Top

Published in:

03-09-2022 | Anesthetics | Special Issue Insight

Volatile anesthetics for ICU sedation: the future of critical care or niche therapy?

Authors: Jeremy R. Beitler, Daniel Talmor

Published in: Intensive Care Medicine | Issue 10/2022

Excerpt

The first widely publicized use of an inhaled anesthetic, in the mid-nineteenth century, details several patients who achieved not general anesthesia but rather a depth of sedation routinely targeted today in ventilator-dependent patients in the intensive care unit (ICU) [1]. As Henry Jacob Bigelow writes in 1846 on the effects of inhaled ether [1]:

“The phenomena of the lethargic state are not such as to lead the observer to infer this insensibility. Almost all patients under the dentist’s hands scowl or frown; some raise the hand. … Many patients open the mouth, or rise themselves in the chair, upon being directed to do so.”

…

Bigelow HJ (1846) Insensibility during surgical operations produced by inhalation. Boston Med Surg J 35:309–317CrossRef

Meiser A, Volk T, Wallenborn J et al (2021) Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: an open-label, phase 3, randomised controlled, non-inferiority trial. Lancet Respir Med 9:1231–1240CrossRef

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 32:2241–2246CrossRef

Bellgardt M, Georgevici AI, Klutzny M et al (2019) Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial. Ann Intensive Care 9:118CrossRef

Sackey PV, Radell PJ, Granath F, Martling CR (2007) Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients. Anaesth Intensive Care 35:348–356CrossRef

Jabaudon M, Boucher P, Imhoff E et al (2017) Sevoflurane for sedation in acute respiratory distress syndrome: a randomized controlled pilot study. Am J Respir Crit Care Med 195:792–800. https://doi.org/10.1164/rccm.201604-0686OCCrossRefPubMed

Röhm KD, Wolf MW, Schöllhorn T et al (2008) Short-term sevoflurane sedation using the Anaesthetic Conserving Device after cardiothoracic surgery. Intensive Care Med 34:1683. https://doi.org/10.1007/s00134-008-1157-xCrossRefPubMed

Belda JF, Soro M, Badenes R et al (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 106:1207–1214. https://doi.org/10.1213/ane.0b013e31816782ffCrossRefPubMed

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 33:585–590CrossRef

10.

Herzog-Niescery J, Vogelsang H, Gude P et al (2019) Environmental safety: air pollution while using MIRUS™ for short-term sedation in the ICU. Acta Anaesthesiol Scand 63:86–92. https://doi.org/10.1111/aas.13222CrossRefPubMed

11.

Bomberg H, Veddeler M, Volk T et al (2018) Volumetric and reflective device dead space of anaesthetic reflectors under different conditions. J Clin Monit Comput 32:1073–1080. https://doi.org/10.1007/s10877-018-0105-8CrossRefPubMed

12.

Sturesson LW, Bodelsson M, Jonson B, Malmkvist G (2014) Anaesthetic conserving device AnaConDa®: dead space effect and significance for lung protective ventilation. Br J Anaesth 113:508–514. https://doi.org/10.1093/bja/aeu102CrossRefPubMed

13.

Bomberg H, Meiser F, Daume P et al (2019) Halving the volume of AnaConDa: evaluation of a new small-volume anesthetic reflector in a test lung model. Anesth Analg 129:371–379. https://doi.org/10.1213/ANE.0000000000003452CrossRefPubMed

14.

Morán I, Bellapart J, Vari A, Mancebo J (2006) Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange. Intensive Care Med 32:524–531. https://doi.org/10.1007/s00134-006-0073-1CrossRefPubMed

15.

Patel SB, Kress JP (2012) Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med 185:486–497. https://doi.org/10.1164/rccm.201102-0273CICrossRefPubMed

16.

Mesnil M, Capdevila X, Bringuier S et al (2011) Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 37:933–941. https://doi.org/10.1007/s00134-011-2187-3CrossRefPubMed

17.

Müller-Wirtz LM, Behne F, Kermad A et al (2022) Isoflurane promotes early spontaneous breathing in ventilated intensive care patients: a post hoc subgroup analysis of a randomized trial. Acta Anaesthesiol Scand 66:354–364. https://doi.org/10.1111/aas.14010CrossRefPubMed

18.

Dzierba AL, Khalil AM, Derry KL et al (2021) Discordance between respiratory drive and sedation depth in critically ill patients receiving mechanical ventilation. Crit Care Med 49:2090–2101. https://doi.org/10.1097/CCM.0000000000005113CrossRefPubMed

19.

