title: [Efficacy, safety and cost of sedation with sevoflurane in intensive care unit].
abstract: OBJECTIVE
  To study efficacy, systemic and cerebral haemodynamic, and cost of sedation with sevoflurane after midazolam failure.
  
  
  METHODS
  Prospective observational study in a mixed intensive care unit.
  
  
  METHODS
  Mechanically ventiled patients in whom deep sedation failed (Ramsay score<5 despite midazolam 10mg/h and fentanyl 400μg/h) were enrolled. Sedation with sevoflurane and fentanyl (200μg/h) was performed during 48 hours. Sevoflurane was administered with a dedicated filter (AnaConDa™) and sevoflurane infusion rate was adjusted in order to achieve a Ramsay score ≥5. Ramsay score, mean arterial blood pressure, norepinephrine dose/24h, intracranial pressure and cerebral perfusion pressure in patients with brain injury were measured. Directs costs for sedation were calculated. An analysis of variance for repeated measures compared values between D0 (intravenous sedation), D1 and D2 (inhaled sedation).
  
  
  RESULTS
  Twenty-five patients (age=51 [38-63], SAPS II=43 [33-49]) were enrolled. Ramsay score was 4 [4,5] at D0 and 6 [6] at D1 and D2 (P<0.05 vs D0). Mean arterial pressure was significantly lower at D1 (80 [73-86] mmHg) as compared to D0 (84 [77-92] mmHg) and D2 (84 [78-91] mmHg) (P<0,05). Norepinephrine consumption was lower at D2 as compared to D1 (P<0,05). Intracranial pressure was lower at D1 (9 [5-13] mmHg) and D2 (11 [7-15] mmHg) as compared to D0 (12 [7-17] mmHg) (P<0.05). PPC was stable at D1 and increased at D2. Directs costs were significantly increased with sevoflurane.
  
  
  CONCLUSIONS
  Sevoflurane is an effective and safe alternative to midazolam in ICU patients associated with a moderate increase in costs.
authors.affiliation: Service de réanimation polyvalente, hôpital Font-Pré, 1208, avenue Colonel-Picot, 83000 Toulon, France. magalibisbal@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Bisbal
authors.forename: J-M
authors.initials: JM
authors.lastname: Arnal
authors.forename: A
authors.initials: A
authors.lastname: Passelac
authors.forename: M
authors.initials: M
authors.lastname: Sallée
authors.forename: D
authors.initials: D
authors.lastname: Demory
authors.forename: S-Y
authors.initials: SY
authors.lastname: Donati
authors.forename: I
authors.initials: I
authors.lastname: Granier
authors.forename: G
authors.initials: G
authors.lastname: Corno
authors.forename: J
authors.initials: J
authors.lastname: Durand-Gasselin
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003422:Critical Care / Q000191:economics; D054810:Deep Sedation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units / Q000191:economics*; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000494:pharmacology; D015742:Propofol; D011446:Prospective Studies; D012121:Respiration, Artificial; D000077149:Sevoflurane; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D002245:Carbon Dioxide; D000077149:Sevoflurane; D008874:Midazolam; D005283:Fentanyl; D009638:Norepinephrine; D015742:Propofol