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Published in: Intensive Care Medicine 7/2009

01-07-2009 | Original

Short-term evaluation of sedation with sevoflurane administered by the anesthetic conserving device in critically ill patients

Authors: Maurizio Migliari, Giacomo Bellani, Roberto Rona, Stefano Isgrò, Beatrice Vergnano, Tommaso Mauri, Nicolò Patroniti, Antonio Pesenti, Giuseppe Foti

Published in: Intensive Care Medicine | Issue 7/2009

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Abstract

Purpose

Assessing feasibility and physiological effects of sedation with sevoflurane, administered with the anesthetic conserving device (AnaConDa), in comparison with propofol and remifentanil.

Methods

Seventeen patients undergoing mechanical ventilation underwent sedation with sevoflurane delivered with AnaConDa (phase SevAn), preceded and followed by sedation with propofol and remifentanil (phases ProRe1, ProRe2), with the same sedation targets.

Results

With both strategies it was possible to achieve the sedation targets. Time required to sedate and awake patients was greater during SevAn than ProRe1: respectively, 3.3 ± 3.0 versus 8.9 ± 6.1 and 7.47 ± 5.05 versus 16.3 ± 11.4 min. During SevAn the PaCO2 and minute ventilation increased. Hemodynamics was stable between ProRe1 and SevAn, except for an increase in heart rate in the SevAn phase. Environmental pollution from sevoflurane was within the safety limits.

