Sedation in the ICU is necessary, but not without its share of problems. So it is worth paying attention to the people who are trying to find a way forward. One field where progress is being made is using volatile anaesthetics as sedatives, instead of pure intravenous sedation. A good example is Mesnil & co’s study in Intensive Care Medicine in 2011 where they compared sevoflurane to midazolam and propofol for ICU-sedation.
60 patients who were expected to require sedation for more than 24h were randomised to sedation with either midazolam, sevoflurane or propofol. In all groups remifentanyl was used as a secondary sedative. Most important end-points were wake-up time and time to extubation after stopping sedatives.
Sevoflurane, not surprisingly, had significantly shorter wake-up times and extubation delays compared to Propofol and, especially, Midazolam.
Take a look at the midazolam-group. Average time to extubation was 10 hours. Compare that to an average of 30 minutes in the Sevoflurane group.
So, it seems volatile anaesthetics is an interesting alternative to what we are doing now.
More on this tomorrowish ( Yes, I tease…)
Intensive Care Med. 2011 Jun;37(6):933-41. Epub 2011 Mar 29. Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Mesnil M, Capdevila X, Bringuier S, Trine PO, Falquet Y, Charbit J, Roustan JP, Chanques G, Jaber S.