A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa^® device

Abstract

The intensive care unit (ICU) environment is often perceived to be hostile and frightening by patients due to unfamiliar surroundings coupled with presence of numerous personnel, monitors and other equipments as well as a loss of perception of time. Mechanical ventilation and multiple painful procedures that often need to be carried out in these critically ill patients add to their overall anxiety. Sedation is therefore required not only to allay the stress and anxiety, but also to allow for mechanical ventilation and other invasive therapeutic and diagnostic procedures to be performed. The conventional intravenous sedative agents used in ICUs suffer from problems of over sedation, tachyphylaxis, drug accumulation, organ specific elimination and often lead to patient agitation on withdrawal. All this tend to prolong the ventilatory as well as ICU and hospital discharge time, which increase the risk for infection and add to the overall increase in morbidity, mortality and hospital costs. In 2005, the anaesthetic conserving device (AnaConDa®) was marketed for ICU sedation with volatile anaesthetic agents. A number of trials have shown the effectiveness of using volatile anaesthetic agents for ICU sedation with the AnaConDa device. Compared with intravenous sedatives, use of volatile anaesthetic agents have resulted in shorter wake up and extubation time, lesser duration of mechanical ventilation and faster discharge from hospitals. This review shall focus on the benefits, technical pre-requisites and status of sedation with volatile anaesthetic agents in ICUs with the AnaConDa® device.

Sedation practices in the Neurocritical Care Unit

“…Inhalational conserving systems such as AnaConDa ® have been used for sedation in the Neurocritical Care Unit. [46][47][48][49] While targeted sedation levels were reached with isoflurane and sevoflurane, there was no significant increase in ICP in patients with baseline low or normal ICP. [50] However, increase in ICP reduction in MAP and CPP can be expected in certain patients, related to rebreathing of CO 2 within the conserving system, and thus baseline PCO 2 levels are elevated during its use.…”

Volatile Anesthetic Sedation During Therapeutic Hypothermia After Cardiac Arrest in the ICU

“…Hellström et al (5) describe the delivery of volatile anesthetic agents in the ICU with the AnaConDa (Anesthesia Conserving Device), a miniature vaporizer that is inserted between the endotracheal tube and the Y piece of a standard ICU ventilator circuit (described in detail at http://www.sedanamedical.com/aboutanaconda_po.php). The AnaConDa device has been previously used to deliver volatile anesthetics in the ICU environment (11) although this case series is (to the best of our knowledge) the first to describe the use of volatile anesthetics during therapeutic hypothermia after cardiac arrest in humans.…”

Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review

“…(15) The principle of the charcoal filter was further developed, leading to the creation of a device for inhalation sedation AnaConDa TM (Anaesthetic Conserving Device; Sedana Medical, Uppsala, Sweden), which enables sedation and analgesia of patients in ICU with isoflurane and sevoflurane. (16) The Anaesthetic Conserving Device (ACD, AnaConDa TM ) is a modified heat and moisture exchanger, which is inserted between the Y-piece of the breathing circuit and the endotracheal tube (ET-tube) (figure 1) and can be used with any type of ICU ventilator (17,18) without a heated humidifier. The ACD contains active lipophilic carbon fibres, which have the capacity to bind 90% of the expired volatile anaesthetic.…”