Conclusions

Sevoflurane can be effectively and safely used for short-term sedation of ICU patients with stable hemodynamic conditions.
Literature
1.
2.
go back to reference Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141PubMedCrossRef Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141PubMedCrossRef
3.
go back to reference Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ (2000) Sedation in the intensive care unit: a systematic review. JAMA 283:1451–1459PubMedCrossRef Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ (2000) Sedation in the intensive care unit: a systematic review. JAMA 283:1451–1459PubMedCrossRef
4.
go back to reference Ebert TJ (2006) Inhalation Anesthesia. In: Barash PG, Cullen BF, Stoelting RK (eds) Clinical anesthesia. Lippincott Williams & Wilkins, Philadelphia, pp 384–420 Ebert TJ (2006) Inhalation Anesthesia. In: Barash PG, Cullen BF, Stoelting RK (eds) Clinical anesthesia. Lippincott Williams & Wilkins, Philadelphia, pp 384–420
5.
go back to reference Patel SS, Goa KL (1996) Sevoflurane. A review of its pharmacodynamic and pharmacokinetic properties and its clinical use in general anaesthesia. Drugs 51:658–700PubMedCrossRef Patel SS, Goa KL (1996) Sevoflurane. A review of its pharmacodynamic and pharmacokinetic properties and its clinical use in general anaesthesia. Drugs 51:658–700PubMedCrossRef
6.
go back to reference Sackey PV, Martling CR, Granath F, Radell PJ (2004) Prolonged isoflurane sedation of intensive care unit patients with the anesthetic conserving device. Crit Care Med 32:2241–2246PubMed Sackey PV, Martling CR, Granath F, Radell PJ (2004) Prolonged isoflurane sedation of intensive care unit patients with the anesthetic conserving device. Crit Care Med 32:2241–2246PubMed
7.
go back to reference Rohm KD, Wolf MW, Schollhorn T, Schellhaass A, Boldt J, Piper SN (2008) Short-term sevoflurane sedation using the anaesthetic conserving device after cardiothoracic surgery. Intensive Care Med 34:1683–1689PubMedCrossRef Rohm KD, Wolf MW, Schollhorn T, Schellhaass A, Boldt J, Piper SN (2008) Short-term sevoflurane sedation using the anaesthetic conserving device after cardiothoracic surgery. Intensive Care Med 34:1683–1689PubMedCrossRef
8.
go back to reference Belda JF, Soro M, Badenes R, Meiser A, Garcia ML, Aguilar G, Marti FJ (2008) The predictive performance of a pharmacokinetic model for manually adjusted infusion of liquid sevofluorane for use with the anesthetic-conserving device (AnaConDa): a clinical study. Anesth Analg 106:1207–1214PubMedCrossRef Belda JF, Soro M, Badenes R, Meiser A, Garcia ML, Aguilar G, Marti FJ (2008) The predictive performance of a pharmacokinetic model for manually adjusted infusion of liquid sevofluorane for use with the anesthetic-conserving device (AnaConDa): a clinical study. Anesth Analg 106:1207–1214PubMedCrossRef
9.
go back to reference Meyer JU, Kullik G, Wruck N, Kuck K, Manigel J (2008) Advanced technologies and devices for inhalational anesthetic drug dosing. Handb Exp Pharmacol 182:451–470 Meyer JU, Kullik G, Wruck N, Kuck K, Manigel J (2008) Advanced technologies and devices for inhalational anesthetic drug dosing. Handb Exp Pharmacol 182:451–470
10.
go back to reference Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRef
11.
go back to reference Singh H (1999) Bispectral index (BIS) monitoring during propofol-induced sedation and anaesthesia. Eur J Anaesthesiol 16:31–36PubMed Singh H (1999) Bispectral index (BIS) monitoring during propofol-induced sedation and anaesthesia. Eur J Anaesthesiol 16:31–36PubMed
12.
go back to reference Rossi A, Polese G, Milic-Emili J (1998) Monitoring respiratory mechanics in ventilator-dependent patients. In: Tobin M (ed) Principles and practice of intensive care monitoring. McGraw Hill, New York, pp 553–596 Rossi A, Polese G, Milic-Emili J (1998) Monitoring respiratory mechanics in ventilator-dependent patients. In: Tobin M (ed) Principles and practice of intensive care monitoring. McGraw Hill, New York, pp 553–596
13.
go back to reference Sackey PV, Martling CR, Nise G, Radell PJ (2005) Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the anesthetic conserving device. Crit Care Med 33:585–590PubMedCrossRef Sackey PV, Martling CR, Nise G, Radell PJ (2005) Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the anesthetic conserving device. Crit Care Med 33:585–590PubMedCrossRef
14.
go back to reference Accorsi A, Valenti S, Barbieri A, Raffi GB, Violante FS (2003) Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels. Int Arch Occup Environ Health 76:129–136PubMed Accorsi A, Valenti S, Barbieri A, Raffi GB, Violante FS (2003) Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels. Int Arch Occup Environ Health 76:129–136PubMed
15.
go back to reference Malan TP Jr, DiNardo JA, Isner RJ, Frink EJ Jr, Goldberg M, Fenster PE, Brown EA, Depa R, Hammond LC, Mata H (1995) Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology 83:918–928PubMedCrossRef Malan TP Jr, DiNardo JA, Isner RJ, Frink EJ Jr, Goldberg M, Fenster PE, Brown EA, Depa R, Hammond LC, Mata H (1995) Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology 83:918–928PubMedCrossRef
16.
go back to reference Yeo ST, Holdcroft A, Yentis SM, Stewart A (2007) Analgesia with sevoflurane during labour: i. Determination of the optimum concentration. Br J Anaesth 98:105–109PubMedCrossRef Yeo ST, Holdcroft A, Yentis SM, Stewart A (2007) Analgesia with sevoflurane during labour: i. Determination of the optimum concentration. Br J Anaesth 98:105–109PubMedCrossRef
17.
go back to reference Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network (2000) N Engl J Med 342:1301–1308 Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network (2000) N Engl J Med 342:1301–1308
Metadata
Title
Short-term evaluation of sedation with sevoflurane administered by the anesthetic conserving device in critically ill patients
Authors
Maurizio Migliari
Giacomo Bellani
Roberto Rona
Stefano Isgrò
Beatrice Vergnano
Tommaso Mauri
Nicolò Patroniti
Antonio Pesenti
Giuseppe Foti
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1414-7

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