Observations on the Effects of Inhaled Isoflurane in Long-term Sedation of Critically Ill Children Using a Modified AnaConDa©-System

Abstract

Long-term intravenous sedation may present problems due to dependence and side effects. Medical records of children who were administered isoflurane were reviewed. 15 patients (9 boys, 6 girls) with a mean age of 11.8 month (+2.4) were analysed.Analgesia and sedation was given in mean 9.7+1.1 days before commencing inhalation using a modified application device (AnaConDa©). Administration was given over a period of 7.2+1.4 days. Depth of sedation was monitored by using Comfort- and Hartwig-scores. Observations included continuous monitoring of heart-rate, pulse oxymetry, blood pressure and cerebral tissue oxygenation.Within 4 h post administration of isoflurane a satisfactory increase in the depth of sedation was seen and kept till extubation. 6/15 patients received tracheostomies during the observation period. None of the patients observed suffered life-critical events of the modified application of isoflurane proceeded without complications. Ketamine and clonidine infusion rates were significantly reduced (p<0.005) as well as the use and overall infusion rate of midazolam, γ-hydroxy butyrate, fentanyl and morphine (p<0.05).Isoflurane inhalation may provide an additional option for long-term sedation in a specific group of critically ill infants but neurodegenerative toxic effects will have to be taken into account when using volatile anesthetics at any time during infancy.

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

“…15,17,20,22 However, Eifinger et al did not report hypotension in their 15 patients. 21 We recorded hemodynamic parameters very thoroughly in our patients, and found that mean arterial blood pressure decreased in all patients within 24 hours after the start of isoflurane sedation. This decrease was most significant during the first 4 hours after initiation of LTIS.…”

“…17 More recently, 2 studies with larger pediatric cohorts showed that this approach is feasible in the PICU. 15,21 However, the vast majority of these patients had extrapulmonary rather than pulmonary diseases requiring long-term mechanical ventilation. One of 3 patients in Sackey's 2005 study had "significant respiratory distress" and responded well to isoflurane sedation.…”

“…17 None of the 15 patients in the study by Eifinger et al had primary pulmonary pathology, and only a small subset of patients (4/23) in the study by Mencia et al were ventilated due to respiratory disease. 15,21 Another 5 infants with severe bronchiolitis due to infection with respiratory syncitial virus (RSV) received LTIS with sevoflurane in the case report series by Nacoti et al 22 Although the period of inhalative sedation was rather short (mean Sevoflurane MAC-hours: 41.2), increased respiratory mechanics and gas exchange could be demonstrated in all 5 patients. Despite of the low patient number, this study is remarkable because bronchial obstruction plays a major role in the pathogenesis of RSV bronchiolitis, and sevoflurane as well as isoflurane are potent bronchodilators.…”

Longitudinal impact on rat cardiac tissue transcriptomic profiles due to acute intratracheal inhalation exposures to isoflurane

“…In conclusion, the present data do not allow us to make determinations about the potential impact on cardiac genes following single (non-repeated) low-dose exposures to ISO as used in many in-patient protocols. On the other hand, repeated ISO use has been employed over time in the sedation of critically Ill children [ 74 ] and in the post-operative intensive care of some cardiac surgery patients [ 75 ]. ISO has also been seen as one of the volatile anesthetic agents for use in long-term critical care sedation (VALTS) of intensive care unit (ICU) patients [ 76 ].…”

The role and mechanism of TLR4-siRNA in the impairment of learning and memory in young mice induced by isoflurane

“…13,14 Isoflurane inhalation can induce hippocampal neuroinflammation and cognitive dysfunction in rats. 15,16 Isoflurane inhalation in children may produce neurodegenerative toxic effect 17 and induce hippocampal apoptosis, 15,18 and its prolonged use in early life is considered to be closely related to cognitive impairment in later life. 19 Isoflurane induced persistent and progressive decrease in hippocampal neural stem cell pool and neurogenesis in the developing brain of young rodents, with significant object recognition and reversal learning impairment which became more obvious as they grew older, whereas similar findings were not observed in adult rodents.…”