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2023, Number 4

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Med Crit 2023; 37 (4)

Experience and literature review in the use of the Anesthetic Conserving Device (AnaConDa) during the pandemic in patients with COVID-19 pneumonia at a public hospital

Morales HMG, Díaz CM, Magaña MI

Language: Spanish
References: 41
Page: 334-341
PDF size: 265.43 Kb.


ABSTRACT

Introduction: on March 11, 2020, the director general of the World Health Organization declared the disease caused by the SARS-CoV-2 virus (COVID-19) a pandemic. In this context, there was also a shortage of medicines which were intended to be used as treatment or maintenance. Medical societies such as the Spanish Society of Intensivists and Critical Care in Coronary Units (SEMICYUC) as well as Dutch and German societies have prepared sedation recommendations in the context of the pandemic. In order to achieve adequate sedation during the COVID-19 pandemic. Our intention in this work is to describe what was observed in terms of hemodynamic, ventilatory and neurological response of each of the patients subjected to inhaled sedation. Objective: to show the usefulness of inhaled anesthetics during the period of intravenous sedative shortages during the COVID-19 pandemic. Material and methods: the current study is a retrospective, descriptive study, which aims to show the response of ventilatory and gasometric parameters (PEEP, PaO2/FiO2, pCO2, SatO2) and their associated outcomes in patients with pneumonia and COVID-19 in the Intensive Care Unit after receiving the AnaConDa device (Anesthetic Conserving Device). Results: 12 cases were obtained in which AnaConDa was used during the period from February 2021 to February 2022. Forty percent (n = 4) of the study population were discharged from the ICU because of improvement, the rest were deaths. Patients with obesity as measured by body mass index (BMI) were discharged due to death, corresponding to 50% (n = 5) of the population. With respect to the gasometric parameters, pH prior to AnaConDa showed a tendency to acidosis of respiratory origin with an average of 7.33 at the expense of pCO2 with a mean of 55 mmHg and an average arterial saturation SatO2 of 92%. Conclusions: the present study confirms that inhaled sedation allows a reduction in the use of intravenous sedatives, which reduces the risk of suppression syndrome on withdrawal of sedation. It was also possible to achieve levels of deep sedation for a longer period of time without a higher dose requirement, which may have an impact on long-term costs compared to the use of inhaled sedation.


REFERENCES

  1. Ballesteros Sanz MA, Hernández-Tejedor A, Estella A, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, et al. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19). Med Intensiva (Engl Ed). 2020;44(6):371-388.

  2. Ammar MA, Sacha GL, Welch SC, Bass SN, Kane-Gill SL, Duggal A, et al. Sedation, analgesia, and paralysis in COVID-19 patients in the setting of drug shortages. J Intensive Care Med. 2021;36(2):157-174.

  3. Drug Shortages [Internet]. U.S. Food and Drug Administration. 2022 [cited 13 July 2022]. Available in: https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages

  4. Cousins MJ, Mazze RI. Methoxyflurane nephrotoxicity. A study of dose response in man. JAMA. 1973;225(13):1611-1616.

  5. Kassiri N, Ardehali SH, Rashidi F, Reza Hashemian SM. Inhalational anesthetics agents: the pharmacokinetic, pharmacodynamics, and their effects on human body. Biomed Biotechnol Res J. 2018;2(3):179-177.

  6. Jabaudon M, Boucher P, Imhoff E, Chabanne R, Faure JS, Roszyk L, et al. Sevoflurane for sedation in acute respiratory distress syndrome. a randomized controlled pilot study. Am J Respir Crit Care Med. 2017;195(6):792-800.

  7. Sackey PV, Martling CR, Granath F, Radell PJ. Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med. 2004;32(11):2241-2246.

  8. Jerath A, Parotto M, Wasowicz M, Ferguson ND. Volatile anesthetics. Is a New player emerging in critical care sedation? Am J Respir Crit Care Med. 2016;193(11):1202-1212.

  9. Mesnil M, Capdevila X, Bringuier S, Trine PO, Falquet Y, Charbit J, et al. Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med. 2011;37(6):933-941.

  10. Jung S, Na S, Kim HB, Joo HJ, Kim J. Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation. Acute Crit Care. 2020;35(3):197-204.

  11. Berry CJ, Thedens DR, Light-McGroary K, Miller JD, Kutschke W, Zimmerman KA, et al. Effects of deep sedation or general anesthesia on cardiac function in mice undergoing cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2009;11(1):16.

  12. Purrucker JC, Renzland J, Uhlmann L, Bruckner T, Hacke W, Steiner T, et al. Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study. Br J Anaesth. 2015;114(6):934-943.

  13. Jerath A, Panckhurst J, Parotto M, Lightfoot N, Wasowicz M, Ferguson ND, et al. Safety and efficacy of volatile anesthetic agents compared with standard intravenous midazolam/propofol sedation in ventilated critical care patients: a meta-analysis and systematic review of prospective trials. Anesth Analg. 2017;124(4):1190-1199.

  14. Wong K, Wasowicz M, Grewal D, Fowler T, Ng M, Ferguson ND, et al. Efficacy of a simple scavenging system for long-term critical care sedation using volatile agent-based anesthesia. Can J Anaesth. 2016;63(5):630-632.

  15. Barash PG, Cahalan MK, Cullen BF, Stock MC, Stoelting RK, Ortega R, et al. Clinical anesthesia. 8th ed. Philadelphia, PA: Wolters Kluwer; 2017.

