title: Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam.
abstract: OBJECTIVE
  To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (i.v.) sedation with propofol or midazolam.
  
  
  METHODS
  Randomized controlled trial. Sixty intensive care unit (ICU) patients expected to require more than 24 h sedation were randomly assigned to one of three groups: group S, inhaled sevoflurane; group P, i.v. propofol; group M, i.v. midazolam. All patients also received i.v. remifentanil for goal-directed sedation (Ramsay scale and pain score) until extubation or for a maximum of 96 h. Primary end points were wake-up times and extubation delay from termination of sedative administration. Proportion of time within Ramsay score 3-4, i.v. morphine consumption at 24 h post extubation, hallucination episodes after end of sedation, adverse events, inorganic fluoride plasma levels, and ambient sevoflurane concentrations were recorded.
  
  
  RESULTS
  Forty-seven patients were analyzed. Wake-up time and extubation delay were significantly (P<0.01) shorter in group S (18.6 ± 11.8 and 33.6 ± 13.1 min) than in group P (91.3 ± 35.2 and 326.11 ± 360.2 min) or M (260.2 ± 150.2 and 599.6 ± 586.6 min). Proportion of time within desired interval of sedation score was comparable between groups. Morphine consumption during the 24 h following extubation was lower in group S than in groups P and M. Four hallucination episodes were reported in group P, five in group M, and none in group S (P=0.04). No hepatic or renal adverse events were reported. Mean plasma fluoride value was 82 μmol l(-1) (range 12-220 μmol l(-1)), and mean ambient sevoflurane concentration was 0.3 ± 0.1 ppm.
  
  
  CONCLUSIONS
  Long-term inhaled sevoflurane sedation seems to be a safe and effective alternative to i.v. propofol or midazolam. It decreases wake-up and extubation times, and post extubation morphine consumption, and increases awakening quality.
authors: Department of Anesthesiology and Critical Care Lapeyronie (DAR A), Montpellier I University and Montpellier University Lapeyronie Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Equipe soutenue par la Région et l'Inserm (ERI) -25, Route de Ganges, 34295 Montpellier, Cedex 5, France.
authors: Malcie
authors: M
authors: Mesnil
authors: Xavier
authors: X
authors: Capdevila
authors: Sophie
authors: S
authors: Bringuier
authors: Pierre-Olivier
authors: PO
authors: Trine
authors: Yoan
authors: Y
authors: Falquet
authors: Jonathan
authors: J
authors: Charbit
authors: Jean-Paul
authors: JP
authors: Roustan
authors: Gerald
authors: G
authors: Chanques
authors: Samir
authors: S
authors: Jaber
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012121:Respiration, Artificial; D000077149:Sevoflurane; D015300:Ventilator Weaning
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D008874:Midazolam; D015742:Propofol