Journal Article

Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam

Mesnil, Malcie, Roustan, Jean-Paul, Capdevila, Xavier, Bringuier, Sophie, Falquet, Yoan, Chanques, Gerald, Charbit, Jonathan, Jaber, Samir, Trine, Pierre-Olivier

2011

Overview

Purpose To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (IV) sedation with propofol or midazolam. Methods Randomized controlled trial. Sixty intensive care unit (ICU) patients expected to require more than 24 h sedation were randomly assigned to one of three groups: group S, inhaled sevoflurane; group P, IV propofol; group M, IV midazolam. All patients also received IV remifentanil for goal-directed sedation (Ramsay scale and pain score) until extubation or for a maximum of 96 h. Primary end points were wake-up times and extubation delay from termination of sedative administration. Proportion of time within Ramsay score 3–4, IV morphine consumption at 24 h post extubation, hallucination episodes after end of sedation, adverse events, inorganic fluoride plasma levels, and ambient sevoflurane concentrations were recorded. Results Forty-seven patients were analyzed. Wake-up time and extubation delay were significantly ( P  < 0.01) shorter in group S (18.6 ± 11.8 and 33.6 ± 13.1 min) than in group P (91.3 ± 35.2 and 326.11 ± 360.2 min) or M (260.2 ± 150.2 and 599.6 ± 586.6 min). Proportion of time within desired interval of sedation score was comparable between groups. Morphine consumption during the 24 h following extubation was lower in group S than in groups P and M. Four hallucination episodes were reported in group P, five in group M, and none in group S ( P  = 0.04). No hepatic or renal adverse events were reported. Mean plasma fluoride value was 82 μmol l −1 (range 12–220 μmol l −1 ), and mean ambient sevoflurane concentration was 0.3 ± 0.1 ppm. Conclusions Long-term inhaled sevoflurane sedation seems to be a safe and effective alternative to IV propofol or midazolam. It decreases wake-up and extubation times, and post extubation morphine consumption, and increases awakening quality.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adult / Anesthesia / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Anesthesiology / Anesthetics, Inhalation - administration & dosage / Anesthetics, Inhalation - adverse effects / Anesthetics, Inhalation - therapeutic use / Anesthetics, Intravenous - administration & dosage / Anesthetics, Intravenous - adverse effects / Anesthetics, Intravenous - therapeutic use / Biological and medical sciences / Clinical death. Palliative care. Organ gift and preservation / Comparative analysis / Critical care / Critical Care Medicine / Emergency Medicine / Extubation / Female / Fluorides / Hallucinations / Hospital patients / Humans / Hyperthermia / Hypnotics and Sedatives - administration & dosage / Hypnotics and Sedatives - adverse effects / Hypnotics and Sedatives - therapeutic use / Intensive / Intensive care / Intensive care medicine / Intensive Care Units / Male / Medical sciences / Medicine / Medicine & Public Health / Methyl Ethers - administration & dosage / Methyl Ethers - adverse effects / Methyl Ethers - therapeutic use / Midazolam - administration & dosage / Midazolam - adverse effects / Midazolam - therapeutic use / Middle Aged / Morphine / Opioids / Original / Outcome Assessment, Health Care / Pain Medicine / Patients / Pediatrics / Phenols / Pneumology/Respiratory System / Propofol - administration & dosage / Propofol - adverse effects / Propofol - therapeutic use / Remifentanil / Respiration, Artificial / Sevoflurane / Ventilator Weaning / Ventilators