Volatile sedation with sevollurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConD (R): an observational study

作者：Purrucker J C; Renzland J; Uhlmann L; Bruckner T; Hacke W; Steiner T; Boesel J^*

来源：British Journal of Anaesthesia, 2015, 114(6): 934-943.

DOI：10.1093/bja/aev070

• critical care
• inhalation anesthetics
• sevoflurane
• stroke

Background: The anaesthetic conserving device, AnaConDa (R), 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 17.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also 1-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, Pa-co2, increased slightly [0.3 (0.8) kPa; P=0.1041, ICP did not change 10.2 (3.9) mm Hg; P=0.865], but MAP (-6 (6.9) mm Hg; P=0.0021 and thus CPP decreased [-6 (8.5) mm Hg; P=0.010].
Conclusion: 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.

• 出版日期2015-6