Transcript desflurane
® Desflurane Desflurane Chemistry Desflurane: fluorine atom replaces chlorine atom on the alpha ethyl carbon of isoflurane Isoflurane H F H C O C C F F Cl Desflurane F F H BrF3 F H F C O C C F F F F Distinguishing Characteristics of Desflurane The differences in the chemical structure of desflurane result in several distinguishing characteristics: Solubility Potency Stability Vapor pressure Key Areas of Differences: SOLUBILITY Agent Blood/Gas Partition Coefficient Brain Blood Fat Blood Muscle Blood Halothane Enflurane Isoflurane 2.54 1.8 1.46 1.9 1.3 1.6 51 36 45 3.4 1.7 4.0 Desflurane 0.42 1.3 27 2.0 Sevoflurane 0.69 1.7 48 3.1 Key Areas of Differences: PHYSICAL PROPERTIES MAC AGENT Halothane Enflurane Isoflurane Desflurane Sevoflurane MAC-(45 yr old) CONCENTRATION 0.77% 1.7% 1.15% 6% 2.1% Key Areas of Differences: METABOLISM AGENT %METABOLIZED Halothane Enflurane Isoflurane Desflurane Sevoflurane 15-20% 2% 0.17% 0.02% 5% Inhalation Anesthetics Characteristics Ideal Halothane SOLUBILITY (blood:gas) Low 2.54 1.8 1.46 0.42 0.69 METABOLISM None 20% 2% 0.17% 0.02% 5% CV DEPRESSION None Signif. Moderate Minimal Minimal PUNGENCY None Low Enflurane Some Isoflurane Desflurane Sevoflurane Minimal Low Moderate Moderate STABILITY IN CO2 ABSORBERS Yes Yes Yes Yes Yes No SUPRANE TECHNIQUE Solubility equal to N2O Turn on and off like N2O No need to overpressure No need to titrate down for fast wake-up Low flow = low cost INDUCTION (WASH-IN) Premed with fentanyl (1.5 - 2 ug/kg) IV induction (propofol) Turn on Suprane at 3-6% 3-5 liter flow for 5-10 minutes Reduce flows to 1-2 liters Adjust Suprane conc. 1-2% as needed CHANGING DEPTH Do not need to overpressure Increase conc. in 1-2% increments To hasten change, increase flow rate to 3-5 liters for 2-3 minutes. Emergence Maintain required depth to the end of the case. (3-6%). Consider reversing relaxant prior to shutting off the Suprane Provide for post-op analgesia Perform airway manipulation and suctioning under adequate level of anesthesia Use small dose of opioid, propofol, or lidocaine WAKE - UP Turn off the Suprane at end of surgery Flush the circuit Increase oxygen flow to 8-10 liters Patient will awaken and be alert in 3-5 min. Recovery Time and Fast-Tracking Desflurane (n=40) Sevoflurane (n=40) Propofol (n=40) 15 12 8.3 9 * 8.9 Minutes 6 4.7 5.2 5.1 14.7 11.3 * 9.8 5.6 3 0 Awakening Extubation * P<.05 Song and White. Anesthesiology. 1997;87:A33 Orientation * Desflurane 사용량 마취제 사용량 = 마취제농도(%)Ⅹ산소유량(ml)Ⅹ마취시간(분) 액체 1ml당 발생되는 증기량(210) 6%농도사용시 4L/min → 68,5ml/h 2L/min → 34.2ml/h 8%농도사용시 4L/min → 91.4ml/h 2L/min → 45.7ml/h (7.0h/BTL) (5.2h/BTL) 보험인정 초회량 15ml/15min, 유지량 10.7ml/15min 1시간 사용시 = 47.1ml 2시간 사용시 = 89.9ml (5.6h/BTL) 시간별 기준약가 비교 성분명 Enflurane 기준약가 0:15 0:30 0:45 1:00 1:15 1:30 1:45 2:00 \219/ml 1,643 3,285 4,928 6,570 8,213 9,855 11,498 13,140 Isoflurane Propofol Sevoflurane Desfllurane 성분명 Enflurane Isoflurane Propofol Sevoflurane Desfllurane 성분명 Enflurane Isoflurane Propofol Sevoflurane Desfllurane \519/ml 6,695 9,616 12,490 15,364 18,239 21,113 23,987 26,862 \8,928/200mg 8,928 17,856 17,856 17,856 26,784 26,784 26,784 35,712 \763/ml 7,249 11,064 14,879 18,694 22,509 26,324 30,139 33,954 \374/ml 5,610 9,612 13,614 17,616 21,617 25,619 29,621 33,623 기준약가 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 \219/ml 13,323 14,803 16,283 17,763 19,244 20,724 22,204 23,684 \519/ml 29,736 32,610 35,484 38,359 41,233 44,107 46,982 49,856 \8,928/200mg 35,712 44,640 44,640 44,640 \763/ml 37,769 41,584 45,399 49,214 53,029 56,844 60,659 64,474 \374/ml 37,625 41,626 45,628 49,630 53,632 57,634 61,635 65,637 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 \219/ml 25,165 26,645 28,125 29,606 31,086 32,566 34,046 35,527 \519/ml 52,730 55,605 58,479 61,353 64,227 67,102 69,976 72,850 \8,928/200mg 66,840 44,640 44,640 44,640 \763/ml 68,289 72,104 75,919 79,734 83,549 87,364 91,179 94,994 \374/ml 69,639 73,641 77,643 81,644 85,646 89,648 93,650 97,652 기준약가 • 성분 : Desflurane • 허가년월일 : 1996년 2월 3일 • 발매년월일 : 1996년 8월 • 수입처 : Baxter • 함량 : 100ml당 데스프루란(U.S.P) 100ml • 제형 : 240ml • 보험수가 : 374원/ml (1Bottle당 89,760원) Desflurane의 보험영역 뇌질환(Brain) 심장질환(Heart) 신장질환(Kidney) 장기이식(Organ Transplantation) 신생아 수술(Neonate) 2시간 이내의 수술환자 (Within 2hours Surgery) 간질환 및 간질환의 기왕력이 있는 환자 (Liver disease or a case history of liver disease)