Contents

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Show Summary Details
Page of

Inhalational anaesthetic agents in critical illness 

Inhalational anaesthetic agents in critical illness
Chapter:
Inhalational anaesthetic agents in critical illness
Author(s):

Laurent Beydon

and Flavie Duc

DOI:
10.1093/med/9780199600830.003.0046
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 24 July 2021

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.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.