[SigmaSRNA]

Is it just me or is Dr. Eger seriously pushing desflurane? I really like his book and the DVD set and I've learned alot. I've also learned that desflurane can do no wrong (according to Dr. Eger). Is there anyone who uses des on a regular basis that can give me some NEGATIVES on using this drug. I'm in my 1st year of didactics so I have not used this drug (or any others as a matter of fact).

[rn29306]

desflurane = deathflurane


On a serious note, i really can't stand the stuff. Others swear by it. In talking with CRNAs about this gas, it's mostly an immediate hate thing (perhaps that's me right now) and then after speaking with reps, some like it and others don't. It has been my experience you have to have your narcotics dialed in correctly at the end of the case due to how fast des comes out of your system. If you don't, you will have a consciously hurting patient in PACU.

Out pt surgery centers love the stuff understandably.

Would love to hear from the really experienced CRNAs about des.
Maybe I'm way off here, but this has been my experience.

[Nitecap]

Hey if you want an effective agent that assists in a rapid recovery des is good. Yes you need to stay ontop with opiods or other pain control b/c the pt will wake up fast, sometimes quicker than you anticipate and be hurting. But we all know the volatile agents arent analgesics. A volatile should be chosen to whats best for the pt. If we want rapid recovery b/c we are afraid the pt may not tolerate being so sleepy in PACU then Des isnt such a bad choice but like with any drug largely its how the anesthetist administers and titrates it that has a more signifigant effect on the pt.

[athomas91]

i personally think that all the anesthetics have their pro's and con's and should be used according to the patient...
yeah, i hate that des patients wake up sputtering...
yeah, i hate that iso patients take longer to wake up...
if i had to pick a fav it would be sevo - but i don't use it on long cases due to expense...nor would i use des on long cases for this same reason...
however, i use them all so that my timing is on no matter what agent i choose..

[BigDave]

Originally Posted by SigmaSRNA

Is it just me or is Dr. Eger seriously pushing desflurane? I really like his book and the DVD set and I've learned alot. I've also learned that desflurane can do no wrong (according to Dr. Eger).

Maybe that is why Baxter gave us the book/DVD set for free!

[air]

Originally Posted by athomas91

i personally think that all the anesthetics have their pro's and con's and should be used according to the patient...
yeah, i hate that des patients wake up sputtering...
yeah, i hate that iso patients take longer to wake up...
if i had to pick a fav it would be sevo - but i don't use it on long cases due to expense...nor would i use des on long cases for this same reason...
however, i use them all so that my timing is on no matter what agent i choose..

I had experiemented in changing my agents.

For long cases, I use Iso if it suits the patient. Towards the end, I turn on DES or Ultane. My interest in nitrous is minimal. Some pros use 70% nitrous in the end and keep their patients vented, blow off your agent, then turn off your nitrous keep your oxygen at 6-7 liter flow, 100%. Within two minutes you call the patient's name, the open their eyes and follow commands. Well this applies if they are adequately reversed.

[air]

Originally Posted by SigmaSRNA

Is it just me or is Dr. Eger seriously pushing desflurane? I really like his book and the DVD set and I've learned alot. I've also learned that desflurane can do no wrong (according to Dr. Eger). Is there anyone who uses des on a regular basis that can give me some NEGATIVES on using this drug. I'm in my 1st year of didactics so I have not used this drug (or any others as a matter of fact).

I think ultane is a very benign drug. That kidney issue raised by CAMP SUPRANE is way overblown. In the clinical setting,I have learned to use what my preceptor wants. Some clinical sites have agent preferences mostly related to cost issues

[ltk007]

Sigma...short answer to your statement/question...Yes, Dr Eger does advocate heavily for DES...He basically invented the product and is doing his best to market it....Despite his vested interest in one particular agent, he is still the world authority on IA's/U&D...I agree w/ the others as to the pros/cons of each agent...There is definitely a place for DES in everyday practice, while as a whole I don't find it to be more/less superior than the other VA's

[EmeraldNYL]

Desflurane flows from a fountain where I am doing my clinicals and I have come to love the stuff. A lot of our cases are shorter so the patients always wake up faster and you seem to have faster room turnover because of it. For a longer case I try not to use Des because it is expensive, and then I like to wake my patients up with nitrous.