Desflurane muscle relaxation

Desflurane muscle relaxation chemical depresses the neuromuscular junction, it decreases the force of contraction of muscles and increases fade.

Endotracheal intubation is possible. There is a potentiation of nondepolarizing muscle relaxants similar to isoflurane. There have been no reports of malignant hyperthermia in man but has been seen in animals.

It is advisable to avoid Desflurane muscle relaxation dose in susceptible patients.

The following is mentioned about Desflurane muscle relaxation in Goodman and Gilman’s Pharmacology –

Desflurane produces direct skeletal muscle relaxation as well as enhancing the effects of nondepolarizing and depolarizing neuromuscular blocking agents.

Caldwell, J.E., Laster, M.J., Magorian, T., et al. The neuromuscular effects of desflurane, alone and combined with pancuronium or succinylcholine in humans. Anesthesiology,1991,74:412-418.

Miller’s Anesthesia says the following about Desflurane muscle relaxation –

The less soluble new inhaled anesthetics desflurane and sevoflurane offer more rapid recovery from anesthesia than with more soluble older anesthetics, such as isoflurane.

However, this rapid recovery comes at a price: the new anesthetics are more expensive. Might it be possible to have the best of both worlds by using isoflurane for the major portion of anesthesia and reserve desflurane (or sevoflurane) for the final minutes?

The premise would be that such an approach would provide the economy of isoflurane and the rapid recovery of desflurane. Neumann and colleagues tested this premise.

Volunteers were anesthetized for 2 hours on three occasions: once with 1.25 MAC isoflurane, once with 1.25 MAC desflurane, and once with 1.5 hours of 1.25 MAC isoflurane followed by 0.5 hours of a combination of desflurane and isoflurane (“crossover”).

The combination provided a total of 1.25 MAC (i.e., desflurane was added as the isoflurane was eliminated, the addition being sufficient to sustain a total of 1.25 MAC). To ensure economy, all anesthetics were delivered at an inflow rate of 2 L/min.

The premise was not realized. Recovery after crossover was no faster than recovery after isoflurane alone . Recovery after desflurane muscle relaxation alone was considerably faster than recovery after either isoflurane or the crossover from isoflurane to desflurane.

 

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