse Reactions (6.1)].

After induction in adults with an intravenous drug such as thiopental or propofol, SUPRANE (desflurane, USP) can be started at approximately 0.5-1 MAC, whether the carrier gas is O2 or N2O/O2.

Inspired concentrations of SUPRANE (desflurane, USP) greater than 12% have been safely administered to patients, particularly during induction of anesthesia. Such concentrations will proportionately dilute the concentration of oxygen; therefore, maintenance of an adequate concentration of oxygen may require a reduction of nitrous oxide or air if these gases are used concurrently.

Maintenance

Surgical 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 (desflurane, USP) with or without the concomitant use of nitrous oxide.

During the maintenance of anesthesia with inflow rates of 2 L/min or more, the alveolar concentration of SUPRANE (desflurane, USP) will usually be within 10% of the inspired concentration [FA/FI, see Figure 2 in Clinical Pharmacology (12.3)].

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 (desflurane, USP).

Concentrations of SUPRANE (desflurane, USP) 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.

Maintenance of Anesthesia in Intubated Pediatric Patients

SUPRANE (desflurane, USP) is indicated for maintenance of anesthesia in infants and children after induction of anesthesia with agents other than SUPRANE (desflurane, USP), and tracheal intubation.

SUPRANE (desflurane, USP), 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 Clinical Studies (14.5)].

Changes in blood pressure during maintenance of and recovery from anesthesia with SUPRANE (desflurane, USP)/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 SUPRANE (desflurane, USP) than with halothane. Patients were judged fit for discharge from post-anesthesia care units within one hour with both SUPRANE (desflurane, USP) and halothane. There were no differences in the incidence of nausea and vomiting between patients receiving SUPRANE (desflurane, USP) or halothane.

Recovery

The recovery from general anesthesia should be assessed carefully before patients are discharged from the post anesthesia care unit (PACU).

Use in Patients with Coronary Artery Disease

In patients with coronary artery disease, maintenance of normal hemodynamics is important to prevent myocardial ischemia. Marked increases in pulse rate, mean arterial pressure and levels of epinephrine and norepinephrine are associated with a rapid increase in desflurane concentrations. SUPRANE (desflurane, USP) should not be used as the sole agent for anesthetic induction in patients with coronary artery disease or patients where increases in heart rate or blood pressure are undesirable. It should be used with other medications, preferably intravenous opioids and hypnotics [see Clinical Studies (14.2)].

Neurosurgical Use

SUPRANE (desflurane, USP) may produce a dose-dependent increase in cerebrospinal fluid pressure (CSFP) when administered to patients with intracranial space occupying lesions. SUPRANE (desflurane, USP) should be administered at 0.8 MAC or less, and in conjunction with a barbiturate induction and hyperventilation (hypocapnia) until cerebral decompression in patients with known or suspected increases in CSFP. Appropriate attention must be paid to maintain cerebral perfusion pressure [see Clinical Studies (14.4)].

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