Sevoflurane, a sigh of relief in COVID-19?

Nieuwenhuijs-Moeke, Gertrude J.; Jainandunsing, Jayant S.; Struys, Michel

doi:10.1016/j.bja.2020.04.076

Cited by 35 publications

(39 citation statements)

References 25 publications

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“…Second, although a safe neuroprotection strategy is not available, Xu et al suggested a possible treatment with vitamin D as a potential prophylactic, immunoregulatory, and neuroprotective treatment without side effects but further studies are necessary [ 60 ]. The role of sedative agents, such as halogenated vapor, could help to treat COVID-19-related acute respiratory distress syndrome and could exert some neuroprotective effects on the cerebral system [ 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Melegari

Rivi

Zelent

et al. 2021

IJERPH

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The main focus of Coronavirus disease 2019 (COVID-19) infection is pulmonary complications through virus-related neurological manifestations, ranging from mild to severe, such as encephalitis, cerebral thrombosis, neurocognitive (dementia-like) syndrome, and delirium. The hospital screening procedures for quickly recognizing neurological manifestations of COVID-19 are often complicated by other coexisting symptoms and can be obscured by the deep sedation procedures required for critically ill patients. Here, we present two different case-reports of COVID-19 patients, describing neurological complications, diagnostic imaging such as olfactory bulb damage (a mild and unclear underestimated complication) and a severe and sudden thrombotic stroke complicated with hemorrhage with a low-level cytokine storm and respiratory symptom resolution. We discuss the possible mechanisms of virus entrance, together with the causes of COVID-19-related encephalitis, olfactory bulb damage, ischemic stroke, and intracranial hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Melegari

Rivi

Zelent

et al. 2021

IJERPH

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“…To the best of our knowledge, no studies have investigated the effect of isoflurane sedation in patients suffering from C-ARDS so far, and it remains understudied whether the observed pathophysiologic pulmonary abnormalities, such as exudative and proliferative phases of a diffuse alveolar injury, might have an impact on the feasibility of volatile sedation ( 25 – 27 ). As increasingly discussed, inhalation of volatile anesthetics might be of some benefit in COVID-19–infected patients ( 2 , 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the potential benefits of sedation using volatile anesthetics in COVID-19–induced acute respiratory distress syndrome (C-ARDS) have been increasingly discussed ( 2 , 3 ).…”

mentioning

confidence: 99%

Volatile Isoflurane in Critically Ill Coronavirus Disease 2019 Patients—A Case Series and Systematic Review

Flinspach

Zacharowski

Ioanna

et al. 2020

Critical Care Explorations

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Objectives: The ongoing coronavirus pandemic is challenging, especially in severely affected patients who require intubation and sedation. Although the potential benefits of sedation with volatile anesthetics in coronavirus disease 2019 patients are currently being discussed, the use of isoflurane in patients with coronavirus disease 2019–induced acute respiratory distress syndrome has not yet been reported. Design: We performed a retrospective analysis of critically ill patients with hypoxemic respiratory failure requiring mechanical ventilation. Setting: The study was conducted with patients admitted between April 4 and May 15, 2020 to our ICU. Patients: We included five patients who were previously diagnosed with severe acute respiratory syndrome coronavirus 2 infection. Intervention: Even with high doses of several IV sedatives, the targeted level of sedation could not be achieved. Therefore, the sedation regimen was switched to inhalational isoflurane. Clinical data were recorded using a patient data management system. We recorded demographical data, laboratory results, ventilation variables, sedative dosages, sedation level, prone positioning, duration of volatile sedation and outcomes. Measurements & Main Results: Mean age (four men, one women) was 53.0 (± 12.7) years. The mean duration of isoflurane sedation was 103.2 (± 66.2) hours. Our data demonstrate a substantial improvement in the oxygenation ratio when using isoflurane sedation. Deep sedation as assessed by the Richmond Agitation and Sedation Scale was rapidly and closely controlled in all patients, and the subsequent discontinuation of IV sedation was possible within the first 30 minutes. No adverse events were detected. Conclusions: Our findings demonstrate the feasibility of isoflurane sedation in five patients suffering from severe coronavirus disease 2019 infection. Volatile isoflurane was able to achieve the required deep sedation and reduced the need for IV sedation.

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“…The use of fentanyl (at a dose of 3-5 μg/kg) in patients receiving ritonavir/lopinavir may lead to an increase in the adverse effects of the opioid; therefore, in this case remifentanil could be a valid pharmacological alternative [36,37]. There are no contraindications to the use of halogenates in COVID patients, but special attention should be paid to titrate delivered concentration in hypovolemic, hypotensive, or hemodynamically compromised patients [38,39]. Often in the first phase of COVID-19, patients have good compliance, poor oxygenation, and without dyspnea.…”

Section: General Anesthesiamentioning

confidence: 99%

Anesthetic Consideration for Patients with Corona Virus Disease

Bilotta

Titi

Lazzaro

et al. 2020

Clinical Synopsis of COVID-19

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Suspension of elective surgical procedures was one of the first measures to mitigate hospital overload in anticipation of a surge in demand for critical care services during the COVID-19 pandemic [1-3]: many professional societies have released statements on delaying, restricting, and rescheduling non-urgent procedures, to preserve medical resources including healthcare providers, hospital capacities (mostly ICU resources), and personal protective equipment (PPE) [4,5]. This is an additional effect on healthcare induced by the COVID-19 pandemic and risk/benefit ratio, including consequences related to canceling or postponing the procedure should be considered for each patient.Patients affected by COVID-19 have higher perioperative morbidity and mortality, due to a high rate of ARDS, cardiac injury, kidney failure, and even deaths observed after surgical procedures [6,7]. In COVID-19 patients, who underwent elective or emergency surgery, male gender, age > 70 years, presence of comorbidities [American Society of Anesthesiologists (ASA) grades 3-5], and cancer surgery were associated with an increase of pulmonary complications and 30-day mortality [8]. Furthermore, preexist comorbidities-hypertension, chronic obstructive pulmonary disease, diabetes, and cardiovascular disease-increase susceptibility in developing severe . Higher risk to be infected by COVID-19 and poor outcomes were reported also in immunocompromised and oncologic patients caused by respiratory viral infections: indeed conventional coronaviruses are often associated with higher rates of oxygen requirement and

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Sevoflurane, a sigh of relief in COVID-19?

Cited by 35 publications

References 25 publications

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Volatile Isoflurane in Critically Ill Coronavirus Disease 2019 Patients—A Case Series and Systematic Review

Anesthetic Consideration for Patients with Corona Virus Disease

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