April FY23

[kristenhorsman]

This month's article is presented by Samantha Simmons. She chose a pertinent article regarding the hot topic of decreasing to use of Desflurane in the OR. 

Here is the link.

Please answer the following two questions:

1. During which cases or for which patients (if any) do you use Desflurane?

2. If desflurane were removed from our institution, how would you adjust your anesthetic?

[Kels]

1.) Usually if I decide to use Desflurane it is based on the patient body habitus . I have used Desflurane on morbidly obese patients.

2.) If Desflurane is removed from our institution I will use low flow sevo

[Tracey Trainum]

1. I have not used desflurane in my practice for a very long time due to cost/environmental concerns. Considering desflurane was extremely popular when I trained, it was an adjustment for me to move away from using it as my primary anesthetic choice. As I started to use it less, I still used it in obese patients for it's lower BGC and presumed "faster" wake ups.
2. Desflurane has been removed from GSS. For general anesthesia I either do TIVA or a split technique (propofol/sevo). I also sometimes incorporate nitrous oxide. I haven't noticed any delays in emergence without desflurane....it's all about timing.

[Amy Swank]

1. I have not used Desflurane since working working here at Hopkins, using Sevo for my IA or straight TIVA or a combination technique. At other places, I would use Des if it was the only option.

I thought it was fascinating that regarding waste anesthetic gasses, the atmospheric lifetimes of Des is 9-12 years! only surpassed by Nitrous at 114 years. I had no idea! Low flow is essential.
On the other hand Propofol waste is also serious - not naturally degraded and is toxic to wildlife (we are all doomed).

2. Picking the best of what is available at this moment of practice, eliminating Desflurane on the anesthesia machine vaporizer selection does not impact my care here at all.

[Christine Velarde]

1. I only use Desflurane if I had a cardiac cripple that I could not give much anesthesia. I also would use it for morbidly obese with sleep apnea. 2. If no desflurane were in circuit I would use TIVA/sevo.

[Anne McNulty]

(1) I rarely use desflurane. It is much too harseh on the airway. If I have a critically ill ICU Patient, that does not have airway disease and extubation is unlikely, then I may use low does desflurane. (2) I will not miss this gas. i have always found a substitution .

[aileenm4]

1. I havent used Desfluarne in my practice for years, I find it to make patients cough and have airway irritation and tachycardic.
2. I think Desflurane should be removed from the ORs, it is expensive, horrible for the environment and we have other alternative agents. even for the morbidly obesese