Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients

Bellgardt, Martin; Bomberg, Hagen; Herzog-Niescery, Jenny; Dasch, Burkhard; Vogelsang, Heike; Weber, Thomas P.; Steinfort, Claudia; Uhl, Waldemar; Wagenpfeil, Stefan; Volk, Thomas; Meiser, Andreas

doi:10.1097/eja.0000000000000252

Cited by 72 publications

(39 citation statements)

References 33 publications

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“…Sevoflurane, but not isoflurane, was found to increase blood-brain barrier permeability in old rats, promoting extravasation of immunoglobulin G with a selective affinity for pyramidal neurons [41]. The clinical utility remains debatable; long-term sedation with isoflurane was well tolerated in a retrospective analysis and associated with a higher 365-d survival (not delirium) compared with propofol/midazolam sedation [42].…”

Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 93%

Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.

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Section: Psychomotoric Subtypes Of Deliriummentioning

confidence: 93%

Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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“…Recently, a number of trials have demonstrated the safety of long-time lower doses of isoflurane for ICU sedation. [1819] The above statements supported the protective effects on sepsis by the 0.5 MAC isoflurane in 60% oxygen which would be a good therapy for sepsis with improved clinical safety and broader clinical applications. However, the mechanism regarding the interaction between oxygen and isoflurane remains to be further studied.…”

Section: Discussionmentioning

confidence: 75%

“…The previous studies have reported that both hyperoxia[891011] and anesthetic dose isoflurane[121314] have significant protective effects on complex inflammation-mediated conditions including sepsis in various animal models of inflammation, and their application to the patients with critical diseases is limited because the use of anesthetic dose isoflurane in critically ill patients may have serious adverse consequences. [151617] A large number of trials have demonstrated the safety of long-time lower doses of isoflurane for ICU sedation,[1819] and long-term hyperoxia treatment can induce oxygen toxicity associated with the overproduction of reactive oxygen species (ROS). [20212223] Here, we demonstrated that combined administration of a low-dose isoflurane (0.5 minimum alveolar concentration [MAC]) with 60% oxygen reduced inflammatory responses to sepsis in animals and human peripheral blood mononuclear cells (PBMCs) and increased the 7-day survival rate of animals with experimental sepsis.…”

Section: Introductionmentioning

confidence: 99%

Sub-anesthesia Dose of Isoflurane in 60% Oxygen Reduces Inflammatory Responses in Experimental Sepsis Models

Huang

Wang

Sun

et al. 2017

Chinese Medical Journal

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Background:Sepsis is a major cause of mortality in Intensive Care Units. Anesthetic dose isoflurane and 100% oxygen were proved to be beneficial in sepsis; however, their application in septic patients is limited because long-term hyperoxia may induce oxygen toxicity and anesthetic dose isoflurane has potential adverse consequences. This study was scheduled to find the optimal combination of isoflurane and oxygen in protecting experimental sepsis and its mechanisms.Methods:The effects of combined therapy with isoflurane and oxygen on lung injury and sepsis were determined in animal models of sepsis induced by cecal ligation and puncture (CLP) or intraperitoneal injection of lipopolysaccharide (LPS) or zymosan. Mouse RAW264.7 cells or human peripheral blood mononuclear cells (PBMCs) were treated by LPS to probe mechanisms. The nuclear factor kappa B (NF-κB) signaling molecules were examined by Western blot and cellular immunohistochemistry.Results:The 0.5 minimum alveolar concentration (MAC) isoflurane in 60% oxygen was the best combination of oxygen and isoflurane for reducing mortality in experimental sepsis induced by CLP, intraperitoneal injection of LPS, or zymosan. The 0.5 MAC isoflurane in 60% oxygen inhibited proinflammatory cytokines in peritoneal lavage fluids (tumor necrosis factor-alpha [TNF-α]: 149.3 vs. 229.7 pg/ml, interleukin [IL]-1β: 12.5 vs. 20.6 pg/ml, IL-6: 86.1 vs. 116.1 pg/ml, and high-mobility group protein 1 [HMGB1]: 323.7 vs. 449.3 ng/ml; all P < 0.05) and serum (TNF-α: 302.7 vs. 450.7 pg/ml, IL-1β: 51.7 vs. 96.7 pg/ml, IL-6: 390.4 vs. 722.5 pg/ml, and HMGB1: 592.2 vs. 985.4 ng/ml; all P < 0.05) in septic animals. In vitro experiments showed that the 0.5 MAC isoflurane in 60% oxygen reduced inflammatory responses in mouse RAW264.7 cells, after LPS stimulation (all P < 0.05). Suppressed activation of NF-κB pathway was also observed in mouse RAW264.7 macrophages and human PBMCs after LPS stimulation or plasma from septic patients. The 0.5 MAC isoflurane in 60% oxygen also prevented the increases of phospho-IKKβ/β, phospho-IκBβ, and phospho-p65 expressions in RAW264.7 macrophages after LPS stimulation (all P < 0.05).Conclusion:Combined administration of a sedative dose of isoflurane with 60% oxygen improves survival of septic animals through reducing inflammatory responses.

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“…A similar reduction in pulmonary complications has been demonstrated in a recent meta-analysis showing that volatile as opposed to intravenous anesthesia is associated with a significant reduction in overall mortality for cardiac surgical patients [11]. Although specific prospective data regarding the use of inhaled sedation in the ICU to prevent or treat lung injury is lacking, retrospective analysis of patients receiving inhaled sedation suggests an association between its use and reductions in 1-year and in-hospital mortality, perhaps related to a significant increase in ventilator-free days compared to sedation with intravenous agents [12]. …”

Section: Human Datamentioning

confidence: 99%