Desflurane for maintenance of anaesthesia

Product overview

Desflurane has a marketing authorisation for induction and maintenance of general anaesthesia for inpatient and outpatient surgery in adults, and for the maintenance of anaesthesia in infants and children. It is administered by inhalation (see the desflurane SPCs).

During general anaesthesia, several different types of medicines are given together (including anaesthetics, opioids and neuromuscular blocking agents). Anaesthesia is usually induced with an intravenously administered anaesthetic (such as propofol), but an inhaled volatile anaesthetic (such as sevoflurane) is sometimes used. Anaesthesia is then maintained with an intravenous or inhaled anaesthetic (such as desflurane, isoflurane or sevoflurane). Total intravenous anaesthesia (TIVA) is a technique in which surgery or procedures are carried out with all anaesthetic drugs given intravenously (see the BNF treatment summary for anaesthesia).

Desflurane has a global warming potential 2,500 times greater than carbon dioxide, which is significantly higher than alternative volatile anaesthetic agents (Sherman et al. 2012). It is the first medicine to be decommissioned by the NHS in England because of global warming potential. The purpose of this evidence summary is to support the implementation of the national policy to stop routine use of desflurane in anaesthetic practice in the NHS in England by early 2024 (Greener NHS Putting anaesthetic emissions to bed: commitment on desflurane, 13 January 2023). The evidence summary will inform decision making and, if necessary, guidance development on any exceptional circumstances where continuing to use desflurane is acceptable to ensure patient outcomes are not compromised.

The evidence review summarises the best available evidence on the clinical and cost benefits of using desflurane for maintenance of anaesthesia compared with other general anaesthetic agents in:

The scope of the evidence review was agreed by NHS England, the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. The 2 populations included within the scope of the review were identified by NHS England from extensive clinical engagement and consultation with experts. These 2 populations have been most frequently and consistently raised by anaesthetists within the NHS in England as cases where patient outcomes and use of NHS resources could possibly benefit from the use of desflurane over alternatives and, therefore, where an evidence review into the use of desflurane would be most beneficial.