Renal Integrity in Sevoflurane Sedation in the Intensive Care Unit with the Anesthetic-Conserving Device: A Comparison with Intravenous Propofol Sedation

Röhm, Kerstin D.; Mengistu, Andinet; Boldt, Joachim; Mayer, Jochen; Beck, Grietje; Piper, Swen N.

doi:10.1213/ane.0b013e3181a1988b

Cited by 62 publications

(48 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, a device for its delivery outside the operating room is not yet standardised [24]. The Anaesthetic Conserving Device (AnaConDa®) has being used to deliver sevoflurane to sedate mechanically ventilated patients through traqueal cannula [27–29]. In this study, sevoflurane was provided through a mask placed over the nose; some authors used a nasal cannula [25] or the same mask used to deliver nitrous oxide [9, 10, 30].…”

Section: Discussionmentioning

confidence: 99%

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Gomes

Sado-Filho

et al. 2017

BMC Pediatr

View full text Add to dashboard Cite

BackgroundThere is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children’s behaviour with minimal adverse events.MethodsThis is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK – 100% oxygen; Group MKS – inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children’s sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%.ResultsMK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01).ConclusionsThe addition of sevoflurane to oral midazolam-ketamine improved the children’s crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events.Trial registrationClinical Trials NCT02284204. Registered 5 October 2014.

show abstract

Section: Discussionmentioning

confidence: 99%

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Gomes

Sado-Filho

et al. 2017

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…Because long-term sedation with sevoflurane may result in renal toxicity, 20,22 we monitored renal function in our study using NGAL and creatinine. Although we found higher NGAL levels in sevoflurane-treated animals, creatinine levels were not different between groups.…”

Section: Discussionmentioning

confidence: 99%

“…20,22,23 The anti-inflammatory properties of volatile anesthetics have been demonstrated in experimental (LPS-induced) lung injury.…”

mentioning

confidence: 99%

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Kellner

Müller

Piegeler

et al. 2017

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required. In such patients, usually the first choice an intravenously administered drug. However, growing evidence suggests that volatile anesthetics such as sevoflurane are a valuable alternative. In this study, we evaluate pulmonary and systemic effects of long-term (24-hour) sedation with sevoflurane compared with propofol in an in vivo animal model of ALI. METHODS Adult male Wistar rats were subjected to ALI by intratracheal lipopolysaccharide (LPS) application, mechanically ventilated and sedated for varying intervals up to 24 hours with either sevoflurane or propofol. Vital parameters were monitored, and arterial blood gases were analyzed. Inflammation was assessed by the analysis of bronchoalveolar lavage fluid (BALF), cytokines (monocyte chemoattractant protein-1 [MCP-1], cytokine-induced neutrophil chemoattractant protein-1 [CINC-1], interleukin , IL-12/12a, transforming growth factor-, and IL-10) in blood and lung tissue and inflammatory cells. The alveolocapillary barrier was indirectly assessed by wet-to-dry ratio, albumin, and total protein content in BALF. Results are presented as mean ± standard deviation. RESULTS After 9 hours of ventilation and sedation, oxygenation index was higher in the LPS/sevoflurane (LPS-S) than in the LPS/propofol group (LPS-P) and reached 400 ± 67 versus 262 ± 57 mm Hg after 24 hours (P < .001). Cell count in BALF in sevoflurane-treated animals was lower after 18 hours (P = .001) and 24 hours (P < .001) than in propofol controls. Peak values of CINC-1 and IL-6 in BALF were lower in LPS-S versus LPS-P animals (CINC-1: 2.7 ± 0.7 vs 4.0 ± 0.9 ng/mL; IL-6: 9.2 ± 2.3 vs 18.9 ± 7.1 pg/mL, both P < .001), whereas IL-10 and MCP-1 did not differ. Also messenger RNAs of CINC-1, IL-6, IL-12a, and IL-10 were significantly higher in LPS-P compared with LPS-S. MCP-1 and transforming growth factor-showed no differences. Wet-to-dry ratio was lower in LPS-S (5.4 ± 0.2 vs 5.7 ± 0.2, P = .016). Total protein in BALF did not differ between P-LPS and S-LPS groups. CONCLUSIONS Long-term sedation with sevoflurane compared with propofol improves oxygenation and attenuates the inflammatory response in LPS-induced ALI. Our findings suggest that sevoflurane may improve lung function when used for sedation in patients with ALI. Bacterial lipopolysaccharides (LPSs) are complex glycolipids found on the outer membrane of Gram-negative bacteria 10 and have been utilized to examine in vitro and in vivo inflammatory responses. [10][11][12] Other markers of ALI include endothelial barrier disruption, recruitment and transmigration of neutrophils, and development of a protein-and neutrophil-rich (noncardiogenic) pulmonary edema. [13][14][15][16] According to current guidelines, intravenous propofol, midazolam, and dexmedetomidine are recommended for sustained sedation in critically ill patients. 17,18 However, since the introduction of the Anaesthetic Conserving Device (AnaConDa; S...

