The advantages of inhalational sedation using an anesthetic-conserving device versus intravenous sedatives in an intensive care unit setting: A systematic review

Zohair Al Aseri; Mariam Ali Alansari; Sara Ali Al-Shami; Bayan Alaskar; Dhuha Aljumaiah; Alyaa Elhazmi

doi:10.4103/atm.atm_89_23

The advantages of inhalational sedation using an anesthetic-conserving device versus intravenous sedatives in an intensive care unit setting: A systematic review

Ann Thorac Med. 2023 Oct-Dec;18(4):182-189. doi: 10.4103/atm.atm_89_23. Epub 2023 Oct 17.

Authors

Zohair Al Aseri^{1

2

3}, Mariam Ali Alansari⁴, Sara Ali Al-Shami², Bayan Alaskar², Dhuha Aljumaiah², Alyaa Elhazmi⁵

Affiliations

¹ Department Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
² Department of Clinical Sciences, College of Medicine and Riyadh Hospital, Dar Al Uloom University, Riyadh, Saudi Arabia.
³ Emergency and Critical Care Development Program, Therapeutic Deputyship, Ministry of Health, Riyadh, Saudi Arabia.
⁴ Department of Adult Critical Care, King Fahad Hospital, Al-Ahsa Health Cluster, Al-Hafouf, Saudi Arabia.
⁵ Department of Internal Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Abstract

Background: Sedation is fundamental to the management of patients in the intensive care unit (ICU). Its indications in the ICU are vast, including the facilitating of mechanical ventilation, permitting invasive procedures, and managing anxiety and agitation. Inhaled sedation with halogenated agents, such as isoflurane or sevoflurane, is now feasible in ICU patients using dedicated devices/systems. Its use may reduce adverse events and improve ICU outcomes compared to conventional intravenous (IV) sedation in the ICU. This review examined the effectiveness of inhalational sedation using the anesthetic conserving device (ACD) compared to standard IV sedation for adult patients in ICU and highlights the technical aspects of its functioning.

Methods: We searched the PubMed, Cochrane Central Register of Controlled Trials, The Cochrane Library, MEDLINE, Web of Science, and Sage Journals databases using the terms "anesthetic conserving device," "Anaconda," "sedation" and "intensive care unit" in randomized clinical studies that were performed between 2012 and 2022 and compared volatile sedation using an ACD with IV sedation in terms of time to extubation, duration of mechanical ventilation, and lengths of ICU and hospital stay.

Results: Nine trials were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time compared to IV sedation (midazolam or propofol).

Conclusion: Compared to IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times, ICU length of stay, and duration of mechanical ventilation. More clinical trials that assess additional clinical outcomes on a large scale are needed.

Keywords: Anesthetic conserving device; inhalation sedation; intensive care unit; intravenous sedation; length of stay.

Publication types

Review