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Original Research

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Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review

  • KARNJUŠ 1
  • MEKIŠ D 2
  • KRIŽMARIĆ M3

1Department of Nursing Faculty of Health Sciences, University of Primorska

2Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor

3Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Maribor

DOI: 10.22514/SV111.052016.1 Vol.11,Issue 1,May 2016 pp.1-24

Published: 02 May 2016

*Corresponding Author(s): KARNJUŠ E-mail: igor.kanjus@fvz.upr.si

Abstract

Background. The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.

Methods. The literature search was limited to PubMed, Sage Journals and CINAHL databases, using the terms »anaesthetic conserving device«, »volatile anaesthetic reflection filter«, »AnaConDa« independently and in connection with the terms »sedation« and intensive care unit«. Included are articles published up until December 2014.

Results. Use of inhalation sedation with the Anaesthetic Conserving Device enables faster transition to spontaneous breathing and a shorter awakening time than with intravenous sedation. Even short-term inhalation sedation of patients after open heart procedures has a cardioprotective effect and reduces troponin T values. Despite increased concentrations of inorganic fluoride in serum after sevoflurane exposure, no clinical studies to date have shown its nephrotoxic effect, even after long-term (48 h) sedation. The Anaesthetic Conserving Device is accurate in maintaining target values of volatile anaesthetics. However, increased dead space volume was found in several studies, exceeding the internal volume of the Anaesthetic Conserving Device.

Conclusion. Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment.

Keywords

anaesthetic conserving device, inhalational sedation, intravenous sedation, intensive care unit

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KARNJUŠ , MEKIŠ D , KRIŽMARIĆ M. Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review. Signa Vitae. 2016. 11(1);1-24.

References

1. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30(1):119-41.

2. Sessler CN, Varney K. Patient-focused sedation and analgesia in the ICU. Chest 2008;133(2):552-65.

3. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41(1):263-306.

4. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 2003;29(9):1417-25.

5. Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 1998;26(5):947-56.

6. Sakai EM, Connolly LA, Klauck JA. Inhalation anesthesiology and volatile liquid anesthetics: focus on isoflurane, desflurane, and sevoflurane. Pharmacotherapy 2005;25(12):1773-88.

7. Sturesson LW, Johansson A, Bodelsson M, Malmkvist G. Wash-in kinetics for sevoflurane using a disposable delivery system (AnaConDa) in cardiac surgery patients. Br J Anaesth 2009;102(4):470-6.

8. Meiser A, Laubenthal H. Inhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit. Best Pract Res Clin Anaesthesiol 2005;19(3):523-38.

9. Shiraishi Y, Ikeda K. Uptake and biotransformation of sevoflurane in humans: a comparative study of sevoflurane with halothane, enflurane, and isoflurane. J Clin Anesth 1990;2(6):381-6.

10. Hornuss C, Firsching M, Dolch M, Martignoni A, Peraud A, Briegel J. Long-term isoflurane therapy for refractory bronchospasm associated with herpes simplex pneumonia in a heart transplant patient. Case Rep Med 2010;2010:746263.

11. Tanigami H, Yahagi N, Kumon K, Watanabe Y, Haruna M, Matsui J, et al. Long-term sedation with isoflurane in postoperative intensive care in cardiac surgery. Artif Organs 1997;21(1):21-3.

12. Kehl F, Payne RS, Roewer N, Schurr A. Sevoflurane-induced preconditioning of rat brain in vitro and the role of KATP channels. Brain Res 2004;1021(1):76-81.

13. Thomasson R, Luttropp HH, Werner O. A reflection filter for isoflurane and other anaesthetic vapours. Eur J Anaesthesiol 1989;6(2):89-94.

14. Feigin DS. Misconceptions regarding the pathogenicity of silicas and silicates. J Thorac Imaging 1989;4(1):68-80.

15. Dahm SL, Steptoe P, Luttropp HH, Reinstrup P. Charcoal as an airway isoflurane reflection filter. Eur J Anaesthesiol 1998;15(2):230-3.