show abstract

“…19 When compared with intravenous sedation, volatile sedation has been associated with shorter weaning times, 20 less ICU and hospital days, 21 and no difference in safety. 20,22,23 The anti-inflammatory properties of volatile anesthetics have been demonstrated in experimental (LPS-induced) lung injury. 12 However, little is known about the impact of sedatives on the course of ALI during mechanical BACKGROUND: Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required.…”

mentioning

confidence: 99%

Sevoflurane Abolishes Oxygenation Impairment in a Long-term Rat Model of Acute Lung Injury

Kellner

Müller

Piegeler

et al. 2017

Survey of Anesthesiology

View full text Add to dashboard Cite

BACKGROUND Patients experiencing acute lung injury (ALI) often need mechanical ventilation for which sedation may be required. In such patients, usually the first choice an intravenously administered drug. However, growing evidence suggests that volatile anesthetics such as sevoflurane are a valuable alternative. In this study, we evaluate pulmonary and systemic effects of long-term (24-hour) sedation with sevoflurane compared with propofol in an in vivo animal model of ALI. METHODS Adult male Wistar rats were subjected to ALI by intratracheal lipopolysaccharide (LPS) application, mechanically ventilated and sedated for varying intervals up to 24 hours with either sevoflurane or propofol. Vital parameters were monitored, and arterial blood gases were analyzed. Inflammation was assessed by the analysis of bronchoalveolar lavage fluid (BALF), cytokines (monocyte chemoattractant protein-1 [MCP-1], cytokine-induced neutrophil chemoattractant protein-1 [CINC-1], interleukin , IL-12/12a, transforming growth factor-, and IL-10) in blood and lung tissue and inflammatory cells. The alveolocapillary barrier was indirectly assessed by wet-to-dry ratio, albumin, and total protein content in BALF. Results are presented as mean ± standard deviation. RESULTS After 9 hours of ventilation and sedation, oxygenation index was higher in the LPS/sevoflurane (LPS-S) than in the LPS/propofol group (LPS-P) and reached 400 ± 67 versus 262 ± 57 mm Hg after 24 hours (P < .001). Cell count in BALF in sevoflurane-treated animals was lower after 18 hours (P = .001) and 24 hours (P < .001) than in propofol controls. Peak values of CINC-1 and IL-6 in BALF were lower in LPS-S versus LPS-P animals (CINC-1: 2.7 ± 0.7 vs 4.0 ± 0.9 ng/mL; IL-6: 9.2 ± 2.3 vs 18.9 ± 7.1 pg/mL, both P < .001), whereas IL-10 and MCP-1 did not differ. Also messenger RNAs of CINC-1, IL-6, IL-12a, and IL-10 were significantly higher in LPS-P compared with LPS-S. MCP-1 and transforming growth factor-showed no differences. Wet-to-dry ratio was lower in LPS-S (5.4 ± 0.2 vs 5.7 ± 0.2, P = .016). Total protein in BALF did not differ between P-LPS and S-LPS groups. CONCLUSIONS Long-term sedation with sevoflurane compared with propofol improves oxygenation and attenuates the inflammatory response in LPS-induced ALI. Our findings suggest that sevoflurane may improve lung function when used for sedation in patients with ALI. A cute lung injury (ALI) frequently requires both mechanical ventilation and sedation in the intensive care unit (ICU). 1,2 Currently, approximately 10% of patients treated in the ICU experience ALI or acute respiratory distress syndrome (ARDS), 3 and mortality rates of up to 50% have been described. 4 Immune activation and a massive release of proinflammatory mediators are hallmarks of ALI and ARDS, 5 and mechanical ventilation may further exacerbate the inflammatory response. 6-8 Cytokines recruit effector cells, which amplify the inflammatory response. 9 Bacterial lipopolysaccharides (LPSs) are complex glycolipids found on the outer membrane of Gr...

show abstract

Renal Integrity in Sevoflurane Sedation in the Intensive Care Unit with the Anesthetic-Conserving Device: A Comparison with Intravenous Propofol Sedation

Abstract: Short-term sedation with either sevoflurane using ACD or propofol did not negatively affect renal function postoperatively. Although inorganic fluoride levels were elevated after sevoflurane exposure, glomerular and tubular renal integrity were preserved throughout the hospital stay.

Cited by 62 publications

References 26 publications

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Sevoflurane Abolishes Oxygenation Impairment in a Long-Term Rat Model of Acute Lung Injury

Sevoflurane Abolishes Oxygenation Impairment in a Long-term Rat Model of Acute Lung Injury

Contact Info

Product

Resources

About