L'her Erwan, Dy Lenaïg, Pili Riccardo, Prat Gwenaël, Tonnelier Jean-Marie, Lefevre Montaine, Renault Anne, Boles Jean-Michel
Reanimation et Urgences Medicales, Centre Hospitalier Universitaire de la Cavale Blanche, Brest, France.
Respir Care. 2008 Oct;53(10):1295-303.
Inhaled sedation is efficient and easily controllable; in low concentrations it causes minimal changes in the patient and very little interference with hemodynamics. Awakening after inhaled sedation is quick and predictable. The major reason inhaled sedation has not become widely used in intensive care is that no commercially available administration device has been available.
In our intensive care unit we conducted a prospective observational study to assess the feasibility, benefits, and costs of routine isoflurane sedation via the AnaConDa anesthetic-administration device. We included 15 adult patients who required > 24 hours of deep sedation. Conventional intravenous sedation (benzodiazepine and opioid) had been administered according to a sedation protocol that included a predetermined target Ramsay-scale sedation score. We then switched to inhaled isoflurane via the AnaConDa, and measured sedation efficacy, cumulative dose, and daily cost of sedation. Adverse events were prospectively defined and monitored.
The sedation goal was reached with isoflurane in all 15 patients (P < .01, compared to the conventional sedation protocol). Hemodynamic changes were nonsignificant, and no renal or hepatic dysfunctions were observed. The frequency of meeting the sedation goal was significantly better with isoflurane than with our usual sedation protocol. With isoflurane, awakening from sedation was always <or= 4 hours, despite some long-duration sedations (up to 14.5 d). The overall daily cost of the 2 sedation protocols was not different in the whole group of 15 patients, but in the subgroup of 7 patients who required a mean midazolam infusion larger than the average dose, the cost difference was very significant (euro218 +/- 111 vs euro110 +/- 19, P < .01).
Routine ICU isoflurane sedation with the AnaConDa is easily feasible, effective, safe, and has a relatively short awakening period. In some patients with sedation difficulties, this sedation method may significantly decrease sedation cost and enhance sedation efficacy.
吸入镇静有效且易于控制；低浓度时对患者影响极小，对血流动力学干扰也很小。吸入镇静后苏醒迅速且可预测。吸入镇静未在重症监护中广泛应用的主要原因是一直没有市售的给药装置。
在我们的重症监护病房，我们进行了一项前瞻性观察研究，以评估通过AnaConDa麻醉给药装置进行常规异氟烷镇静的可行性、益处和成本。我们纳入了15名需要深度镇静超过24小时的成年患者。此前已根据包括预定目标Ramsay镇静评分的镇静方案给予常规静脉镇静（苯二氮䓬类和阿片类药物）。然后我们通过AnaConDa改为吸入异氟烷，并测量镇静效果、累积剂量和每日镇静成本。前瞻性地定义并监测不良事件。
所有15例患者使用异氟烷均达到镇静目标（与常规镇静方案相比，P <.01）。血流动力学变化不显著，未观察到肾或肝功能障碍。异氟烷达到镇静目标的频率明显优于我们通常的镇静方案。使用异氟烷时，尽管有一些长时间镇静（长达14.5天），但镇静苏醒时间总是≤4小时。在15例患者的整个组中，两种镇静方案的总体每日成本没有差异，但在7例需要平均咪达唑仑输注量大于平均剂量的亚组患者中，成本差异非常显著（218±111欧元对110±19欧元，P <.01）。
使用AnaConDa进行常规重症监护病房异氟烷镇静易于实施，有效、安全，且苏醒期相对较短。在一些镇静困难的患者中，这种镇静方法可能会显著降低镇静成本并提高镇静效果。