16. Misra S, Koshy T. A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa® device. Indian J Anaesth 2012;56(6):518–23.

17. Enlund M, Wiklund L, Lambert H. A new device to reduce the consumption of a halogenated anaesthetic agent. Anaesthesia 2001;56(5):429-32.

18. Pickworth T, Jerath A, DeVine R, Kherani N, Wąsowicz M. The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report. Can J Anaesth 2013;60(1):38-43.

19. Soukup J, Schärff K, Kubosch K, Pohl C, Bomplitz M, Kompardt J. State of the art: sedation concepts with volatile anesthetics in critically Ill patients. J Crit Care 2009;24(4):535-44.

20. Meiser A, Bellgardt M, Belda J, Röhm K, Laubenthal H, Sirtl C. Technical performance and reflection capacity of the anaesthetic conserving device–a bench study with isoflurane and sevoflurane. J Clin Monit Comput 2009;23(1):11-9.

21. Sackey PV, Martling CR, Granath F, Radell PJ. Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med 2004;32(11):2241-6.

22. Mesnil M, Capdevila X, Bringuier S, Trine PO, Falquet Y, Charbit J, et al. Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 2011;37(6):933-41.

23. Hellström J, Öwall A, Sackey PV. Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery. Scand Cardiovasc J 2012;46(5):262-8.

24. Röhm KD, Wolf MW, Schöllhorn T, Schellhaass A, Boldt J, Piper SN. Short-term sevoflurane sedation using the Anaesthetic Conserving Device after cardiothoracic surgery. Intensive Care Med

2008;34(9):1683-9.

25. Röhm KD, Mengistu A, Boldt J, Mayer J, Beck G, Piper SN. Renal integrity in sevoflurane sedation in the intensive care unit with the anesthetic-conserving device: a comparison with intravenous propofol sedation. Anesth Analg 2009;108(6):1848-54.

26. L’her E, Dy L, Pili R, Prat G, Tonnelier JM, Lefevre M, et al. Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study. Respir Care 2008;53(10):1295-303.

27. Migliari M, Bellani G, Rona R, Isgrò S, Vergnano B, Mauri T, et al. Short-term evaluation of sedation with sevoflurane administered by the anesthetic conserving device in critically ill patients. Intensive Care Med 2009;35(7):1240-6.

28. Perbet S, Bourdeaux D, Sautou V, Pereira B, Chabanne R, Constantin JM, et al. A pharmacokinetic study of 48-hour sevoflurane inhalation using a disposable delivery system (AnaConDa®) in ICU patients. Minerva Anestesiol 2014;80(6):655-65.

29. Marcos-Vidal JM, González R, Garcia C, Soria C, Galiana M, De Prada B. Sedation with sevoflurane in postoperative cardiac surgery: influence on troponin T and creatinine values. Heart Lung Vessel 2014;6(1):33–42.

30. Bösel J, Purrucker JC, Nowak F, Renzland J, Schiller P, Pérez EB, et al. Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa(®): effects on cerebral oxygenation, circulation, and pressure. Intensive Care Med 2012;38(12):1955-64.

31. Villa F, Iacca C, Molinari AF, Giussani C, Aletti G, Pesenti A, et al. Inhalation versus endovenous sedation in subarachnoid hemorrhage patients: effects on regional cerebral blood flow. Crit Care Med

2012;40(10):2797-804.

32. Steurer MP, Steurer MA, Baulig W, Piegeler T, Schläpfer M, Spahn DR, et al. Late pharmacologic conditioning with volatile anesthetics after cardiac surgery. Crit Care 2012;16(5):R191.

33. Hellström J, Öwall A, Bergström J, Sackey PV. Cardiac outcome after sevoflurane versus propofol sedation following coronary bypass surgery: a pilot study. Acta Anaesthesiol Scand 2011;55(4):460-7.

34. Jung C, Granados M, Marsol P, Murat I, Gall O. Use of sevoflurane sedation by the AnaConDa device as an adjunct to extubation in a pediatric burn patient. Burns 2008;34(1):136-8.

