State of the art: Sedation concepts with volatile anesthetics in critically Ill patients

Soukup, Jens; Schärff, Katharina; Kubosch, Kristina; Pohl, C.; Bomplitz, Michael; Kompardt, Jesco

doi:10.1016/j.jcrc.2009.01.003

Cited by 90 publications

(51 citation statements)

References 41 publications

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“…25 Since the launch of the AnaConDa system, the use of sevoflurane and isoflurane has become a more feasible option in Europe, but is still an off-label use in many countries, including the United States. 26,27 The effect of sedation type on the course of ALI is unknown. In this study, we found improved oxygenation and an attenuated pulmonary inflammatory response when sevoflurane was used for sedation versus propofol.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Kellner

Müller

Piegeler

et al. 2017

Anesthesia &Amp; Analgesia

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BACKGROUND Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required. In such patients, usually the first choice an intravenously administered drug. However, growing evidence suggests that volatile anesthetics such as sevoflurane are a valuable alternative. In this study, we evaluate pulmonary and systemic effects of long-term (24-hour) sedation with sevoflurane compared with propofol in an in vivo animal model of ALI. METHODS Adult male Wistar rats were subjected to ALI by intratracheal lipopolysaccharide (LPS) application, mechanically ventilated and sedated for varying intervals up to 24 hours with either sevoflurane or propofol. Vital parameters were monitored, and arterial blood gases were analyzed. Inflammation was assessed by the analysis of bronchoalveolar lavage fluid (BALF), cytokines (monocyte chemoattractant protein-1 [MCP-1], cytokine-induced neutrophil chemoattractant protein-1 [CINC-1], interleukin , IL-12/12a, transforming growth factor-, and IL-10) in blood and lung tissue and inflammatory cells. The alveolocapillary barrier was indirectly assessed by wet-to-dry ratio, albumin, and total protein content in BALF. Results are presented as mean ± standard deviation. RESULTS After 9 hours of ventilation and sedation, oxygenation index was higher in the LPS/sevoflurane (LPS-S) than in the LPS/propofol group (LPS-P) and reached 400 ± 67 versus 262 ± 57 mm Hg after 24 hours (P < .001). Cell count in BALF in sevoflurane-treated animals was lower after 18 hours (P = .001) and 24 hours (P < .001) than in propofol controls. Peak values of CINC-1 and IL-6 in BALF were lower in LPS-S versus LPS-P animals (CINC-1: 2.7 ± 0.7 vs 4.0 ± 0.9 ng/mL; IL-6: 9.2 ± 2.3 vs 18.9 ± 7.1 pg/mL, both P < .001), whereas IL-10 and MCP-1 did not differ. Also messenger RNAs of CINC-1, IL-6, IL-12a, and IL-10 were significantly higher in LPS-P compared with LPS-S. MCP-1 and transforming growth factor-showed no differences. Wet-to-dry ratio was lower in LPS-S (5.4 ± 0.2 vs 5.7 ± 0.2, P = .016). Total protein in BALF did not differ between P-LPS and S-LPS groups. CONCLUSIONS Long-term sedation with sevoflurane compared with propofol improves oxygenation and attenuates the inflammatory response in LPS-induced ALI. Our findings suggest that sevoflurane may improve lung function when used for sedation in patients with ALI. Bacterial lipopolysaccharides (LPSs) are complex glycolipids found on the outer membrane of Gram-negative bacteria 10 and have been utilized to examine in vitro and in vivo inflammatory responses. [10][11][12] Other markers of ALI include endothelial barrier disruption, recruitment and transmigration of neutrophils, and development of a protein-and neutrophil-rich (noncardiogenic) pulmonary edema. [13][14][15][16] According to current guidelines, intravenous propofol, midazolam, and dexmedetomidine are recommended for sustained sedation in critically ill patients. 17,18 However, since the introduction of the Anaesthetic Conserving Device (AnaConDa; S...

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Section: Discussionmentioning

confidence: 99%

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Kellner

Müller

Piegeler

et al. 2017

Anesthesia &Amp; Analgesia

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show abstract

“…Many studies have shown the AnaConDa to be a highly efficient, safe, cost effective, and simple device to use. 1,2,22 There are limited data assessing ambient room contamination, and the optimal scavenging system remains unknown. In accordance with guidance from the manufacturers of AnaConDa and the Canadian Centre for Occupational Health and Safety which governs workplace environmental exposure limits, we used a combined two Deltasorb active scavenging system in conjunction with nine room air exchanges per hour.…”

Section: Discussionmentioning

confidence: 99%

The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report

Pickworth

Jerath

DeVine

et al. 2012

Can J Anesth/J Can Anesth

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“…1,2 Expired gases can be captured using passive charcoal adsorption or active suction-assisted techniques. 3 Our group previously developed an active scavenging system that uses two connected canisters of Deltasorb Ò (Blue-Zone, Concord, ON, Canada) placed between the ICU ventilator's expiratory port and wall-outlet suction. 4 We have shown this system to be highly efficacious for short-term (\ 12 hr) postoperative sedation, with only negligible atmospheric volatile levels present.…”

Section: To the Editormentioning

confidence: 99%

Efficacy of a simple scavenging system for long-term critical care sedation using volatile agent-based anesthesia

Wong

Wąsowicz

Grewal

et al. 2015

Can J Anesth/J Can Anesth

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State of the art: Sedation concepts with volatile anesthetics in critically Ill patients

Cited by 90 publications

References 41 publications

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report

Efficacy of a simple scavenging system for long-term critical care sedation using volatile agent-based anesthesia

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