Sevoflurane administration from extracorporeal membrane oxygenation via the AnaConDa device for a patient with COVID-19: A breakthrough solution for the shortage of intravenous anesthetics

Iwasaki, Yudai; Shiga, Tohru; Hoshi, Naoki; Irimada, Daisuke; Saito, Hiroko; Konno, Daisuke; Saito, Koji; Yamauchi, M.

doi:10.1016/j.hrtlng.2022.06.015

Cited by 5 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, volatile anesthetics administration was effective finor ARDS patients undergoing ECMO [ 43 – 45 ]. Volatile anesthetics could be delivered through the mechanical ventilation [ 43 ] or the ECMO [ 44 ] circuits. Inhaled sedation could be used for patients undergoing cardiac surgery with administration of volatile anesthetics through the Sedaconda -ACD connected directly to the extra corporeal circulation [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Use of volatile anesthetics for sedation in the ICU during the COVID-19 pandemic: A national survey in France (VOL’ICU 2 study)

et al. 2022

View full text Add to dashboard Cite

Background The COVID-19 pandemic has increased the number of patients in ICUs leading to a worldwide shortage of the intravenous sedative agents obligating physicians to find alternatives including inhaled sedation. Inhaled sedation in French ICU has been previously explored in 2019 (VOL’ICU study). This survey was designed to explore the use of inhaled sedation two years after our first survey and to evaluate how the COVID-19 pandemic has impacted the use of inhaled sedation. Methods We designed a national survey, contacting medical directors of French ICUs between June and October 2021. Over a 50-item questionnaire, the survey covered the characteristics of the ICU, data on inhaled sedation, and practical aspects of inhaled ICU sedation for both COVID-19 and non-COVID-19 patients. Answers were compared with the previous survey, VOL’ICU. Results Among the 405 ICUs contacted, 25% of the questionnaires were recorded. Most ICU directors (87%) knew about the use of inhaled ICU sedation and 63% of them have an inhaled sedation’s device in their unit. The COVID-19 pandemic increased the use of inhaled sedation in French ICUs. The main reasons said by the respondent were “need for additional sedative” (62%), “shortage of intravenous sedatives” (38%) and “involved in a clinical trial” (30%). The main reasons for not using inhaled ICU sedation were “device not available” (76%), “lack of familiarity” (60%) and “no training for the teams” (58%). More than 70% of respondents were overall satisfied with the use of inhaled sedation. Almost 80% of respondents stated that inhaled sedation was a seducing alternative to intravenous sedation for management of COVID-19 patients. Conclusion The use of inhaled sedation in ICU has increased fastly in the last 2 years, and is frequently associated with a good satisfaction among the users. Even if the COVID-19 pandemic could have impacted the widespread use of inhaled sedation, it represents an alternative to intravenous sedation for more and more physicians.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of volatile anesthetics for sedation in the ICU during the COVID-19 pandemic: A national survey in France (VOL’ICU 2 study)

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A sweep gas (typically blended oxygen) passes through these fibers to facilitate gas exchange (Figure 2 ). Case reports have described successful administration of sevoflurane (using the AnaConDa device)[ 19 ] and isoflurane (using an isoflurane vaporizer)[ 20 ] through direct insertion in the ECMO sweep gas airline, between the blender and the membrane oxygenator. The sweep gas flow rate can be used to calculate the anesthetic consumption and estimate the effective concentration[ 21 ].…”

Section: Administration Considerationsmentioning

confidence: 99%

“…Microporous polypropylene oxygenators may be preferred if delivering volatile anesthetics through the membrane during ECMO support. Modifying the ECMO circuity to deliver anesthetic gas requires careful considerations including a collection system for gas from the membrane gas outlet and any gas from the native expiration of the ventilator[ 19 ].…”

Section: Administration Considerationsmentioning

confidence: 99%

Inhaled volatile anesthetics in the intensive care unit

Wieruszewski,

ElSaban,

Wieruszewski

et al. 2023

World J Crit Care Med

View full text Add to dashboard Cite

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry, providing intensivists with multiple options to tailor therapy. Furthermore, their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy, mitigating risks associated with conventional sedation modalities. Despite the amounting enthusiasm for the use of these therapies, barriers to widespread utilization include expanding equipment availability, staff familiarity and training of safe use. This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology, administration considerations in intensive care settings, complication considerations, and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

show abstract

“…Sedation of ARDS COVID-19 patients became a great challenge. In addition, younger patients with higher sedative requirements and prone positioning, or those undergoing extracorporeal membrane oxygenation (ECMO) [ 23 ], justified the combination of both anesthetic groups (combined with opioid-based analgesics) to facilitate ventilator synchrony and tube tolerance. These facts gave our group the opportunity to design a clinical trial to assess the potential benefit of sedative agents on oxygenation in patients with ARDS due to COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial

Martínez-Castro,

Monleón,

Puig

et al. 2023

JPM

View full text Add to dashboard Cite

Background: Acute respiratory distress syndrome (ARDS) related to COVID-19 (coronavirus disease 2019) led to intensive care units (ICUs) collapse. Amalgams of sedative agents (including volatile anesthetics) were used due to the clinical shortage of intravenous drugs (mainly propofol and midazolam). Methods: A multicenter, randomized 1:1, controlled clinical trial was designed to compare sedation using propofol and sevoflurane in patients with ARDS associated with COVID-19 infection in terms of oxygenation and mortality. Results: Data from a total of 17 patients (10 in the propofol arm and 7 in the sevoflurane arm) showed a trend toward PaO2/FiO2 improvement and the sevoflurane arm’s superiority in decreasing the likelihood of death (no statistical significance was found). Conclusions: Intravenous agents are the most-used sedative agents in Spain, even though volatile anesthetics, such as sevoflurane and isoflurane, have shown beneficial effects in many clinical conditions. Growing evidence demonstrates the safety and potential benefits of using volatile anesthetics in critical situations.

show abstract

Sevoflurane administration from extracorporeal membrane oxygenation via the AnaConDa device for a patient with COVID-19: A breakthrough solution for the shortage of intravenous anesthetics

Cited by 5 publications

References 13 publications

Use of volatile anesthetics for sedation in the ICU during the COVID-19 pandemic: A national survey in France (VOL’ICU 2 study)

Use of volatile anesthetics for sedation in the ICU during the COVID-19 pandemic: A national survey in France (VOL’ICU 2 study)

Inhaled volatile anesthetics in the intensive care unit

Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial

Contact Info

Product

Resources

About