- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 202) Inhalational anaesthetic agents in critical illness
- Chapter:
- (p. 202) Inhalational anaesthetic agents in critical illness
- Author(s):
Laurent Beydon
and Flavie Duc
- DOI:
- 10.1093/med/9780199600830.003.0046
Inhalational anaesthetic agents have limited applications in the intensive care unit (ICU), as their delivery requires specific equipment, which are not routinely available. Sevoflurane and isoflurane are the two agents eligible for this purpose. They both show good clinical tolerance and versatility, but may raise cerebral blood flow above 1 minimum alveolar concentration. This property makes them unsuitable for sedation in patients suffering from acute brain injury. Sevoflurane is known to be partly metabolized via the cytochrome pathway in inorganic fluoride. This latter accumulates in a dose- and time-dependent manner, especially in a closed circuit with soda lime. However, no clinical renal injury has been proven, despite several studies reporting on sevoflurane in ICUs. A fresh gas flow above 2 L/min is required to limit inorganic fluoride build-up. Halogenates have been proven to allow efficient sedation in ICU patients for up to several days. They may be considered as therapeutic agents especially in refractory status asthmaticus. Insufficient data exist to recommend halogenates to treat status epilepticus. Nitrous oxide, in 50% oxygen, may serve to allow sedation/analgesia for short and moderately procedures. Xenon, an inert gas that discloses anaesthetic properties with extremely fast onset and recovery, and also has no haemodynamic side effects remains confined to the operating theatre. It requires specific anaesthetic machines and is, at present, too expensive to represent a routine inhalational anaesthetic agent.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care