Balanced volatile sedation with isoflurane in critically ill patients with aneurysmal subarachnoid hemorrhage - a retrospective observational study.
| Autor: | Müller MB; Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany., Terpolilli NA; Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany., Schwarzmaier SM; Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany., Briegel J; Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany., Huge V; Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany.; Department of Critical Care and Anaesthesiology, Schön Klinik Bad Aibling, Bad Aibling, Germany. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in neurology [Front Neurol] 2023 Jun 22; Vol. 14, pp. 1164860. Date of Electronic Publication: 2023 Jun 22 (Print Publication: 2023). |
| DOI: | 10.3389/fneur.2023.1164860 |
| Abstrakt: | Introduction: In patients with severe aneurysmal subarachnoid hemorrhage (SAH) deep sedation is often used early in the course of the disease in order to control brain edema formation and thus intracranial hypertension. However, some patients do not reach an adequate sedation depth despite high doses of common intravenous sedatives. Balanced sedation protocols incorporating low-dose volatile isoflurane administration might improve insufficient sedation depth in these patients. Methods: We retrospectively analyzed ICU patients with severe aneurysmal SAH who received isoflurane in addition to intravenous anesthetics in order to improve insufficient sedation depth. Routinely recorded data from neuromonitoring, laboratory and hemodynamic parameters were compared before and up to 6 days after initiation of isoflurane. Results: Sedation depth measured using the bispectral index improved in thirty-six SAH patients (-15.16; p = 0.005) who received additional isoflurane for a mean period of 9.73 ± 7.56 days. Initiation of isoflurane sedation caused a decline in mean arterial pressure (-4.67 mmHg; p = 0.014) and cerebral perfusion pressure (-4.21 mmHg; p = 0.013) which had to be balanced by increased doses of vasopressors. Patients required increased minute ventilation in order to adjust for the increase in PaCO Discussion: A balanced sedation protocol including isoflurane is feasible for SAH patients experiencing inadequately shallow sedation. However, therapy should be restricted to patients without impaired lung function, hemodynamic instability and impending intracranial hypertension. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Müller, Terpolilli, Schwarzmaier, Briegel and Huge.) |
| Databáze: | MEDLINE |
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