Desflurane (DB01189): A Comprehensive Monograph on its Pharmacology, Clinical Utility, and Contemporary Role in Anesthesia

Introduction and Overview

Identity and Classification

Desflurane, identified chemically as (±)1,2,2,2-tetrafluoroethyl difluoromethyl ether, is a highly fluorinated methyl ethyl ether that functions as a volatile liquid general anesthetic.[1] It is classified as an organofluorine compound and is administered clinically as a racemic mixture of its (R) and (S) optical isomers, or enantiomers.[1] As a member of the halogenated ether class of anesthetics, it shares a structural lineage with agents like isoflurane and sevoflurane, but possesses a unique physicochemical profile that defines its distinct clinical behavior.[2]

Historical Context and Development

Desflurane was first synthesized in the 1970s by a team led by Ross Terrell as part of a broad search for non-combustible anesthetic agents.[4] Its development was pursued in the late 1980s by Anaquest (a division of BOC Healthcare) to address a clinical demand for an inhaled anesthetic with more rapid induction and, particularly, faster emergence than the agents available at the time, such as isoflurane and halothane.[3] However, the progression of Desflurane from laboratory synthesis to clinical application was significantly delayed. This was due to formidable challenges posed by its physical properties, namely a very high vapor pressure approaching that of the atmosphere at room temperature and an associated explosive risk during its synthesis process. These hurdles postponed clinical testing until 1988.[5] Following successful trials, Desflurane was granted approval by the U.S. Food and Drug Administration (FDA) on September 18, 1992, a full decade before the widespread adoption of its main competitor, sevoflurane.[3]

Core Clinical Thesis: An Agent of Contrasts