Inhaled sedation with sevoflurane in critically ill children during extracorporeal membrane oxygenation

Laiseca, Laura Butragueño; Murciano, Manuel; López‐Herce, Jesús; Mencía, Santiago

doi:10.1111/pan.14046

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…Five reports describe the use of ketamine infusions in 8 children placed on ECMO. [17][18][19][20][21] Table 2 describes the demographics and ketamine infusion data for these patients. For 2 reports, additional patient and ketamine infusion data was obtained via direct written communication from the authors.…”

Section: Ketamine In Children On Ecmomentioning

confidence: 99%

“…19 Ketamine was initiated as the primary analgesic in 1 patient who also received a propofol infusion for sedation on ECMO (Laiseca 2020), but the remaining 7 patients were initiated on ketamine as the second-line (n = 4), third-line (n = 2), or fourth-line (n = 1), sedative. [17][18][19][20][21] The timing of initiation of ketamine infusion was described in 4 reports for 6 patients, and ketamine was initiated on day 0-35 of ECMO. 17,[19][20][21] Four of the patients were paralyzed and receiving a continuous neuromuscular blocker infusion while on their ketamine infusion.…”

Section: Ketamine In Children On Ecmomentioning

confidence: 99%

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Ketamine Use in Adult and Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review

Flanagan,

Mercer,

Johnson

et al. 2023

Journal of Pharmacy Practice

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Background: Analgesia and sedation are often critical elements of therapy for patients undergoing extracorporeal membrane oxygenation (ECMO). Aside from potential drug-drug interactions, the PK changes associated with ECMO make appropriate analgosedative selection challenging. Ketamine is less lipophilic and has lower protein binding than alternative agents, and may be less impacted by the PK changes during ECMO. Objective: To systematically identify all instances of ketamine use during ECMO support in the literature to elucidate associated efficacy and safety outcomes and prevalence of use, as well as commonly used dosing strategies and pharmacokinetic data. Methods: Web of Science, Cochrane Library, Scopus, Ovid MEDLINE, PubMed, and OVID Embase were searched through 02/2023 using keywords ketamine and ECMO or extracorporal life support (ECLS). Case reports, case series, and studies were included that had (1) original data, (2) included patients that were on ECMO and continuous infusion ketamine, and (3) reported pertinent ketamine related clinical endpoints or prevalence of use. Results: Of the 307 articles screened, 25 were identified as relevant and 11 met our inclusion criteria. Heterogeneity of patient population, ketamine indication, reported outcomes, and reported safety endpoints were identified in the included articles. Commonly reported information includes indications, pharmacokinetics, dosing, adverse effects and use in pediatrics for ketamine, and suspected opioid sparing effect. Conclusion: Our review has found a lack of consistency in reporting and results in adult and pediatric patients. Increased consistency in reporting and larger studies are required to increase our knowledge of ketamine use in both the adult and pediatric patient population.

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Section: Ketamine In Children On Ecmomentioning

confidence: 99%

Section: Ketamine In Children On Ecmomentioning

confidence: 99%

Ketamine Use in Adult and Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review

Flanagan,

Mercer,

Johnson

et al. 2023

Journal of Pharmacy Practice

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Ketamine/propofol/remifentanil

2021

Reactions Weekly

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Halogenated volatile anaesthetics for prolonged sedation in pediatric intensive care unit: first experience in two French pediatric intensive care units

Berger

Sorèze

Rambaud

et al. 2023

Intensive Care Med. Paediatr. Neonatal

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Objective Sedation is necessary for patients to achieve comfort and safety, but prolonged sedation can lead to the need for increased doses, resulting in withdrawal syndrome and delayed extubation. Inhaled anaesthetics (IAs) may cause less withdrawal syndrome while providing similar sedative effects to intravenous agents. This study aims to describe the efficacy of halogenated IAs during prolonged sedation and identify any adverse effects on the PICU. Design This is a retrospective, bicentric cohort study. Setting The study was conducted at two PICUs in university hospitals in Paris between January 2018 and December 2020. Patients The study included 50 children (aged 2.2 years, [0.8–7.2]) who received prolonged sedation (> 72 h) and were sedated with volatile anaesthetics for at least 24 h. Interventions No interventions were performed. Measurements and main results The study found a statistically significant reduction in benzodiazepine dosages (μg/kg/h) (118 [62.5; 200] vs 80.0 [32.5; 120], p < 0.01). Similar results were observed for other hypnotics (ketamine 2.00 [1.00; 2.00] vs 1.50 [1.00; 2.00], p = 0.036, mg/kg/h; clonidine: 0.55 [0.35; 1.27] vs 0.20 [0.12; 0.43], p = 0.036, μg/kg/h). For opioids (μg/kg/h), no significant reduction in doses was observed 24 h after IA introduction (4 [1.00; 8.00] vs 4.00 [1.00; 6.70], p = 0.7). No major adverse effects were reported, although 26% of patients developed withdrawal syndrome. Conclusions Halogenated IAs appear to be a promising therapy to reduce the dosages of hypnotics and opioids used during prolonged sedations.

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Inhaled sedation with sevoflurane in critically ill children during extracorporeal membrane oxygenation

Cited by 5 publications

References 8 publications

Ketamine Use in Adult and Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review

Ketamine Use in Adult and Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review

Ketamine/propofol/remifentanil

Halogenated volatile anaesthetics for prolonged sedation in pediatric intensive care unit: first experience in two French pediatric intensive care units

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