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♦️ Introduction
なっちゃんWe have both Sevo and Des in our OR, but how do you tell them apart? How do you decide which to use??
I received that question, so this time I put together a short, easy summary of the differences between desflurane and sevoflurane — two inhalational anesthetics commonly used in the OR — and how they are used in daily practice.
♦️ First, the conclusion up front 😊
Before getting into the academic details, I’ll say this: sometimes it really does come down to individual anesthesiologists’ preferences… 😅. That said, those preferences are usually based on the items below 👍.
- When you want fast induction and emergence
- 👉 desflurane. Be careful: rapidly increasing its concentration can cause airway stimulation (cough) or circulatory responses, so watch out. (That said, sevoflurane is still plenty fast compared with older inhaled agents.)
- When you want mask induction, or for pediatrics, or when you want to avoid airway stimulation
- 👉 sevoflurane. Induction is smooth and easy to manage. Because desflurane can be airway-irritating, we do not use it for slow/mild mask inductions.
- When environmental impact is a concern
- 👉 prefer sevoflurane (desflurane has a larger greenhouse effect, though in practice the impact is quite small).
- Low-flow anesthesia is possible with both agents, but there are agent-specific caveats (described below).
♦️ Quick comparison
☝️ At first, you don’t need to memorize numbers—just grasp the meanings.
🔷 Key points about desflurane
- MAC (required concentration) is relatively high, but it is poorly soluble in blood (i.e., it does not accumulate in the body).
- Therefore, both induction and emergence are very fast.
- It is minimally metabolized (very low metabolism), so risk of organ toxicity is extremely low.
- However, at high concentrations it can irritate the airway and stimulate the circulation.
🔷 Key points about sevoflurane
- MAC is lower than desflurane, and because it is less irritating to the airway, it is suitable for mask induction.
- Its metabolism is modestly higher than desflurane, and historically there has been discussion about a by-product (Compound A) during low-flow use. Although many reports suggest clinically significant harm is uncommon, you should still follow label warnings.
🔷 Detailed comparison (approximate adult values; see references for details)
| MAC (adult, ~40-year old) | ~ 6.0–6.5% | ~ 2.0–2.1% | Don’t judge by % alone—use age-adjusted eMAC. |
| Blood/gas partition coefficient (solubility) | 0.42 (very low) | 0.69 (low) | Des is less soluble → faster induction/emergence. |
| Metabolic rate | almost 0% (<0.02%) | ~3% | Desflurane is metabolized negligibly. |
| Induction/emergence speed | very fast | fast but slower than des | If early awakening is a priority, desflurane is advantageous. |
| Airway irritation | yes (cough/laryngeal reflex possible at high conc.) | minimal | Sevo is easier for mask induction/pediatrics. |
| Low-flow anesthesia cautions | Risk of CO formation (with dry, strong base CO₂ absorbents) | Compound A caution (follow label & flow recommendations) | Manage absorbent and FGF policies strictly. |
| Vaporizer / equipment | Often requires a dedicated heated/pressurized vaporizer | Usable with general vaporizers | Check machine specs and standardize practice. |
| Environmental impact (GWP100) | **~ 2,540** | **~ 130** | Desflurane has a much higher GWP—check facility policy. |
| Typical indications | Adults where early emergence is desired; obese patients; long cases where rapid recovery is beneficial | Pediatrics; mask induction; patients with high airway reactivity | Choose by clinical situation and facility policy. |
♦️ When would you pick one or the other?
☝️ If mask/inhalational induction is needed (pediatrics, etc.)
さらりーまんSevoflurane is chosen. Because it’s less irritating to the airway, mask induction is smooth.
☝️ If rapid emergence is desired (obesity, elderly, ambulatory/day surgery, etc.)
さらりーまんDesflurane is often advantageous. Emergence and time to extubation tend to be shorter (though sevoflurane is also acceptable).
☝️ For long operations or where deep anesthesia is required
さらりーまんEither agent can be used, but desflurane’s low tissue solubility means it accumulates less and maintains a ‘cleaner’ offset after long cases.
☝️ When environmental policy or facility rules are strict
さらりーまんConsider sevoflurane or TIVA. Desflurane’s GWP is high, and some institutions—especially overseas—have limited its use.
📝 Summary (Take-home points)
- If induction/emergence speed matters → desflurane (but do not increase concentration rapidly).
- For mask induction / pediatrics → sevoflurane (airway friendly).
- Low-flow anesthesia is useful, but observe agent-specific precautions: sevoflurane → Compound A; desflurane → CO risk with certain absorbents.
- Environmental impact is another factor; follow your facility’s policy (in Japan, desflurane is still commonly used, but this may differ overseas).
🔗 Related articles
📚 References & Further reading
- StatPearls — “Desflurane”
- Useful for quick checks of blood/gas coefficients, MAC, metabolism, etc.
- StatPearls — “Anesthetic Gases”
- Useful reference tables on blood/gas, MAC, vaporizers, etc.
- Wissing H. et al., 2001 — Carbon monoxide production from desflurane, enflurane, … (PubMed)
- Experimental demonstration of CO generation under dry absorbent conditions; desflurane showed notable CO production.
- Coppens MJ. et al., 2006 — Mechanisms of CO production (Association of Anaesthetists / review)
- Review of mechanisms under dry absorbent conditions and clinical prevention measures (absorbent management, FGF strategies).
- ASA statement — “Statement on the Use of Low Gas Flows for Sevoflurane” (2023)
- Society guidance on low-flow use of sevoflurane and operational considerations.
- NHS England guidance — “Desflurane decommissioning and clinical use” (2024)
- Describes policy moves toward phased reduction of desflurane use and practical conditions for limited use.
- NOAHRM / Health campaign article — “UK healthcare leads the phase-out of desflurane” (summary)
- Short summary of policy background (NHS trend) based on GWP considerations.
- Recent reviews/meta-analyses on recovery times (desflurane vs sevoflurane) — e.g., Hu et al., BJAnesthesia (2024) / other RCT
- These summarize evidence on extubation and recovery times in specific populations (obesity, ambulatory surgery, etc.).
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