Cardiovascular and respiratory actions of desflurane: is desflurane different from isoflurane?

Abstract

The cardiovascular and respiratory effects of desflurane are reviewed. In experimental animals, desflurane has been shown to produce hemodynamic effects comparable to those produced by isoflurane. Desflurane increases heart rate and decreases both mean arterial pressure and systemic vascular resistance while maintaining cardiac output. In some but not all studies, desflurane has appeared to maintain arterial pressure and systemic vascular resistance to a somewhat greater degree than equianesthetic concentrations of isoflurane. Otherwise, desflurane and isoflurane produce strikingly similar effects on systemic, coronary, renal, hepatic, and cerebral circulation. In addition, desflurane and isoflurane have nearly identical actions on a variety of indices of left ventricular systolic and diastolic function. Although desflurane may cause coronary vasodilation in dogs, no evidence of "coronary steal" has been observed in a canine model of multivessel coronary artery disease. In humans, desflurane produces alterations in systemic hemodynamics that have many similarities to those produced in animals. No differences between the cardiovascular actions of desflurane and isoflurane have been identified in volunteers during spontaneous or controlled ventilation with and without nitrous oxide. Desflurane and isoflurane also produce similar hemodynamic effects during induction and maintenance of anesthesia in a wide variety of clinical settings. To date, no direct evidence of desflurane-related myocardial ischemia or increased cardiovascular morbidity has been observed in patients with coronary artery disease. Desflurane depresses ventilation in animals and humans. Dose-related decreases in tidal volume and increases in respiratory rate, arterial carbon dioxide tension, dead space/tidal ventilation ratio, and intrapulmonary shunt fraction have all been observed in volunteers. These effects are similar to those produced by other currently used volatile anesthetics, including isoflurane. Desflurane, like isoflurane, also appears to be a mild respiratory irritant. Thus, the cardiorespiratory effects of the new volatile anesthetic, desflurane, are remarkably similar to those produced by isoflurane.