Isoflurane compared with midazolam for sedation in the intensive care unit.

Kong, K.L.; Willatts, Sheila M.; Prys‐Roberts, C.

doi:10.1136/bmj.298.6683.1277

Cited by 160 publications

(71 citation statements)

References 18 publications

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“…Furthermore, inhalation anaesthetics have a relaxant effect on uterine muscle [38,39], so that the analgesic effect could be caused by reduction in intensity of the contractions. Isoflurane has been used for sedation in intensive care [40], but the present study indicates that analgesics are necessary as a supplement to isoflurane.…”

Section: Discussionmentioning

confidence: 99%

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Petersen-Felix

Arendt‐Nielsen

Bak

et al. 1996

European Journal of Anaesthesiology

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SummaryThe analgesic effect of subanaesthetic concentrations of ether, trichloroethylene, methoxyflurane and halothane has been investigated previously using either clinical assessment or pain threshold measurements, but with conflicting results. The purpose of the present study was to evaluate the analgesic effect of isoflurane using experimental pain models. We studied 12 healthy volunteers at three randomly chosen subanaesthetic isoflurane concentrations: low (0.10-0.14 vol %), middle (0.16-0.20 vol %) and high (0.22-0.26 vol %). We used thermal pain detection and pain tolerance thresholds to argon laser stimulation, pressure pain detection and pain tolerance thresholds, immersion of the hand in ice water, and the nociceptive reflex to single and repeated (temporal summation) electrical stimulations, as experimental models to assess analgesia. There were no significant changes in the response to heat, cold or mechanical pressure at any of the subanaesthetic concentrations of isoflurane used. The nociceptive reflex thresholds to single stimulations, but not the thresholds for repeated stimulations, were significantly increased in all three isoflurane groups compared with baseline values. The difference between the different isoflurane concentrations was not statistically significant. In experimental pain models, subanaesthetic isoflurane concentrations have little or no analgesic potency. (Br. J. Anaesth. 1995; 75: 55-60)

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Section: Discussionmentioning

confidence: 99%

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

Petersen-Felix

Arendt‐Nielsen

Bak

et al. 1996

European Journal of Anaesthesiology

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“…[3][4][5][6][7][8] There has been a renewed interest in the use of volatile-based sedation within critical care environments given the potential benefits of shorter ventilation time, better pulmonary ventilation/perfusion matching, an improved sedation profile with precise control of dosing, organ protective properties (pre-and post-conditioning), and minimal systemic metabolism with lack of drug accumulation and sedative effects after administration is discontinued. Nevertheless, the use of volatile sedation has been practically limited by the requirement of a bulky expensive anesthetic machine, appropriate scavenging, and the need for the constant presence of an anesthesiologist.…”

Section: Résumémentioning

confidence: 99%

The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report

Pickworth

Jerath

DeVine

et al. 2012

Can J Anesth/J Can Anesth

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“…It was shown also that subanaesthetic doses of isoflurane produced more mental and physical sedation than equianaesthetic doses of nitrous oxide [10]. These data therefore permit selection of volatile anaesthetics for the desired degree of sedation during anaesthesia or in the intensive care unit [11]. Furthermore, differences in hypnotic potencies of volatile anaesthetics are important in view of the fact that, even under surgical anaesthesia, there is some subconscious processing of information, which may modify postoperative psychological behaviour [12].…”

Section: Discussionmentioning

confidence: 99%

MAC-Awake of Isoflurane, Enflurane and Halothane Evaluated by Slow and Fast Alveolar Washout

Gaumann¹,

Mustaki²,

Tassonyi³

1992

Survey of Anesthesiology

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SUMMARYEnd-tidal anaesthetic concentrations at first eye opening in response to a verbal command during recovery from anaesthesia (MAC-awake), were measured for isoflurane (n = 16), enflurane (n = 16) and halothane (n = 14). MAC- MAC-awake has been defined as the alveolar concentration of a volatile anaesthetic at which eye opening to a verbal command occurred for the first time during awakening from anaesthesia [1]. In this initial study, MAC-awake was measured for methoxyflurane, halothane and fluroxene by two different methods. With a slow alveolar washout method, the inspiratory concentration of the anaesthetic was decreased in predetermined steps and kept constant for approximately 15 min to achieve equilibration between alveolar and brain partial pressures. With a fast washout method, the alveolar gas concentration was decreased spontaneously by allowing the patient to breathe ambient air. MACawake values, obtained after equilibration of cerebral and alveolar anaesthetic concentrations, were closely comparable between the different inhalation anaesthetics. A value of 0.52 MAC was observed for methoxyflurane and halothane, 0.60 MAC for fluroxene and 0.67 MAC for ether. It was thus hypothesized that MAC-awake was a fixed ratio of MAC that would allow the prediction of MAC-awake values for other inhalation anaesthetics. Smaller MAC-awake values were observed with fast alveolar washout, as anaesthetic equilibration between brain and alveoli was not achieved and partial pressures in brain lagged behind alveolar pressures. The MAC-awake of isoflurane has been measured only recently by a fast alveolar washout method and was found to be 0.15 MAC [2], which is considerably less than observed for halothane with fast alveolar washout (0.33 MAC) [1].The present study was conducted to clarify the difference between the measured and predicted MAC-awake of isoflurane, by comparing slow and fast alveolar washout. Further, the hypothesis of a uniform MAC-awake value of approximately 0.58 MAC [1], was tested by comparing the MACawake of isoflurane, enflurane and halothane in the presence of brain-alveolar anaesthetic equilibration, as established during slow alveolar washout. PATIENTS AND METHODSAfter approval by the local institutional Research Ethics Committee and with informed consent, we studied 46 patients of ASA physical status I and II, undergoing elective corrective maxillo-facial and plastic facial surgery. The patients were allocated randomly to three groups according to the inhalation anaesthetic administered: group 1 (n = 16) received isoflurane, group II (n = 16) received enflurane and group III (n = 14) halothane. During recovery from anaesthesia, 50 % of the patients in each group were subjected to slow alveolar washout of the inhalation anaesthetic and the other 50% to fast alveolar washout. Patients did not receive any preanaesthetic medication the night before or on the day of surgery. Before induction of anaesthesia, a venous cannula

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Isoflurane compared with midazolam for sedation in the intensive care unit.

Abstract: Isoflurane is a promising alternative technique for sedation of ventilated patients in the intensive care unit.

Cited by 160 publications

References 18 publications

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

The analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain

The scavenging of volatile anesthetic agents in the cardiovascular intensive care unit environment: a technical report

MAC-Awake of Isoflurane, Enflurane and Halothane Evaluated by Slow and Fast Alveolar Washout

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