Desflurane's efficacy, cost and environmental impacts: Considerations for Australian formularies

Desflurane use is declining in Australia, owing to awareness of its environmental impacts, high costs, effective comparator agents and decisions by hospitals and Medicines and Therapeutics Committees (MTCs) to restrict its use. At a roundtable in June 2024, the Council of Australian Therapeutic Advisory Groups (CATAG) agreed to establish an expert advisory group (EAG) to review evidence on desflurane and provide recommendations for its use in Australian hospitals. The Position Statement on the formulary listing of desflurane was released in March 2025. This article provides the evidence review, alongside recommendations, with updates demonstrating continued progress on the reduction of desflurane use. The review found that desflurane is similar to sevoflurane in its clinical efficacy and safety profile, with desflurane demonstrating modest improvements in extubation times that do not translate to reduced stay in the post-anaesthesia care unit or a reduction in complications. In addition, desflurane is a greenhouse gas, with an impact 40-50 times that of sevoflurane. The review also found that cost savings accompany policies to curtail the use of desflurane in health services. The EAG agreed to the following recommendations, which were endorsed by CATAG: 1. Health Service Organisations and MTCs should consider not listing desflurane on hospital or state-based formularies; 2. Health Service Organisations and MTCs should undertake consultation and planning prior to removal of desflurane from theatres; 3. MTCs may consider establishing limited provisions for exceptional use of desflurane based on clinical need.