AnaConDa™ and Mirus™ for intensive care sedation, 24 h desflurane versus isoflurane in one patient.
BACKGROUND
With the AnaConDa™ system, inhalational sedation in the intensive care unit has become popular. The device can be used with common intensive care unit ventilators and is inserted between the Y-piece and the patient. Liquid isoflurane or sevoflurane are delivered by a syringe pump. 90 % of anesthetic exhaled by the patient is absorbed by a reflector and resupplied during the next inspiration. The new Mirus™ system also uses a reflector. Its control unit identifies end-tidal concentrations from the flow, injects anesthetics during early inspiration, controls anesthetic concentrations automatically, and can also apply desflurane. The AnaConDa™ and Mirus™ system are certified 'conformité établi', however, little is known about the Mirus™ and case reports are still lacking.


METHODS
We used the Mirus™ with desflurane for 24 h in a patient suffering from acute respiratory distress syndrome. The patient was treated with kinetic lateral rotational therapy. While deeply sedated, our patient breathed 9.0-12.0 l min(-1) spontaneously. Thereafter, awakening and wash-out were considerably shorter than after isoflurane in the same patient with AnaConDa™. There were no major problems during the sedation. However, consumption of desflurane was high.


CONCLUSIONS
Desflurane sedation with the Mirus™ seems promising, but the reflector should be improved to absorb and resupply more of the anesthetic agent.
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany.
Hagen
H
Bomberg
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany.
Heinrich V
HV
Groesdonk
Department of Anaesthesiology and Intensive Care Medicine, St. Josef Hospital, Katholisches Klinikum Bochum, Ruhr-University, Bochum, Germany.
Martin
M
Bellgardt
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany.
Thomas
T
Volk
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany.
Andreas
A
Meiser
AnaConDa™; Desflurane; Intensive care unit (ICU); Mirus™; Sedation