title: Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study.
abstract: BACKGROUND
  The anaesthetic conserving device, AnaConDa(®), allows use of inhaled anaesthetics for sedation in the intensive care unit. We prospectively measured cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from i.v. to inhalative sedation.
  
  
  METHODS
  25 patients were switched from i.v. to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h).
  
  
  RESULTS
  In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, [Formula: see text] increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010].
  
  
  CONCLUSIONS
  Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: J C
authors.initials: JC
authors.lastname: Purrucker
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Renzland
authors.affiliation: Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Uhlmann
authors.affiliation: Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hacke
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt am Main, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Steiner
authors.affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany julian.boesel@med.uni-heidelberg.de.
authors.forename: J
authors.initials: J
authors.lastname: Bösel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D018685:Anesthetics, Inhalation; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000187:drug effects; D000077149:Sevoflurane; D020521:Stroke / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000628:therapy*
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen
keywords: critical care; inhalation anesthetics; sevoflurane; stroke