  16. González-Rodríguez R, Muñoz Martínez A, Galan Serrano J, Moral García MV. Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa®) anaesthetic conserving device. Rev Esp Anestesiol Reanim. 2014;61(3):133-139.

  17. Jerath A, Wong K, Wasowicz M, Fowler T, Steel A, Grewal D, et al. Use of inhaled volatile anesthetics for longer term critical care sedation: a pilot randomized controlled trial. Crit Care Expl. 2020;2:e0281.

  18. Ferriere N, Bodenes L, Bailly P, L'Her E. Shortage of anesthetics: Think of inhaled sedation! J Crit Care. 2021;63:104-105.

  19. Miller AL, Theodore D, Widrich J. Inhalational anesthetic [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available in: https://www.ncbi.nlm.nih.gov/books/NBK554540/

  20. Deng J, Lei C, Chen Y, Fang Z, Yang Q, Zhang H, et al. Neuroprotective gases--fantasy or reality for clinical use? Prog Neurobiol. 2014;115:210-245.

  21. Orser BA, Wang DS, Lu WY. Sedating ventilated COVID-19 patients with inhalational anesthetic drugs. EBioMedicine. 2020;55:102770.

  22. Suleiman A, Qaswal AB, Alnouti M, Yousef M, Suleiman B, Jarbeh ME, et al. Sedating mechanically ventilated COVID-19 patients with volatile anesthetics: insights on the last-minute potential weapons. Sci Pharm. 2021;89:6.

  23. Shankar JJS, Banfield JC. Comments on Shemie et al.: International guideline development for the determination of death. Intensive Care Med. 2015;41:571.

  24. Kurosawa S, Kato M. Anesthetics, immune cells, and immune responses. J Anesth. 2008;22(3):263-277.

  25. Pirbudak Cocelli L, Ugur MG, Karadasli H. Comparison of effects of low-flow sevoflurane and desflurane anesthesia on neutrophil and T-cell populations. Curr Ther Res Clin Exp. 2012;73(1-2):41-51.

  26. Ramírez García HA, Cerda Arteaga JM, Chávez Pérez C, Sánchez Nava VM. Sedación con sistema AnaConDa en pacientes COVID-19 crítico y su impacto en días de ventilación mecánica. Med Crit. 2022;36(3):138-141.

  27. Schneemilch CE, Hachenberg T, Ansorge S, Ittenson A, Bank U. Effects of different anaesthetic agents on immune cell function in vitro. Eur J Anaesthesiol. 2005;22(8):616-623.

  28. Koutsogiannaki S, Shimaoka M, Yuki K. The use of volatile anesthetics as sedatives for acute respiratory distress syndrome. Transl Perioper Pain Med. 2019;6(2):27-38.

  29. Bellgardt M, Bomberg H, Herzog-Niescery J, Dasch B, Vogelsang H, Weber TP, et al. Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients: Retrospective analysis. Eur J Anaesthesiol. 2016;33(1):6-13.

  30. Landoni G, Pasin L, Cabrini L, Scandroglio AM, Baiardo Redaelli M, Votta CD, et al. Volatile agents in medical and surgical intensive care units: a meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth. 2016;30(4):1005-1014.

  31. Meiser A, Volk T, Wallenborn J, Guenther U, Becher T, Bracht H, et al. Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: an open-label, phase 3, randomised controlled, non-inferiority trial. Lancet Respir Med. 2021;9(11):1231-1240.

  32. Sackey PV, Martling CR, Carlsward C, Sundin O, Radell PJ. Short- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam--a pilot study. Crit Care Med. 2008;36(3):801-806.

  33. Strosing KM, Faller S, Gyllenram V, Engelstaedter H, Buerkle H, Spassov S, et al. Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury. Anesth Analg. 2016;123(1):143-151.

  34. Xiang YY, Chen X, Li J, Wang S, Faclier G, Macdonald JF, et al. Isoflurane regulates atypical type-A γ-aminobutyric acid receptors in alveolar type II epithelial cells. Anesthesiology. 2013;118(5):1065-1075.

  35. Wang L, Ye Y, Su HB, Yang JP. The anesthetic agent sevoflurane attenuates pulmonary acute lung injury by modulating apoptotic pathways. Braz J Med Biol Res. 2017;50(3):e5747.

  36. Forkuo GS, Nieman AN, Kodali R, Zahn NM, Li G, Rashid Roni MS, et al. A novel orally available asthma drug candidate that reduces smooth muscle constriction and inflammation by targeting GABAA receptors in the lung. Mol Pharm. 2018;15(5):1766-1777.

  37. Lalonde G. Miller's anesthesia, eighth edition. Can J Anesth/J Can Anesth. 2015;62(5):558-559.

  38. Schlapfer M, Leutert AC, Voigtsberger S, Lachmann RA, Booy C, Beck-Schimmer B. Sevoflurane reduces severity of acute lung injury possibly by impairing formation of alveolar oedema. Clin Exp Immunol. 2012;168(1):125-134.

  39. Wagner J, Strosing KM, Spassov SG, Lin Z, Engelstaedter H, Tacke S, et al. Sevoflurane posttreatment prevents oxidative and inflammatory injury in ventilator-induced lung injury. PLoS One. 2018;13(2):e0192896.

  40. Matthay MA, McAuley DF, Ware LB. Clinical trials in acute respiratory distress syndrome: challenges and opportunities. Lancet Respir Med. 2017;5(6):524-534.

  41. Palacios Cuesta A, Llorente de la Fuente A. Sedación inhalatoria en cuidados intensivos. An Pediatr Contin. 2014;12(3):142-146.




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