Short-term sevoflurane sedation using the Anaesthetic Conserving Device after cardiothoracic surgery

• Published in: Intensive care medicine Vol. 34; no. 9; pp. 1683 - 1689
• Main Authors: Röhm, Kerstin D., Wolf, Michael W., Schöllhorn, Thilo, Schellhaass, Alexander, Boldt, Joachim, Piper, Swen N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2008; Springer; Springer Nature B.V
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anesthesiology - instrumentation; Anesthetics, Inhalation; Anesthetics, Intravenous; Biological and medical sciences; Coronary Artery Bypass; Critical Care Medicine; Deep Sedation - methods; Emergency Medicine; Equipment Design; Female; Humans; Hypnotics. Sedatives; Intensive; Intensive care medicine; Intensive Care Units; Intraoperative Care; Length of Stay; Male; Medical sciences; Medicine; Medicine & Public Health; Methyl Ethers; Middle Aged; Neuropharmacology; Original; Pain Medicine; Pediatrics; Pharmacology. Drug treatments; Pneumology/Respiratory System; Postoperative Period; Propofol; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Single-Blind Method; Sevoflurane; Propofol; Sedation; Volatile anaesthetics; Intensive care unit; Anaesthetic Conserving Device; Volatile compound; Short term; Intensive care; General anesthetic; Surgery; Sevoflurane . Propofol; Resuscitation; Halogen Organic compounds
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-008-1157-x

Objective We evaluated the procedure of postoperative inhalational sedation with sevoflurane using the Anaesthetic Conserving Device (ACD) with regard to recovery times, feasibility and consumption of anaesthetics in comparison to propofol. Design and setting Prospective, randomised, single-blinded, controlled study in a surgical intensive care unit (ICU) of a 1,000-bed academic hospital. Patients and interventions A total of 70 patients after elective coronary artery bypass graft surgery either received sevoflurane via ACD ( n  = 35) or propofol ( n  = 35) for short-term postoperative sedation in the ICU. Measurements and main results The primary endpoint was extubation time from termination of sedation. Recovery times, consumption of anaesthetics, endtidal sevoflurane concentrations, length of ICU and hospital stay, and side effects were documented. Mean recovery times were significantly shorter with sevoflurane than with propofol (extubation time: 22 vs. 151 min; following commands: 7 vs. 42 min). The mean (SD) sevoflurane consumption was 3.2 ± 1.4 mL/h to obtain mean endtidal concentrations of 0.76 vol%. No serious complications occurred during sedation with either sedative drug. The length of ICU stay was comparable in both groups, but hospital length of stay was significantly shorter in the sevoflurane group. Drug costs (in Euro) for sedation per patient were similar in both groups (sevoflurane: 15.1 ± 9.5 €; propofol: 12.5 ± 5.8 €), while sevoflurane sedation costs that included use of the ACD were significantly higher. Conclusions Sevoflurane administration via ACD is an effective and safe alternative to propofol to provide postoperative short-term ICU sedation. Recovery from sedation was facilitated with sevoflurane instead of propofol and resulted in shorter extubation and ventilator times. Descriptor Neurology/sedation, Sedation and anaesthesia.