Jerath A, Parotto M, Wasowicz M, Ferguson ND (2016) Volatile anesthetics. is a new player emerging in critical care sedation? Am J Respir Crit Care Med 193:1202–1212. https://doi.org/10.1164/rccm.201512-2435CPCrossRefPubMed

20.

FDA Product Label Suprane (Desflurane). www.accessdata.fda.gov/drugsatfda_docs/label/2009/020118s016lbl.pdf

21.

Meiser A, Sirtl C, Bellgardt M et al (2003) Desflurane compared with propofol for postoperative sedation in the intensive care unit. Br J Anaesth 90:273–280. https://doi.org/10.1093/bja/aeg059CrossRefPubMed

22.

Sneyd JR (2022) Avoiding kidney damage in ICU sedation with sevoflurane: use isoflurane instead. Br J Anaesth 129(1):7–10. https://doi.org/10.1016/j.bja.2022.02.031CrossRefPubMed

23.

L’Heudé M, Poignant S, Elaroussi D et al (2019) Nephrogenic diabetes insipidus associated with prolonged sedation with sevoflurane in the intensive care unit. Br J Anaesth 122:e73–e75. https://doi.org/10.1016/j.bja.2019.02.009CrossRefPubMed

24.

Chabanne R, Perbet S, Futier E et al (2014) Impact of the anesthetic conserving device on respiratory parameters and work of breathing in critically ill patients under light sedation with sevoflurane. Anesthesiology 121:808–816. https://doi.org/10.1097/ALN.0000000000000394CrossRefPubMed

25.

Bailly P, Egreteau P-Y, Ehrmann S et al (2021) Inased (inhaled sedation in ICU) trial protocol: a multicentre randomised open-label trial. BMJ Open 11:e042284. https://doi.org/10.1136/bmjopen-2020-042284CrossRefPubMedPubMedCentral

26.

Blondonnet R, Simand L-A, Vidal P et al (2022) Design and rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) randomized controlled trial. J Clin Med 11:2796. https://doi.org/10.3390/jcm11102796CrossRefPubMedPubMedCentral

27.

National Library of Medicine (2022) Efficacy and Safety of Inhaled Isoflurane Delivered Via the Sedaconda ACD-S Compared to Intravenous Propofol for Sedation of Mechanically Ventilated Intensive Care Unit Adult Patients (INSPiRE-ICU2). Identifier NCT05327296. https://clinicaltrials.gov/ct2/show/NCT05327296

28.

National Library of Medicine (2022) Efficacy and Safety of Inhaled Isoflurane Delivered Via the Sedaconda ACD-S Compared to Intravenous Propofol for Sedation of Mechanically Ventilated Intensive Care Unit Adult Patients (INSPiRE-ICU1). Identifier NCT05312385. https://clinicaltrials.gov/ct2/show/NCT05312385

29.

O’Gara B, Talmor D (2016) Lung protective properties of the volatile anesthetics. Intensive Care Med 42:1487–1489. https://doi.org/10.1007/s00134-016-4429-xCrossRefPubMedPubMedCentral

30.

Fukazawa K, Lee HT (2014) Volatile anesthetics and AKI: risks, mechanisms, and a potential therapeutic window. J Am Soc Nephrol 25:884–892. https://doi.org/10.1681/ASN.2013111215CrossRefPubMedPubMedCentral

31.

Stollings LM, Jia L-J, Tang P et al (2016) Immune modulation by volatile anesthetics. Anesthesiology 125:399–411. https://doi.org/10.1097/ALN.0000000000001195CrossRefPubMed

Title: Volatile anesthetics for ICU sedation: the future of critical care or niche therapy?
Authors: Jeremy R. Beitler
Daniel Talmor
Publication date: 03-09-2022
Publisher: Springer Berlin Heidelberg
Keywords: Anesthetics
Anesthetics
Published in: Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06842-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Volatile anesthetics for ICU sedation: the future of critical care or niche therapy?

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 10/2022

How to improve intubation in the intensive care unit. Update on knowledge and devices

Machines that save lives in intensive care: why a special issue in ICM?

EEG monitoring after cardiac arrest

Electroencephalogram in the intensive care unit: a focused look at acute brain injury

Machines that help machines to help patients: optimising antimicrobial dosing in patients receiving extracorporeal membrane oxygenation and renal replacement therapy using dosing software

Update on prevention of intra-vascular accesses complications