The Effect of Sedation with Inhaled Anesthetics on Cognitive and Psychiatric Outcomes in Critically Ill Adults
Sedation of critically ill patients with inhaled anesthetics may reduce lung inflammation, time to extubation, and ICU length of stay compared to intravenous sedatives. However, the impact of inhaled anesthetics on cognitive and psychiatric outcomes in critically ill patients is unclear. In this systematic review, we summarize existing evidence regarding the effect of sedating critically ill patients with inhaled anesthetics on short (in-hospital) and long (post-hospital discharge) neurocognitive and psychiatric outcomes.
Use of inhalational anaesthetic agents in paediatric and adult patients for status asthmaticus, status epilepticus and difficult sedation scenarios
Inhaled volatile anesthetic agents (i.e., sevoflurane, isoflurane) have a long tradition of safe and effective use in operating rooms to provide deep hypnosis appropriate for surgery. In critical care settings, the use of these agents has been mostly limited to ‘rescue’ scenarios in specific medical emergencies that are unresponsive to standard treatments such as severe asthma (status asthmaticus), severe seizures (status epilepticus) and sedation of patients with high and/or difficult sedation needs (e.g. those with burns, chronic pain). Whether inhaled volatile agents should be employed as first line therapy for the above conditions for their combined sedative and therapeutic properties has not been evaluated. Prior to further study and change in practice, evidence summarizing their benefits and limitations needs to be collated. In this systematic review, we summarize the current evidence regarding the efficacy, safety and feasibility of using Inhaled volatile anesthetics in adult and pediatric ICU patient with severe asthma, seizures, and difficult sedation needs.
Volatile versus intravenous sedation in animal models of acute lung injury, sepsis and shock
Inhaled volatile anesthetic agents have been commonly used during the SARS-CoV-2 pandemic providing sedation to critically ill patients with severe form of lung injury known as acute respiratory distress syndrome. Animal models of acute lung injury, sepsis, and shock provide valuable data on cytologic, tissue and organ dysfunction that is not obtainable in human trials. Given the growing interest of employing volatile anesthetics in the critical care setting, there exists a need to summarize the basic science data to inform further human trials and models. The objective of this study is to conduct a systematic review and meta-analysis (depending on feasibility of the data) comparing the effect of inhaled volatile anesthetics to intravenous sedatives on the inflammatory response in animal models of acute respiratory failure, sepsis and shock.
The effects of volatile and intravenous sedative agents on pulmonary and systemic inflammation.
Perioperative and critical care patients have an altered inflammatory response. Volatile agents, whether used in the operating room for anaesthesia or in the intensive care unit for sedation, exert measurable anti-inflammatory and immunomodulatory effects that may translate into beneficial clinical outcomes. In this systematic review we seek to collate existing evidence from perioperative and ICU settings on the anti-inflammatory effects of volatile sedative agents compared with intravenous sedative agents, with the focus on pulmonary and systemic inflammation, and whether these effects correlate with clinically beneficial patient outcomes.