35. Sackey PV, Martling CR, Radell PJ. Three cases of PICU sedation with isoflurane delivered by the »AnaConDa«. Paediatr Anaesth

2005;15(10):879-85.

36. Sackey PV, Martling CR, Nise G, Radell PJ. Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device. Crit Care Med 2005;33(3):585-90.

37. Belda JF, Soro M, Badenes R, Meiser A, García ML, Aguilar G, et al. The predictive performance of a pharmacokinetic model for manually adjusted infusion of liquid sevofluorane for use with the Anesthetic-Conserving Device (AnaConDa): a clinical study. Anesth Analg 2008;106(4):1207-14.

38. Berton J, Sargentini C, Nguyen JL, Belii A, Beydon L. AnaConDa reflection filter: bench and patient evaluation of safety and volatile anesthetic conservation. Anesth Analg 2007;104(1):130-4.

39. Sturesson LW, Malmkvist G, Bodelsson M, Niklason L, Jonson B. Carbon dioxide rebreathing with the anaesthetic conserving device,

AnaConDa®. Br J Anaesth 2012;109(2):279-83.

40. Sturesson LW, Bodelsson M, Johansson A, Jonson B, Malmkvist G. Apparent dead space with the anesthetic conserving device,

AnaConDa®: a clinical and laboratory investigation. Anesth Analg 2013;117(6):1319-24.

41. Sturesson LW, Bodelsson M, Jonson B, Malmkvist G. Anaesthetic conserving device AnaConDa®: dead space effect and significance for lung protective ventilation. Br J Anaesth 2014;113(3):508-14.

42. Chabanne R, Perbet S, Futier E, Ben Said NA, Jaber S, Bazin JE, et al. Impact of the anesthetic conserving device on respiratory parameters and work of breathing in critically ill patients under light sedation with sevoflurane. Anesthesiology 2014;121(4):808-16.

43. European Agency for Safety and Health at Work. Directive 2009/161/EU

– indicative occupational exposure limit values. [cited 2015 July 19]. Available from: URL:

https://osha.europa.eu/en/legislation/directives/commission-directive-2009-161-eu-indicative-occupational-exposure-limit-values.

44. Djafari Marbini H, Palayiwa E, Chantler J. Active gas scavenging is unnecessary when using the AnaConDa volatile agent delivery system. JICS 2009;10:26-8.

45. Jackson DL, Proudfoot CW, Cann KF, Walsh TS. The incidence of sub-optimal sedation in the ICU: a systematic review. Crit Care

2009;13(6):R204.

46. Chanques G, Jaber S, Barbotte E, Violet S, Sebbane M, Perrigault PF, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006;34(6):1691-9.

47. Bourne RS, Mills GH. Sleep disruption in critically ill patients–pharmacological considerations. Anaesthesia 2004;59(4): 374-84.

48. Taves DR, Fry BW, Freeman RB, Gillies AJ. Toxicity following methoxyflurane anesthesia. II. Fluoride concentrations in nephrotoxicity. JAMA 1970;214(1):91-5.

49. Kharasch ED, Hankins DC, Thummel KE. Human kidney methoxyflurane and sevoflurane metabolism. Intrarenal fluoride production as a possible mechanism of methoxyflurane nephrotoxicity. Anesthesiology 1995;82(3):689-99.

50. Tobias JD. Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med 2000;28(6):2122-32.

51. Curley MA, Molengraft JA. Providing comfort to critically ill pediatric patients: isoflurane. Crit Care Nurs Clin North Am 1995;7(2):267-74.

52. Wheeler DS, Clapp CR, Ponaman ML, Bsn HM, Poss WB. Isoflurane therapy for status asthmaticus in children: A case series and protocol. Pediatr Crit Care Med 2000;1(1):55-9.

53. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342(18):1301–8.

54. Ni Chonghaile M, Higgins B, Laffey JG. Permissive hypercapnia: role in protective lung ventilatory strategies. Curr Opin Crit Care 2005;11(1):56-62.

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