Clinical Studies Neuro
Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study.
Purrucker et al
Br J Anaesth March 2015
To prospectively measure cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from IV to inhalative sedation.
25 patients were switched from IV to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h). In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12hour post switch observational period, [Formula: see text] increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010].
Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.
Administration of isoflurane - Controlled dyskinetic movements caused by anti-NMDAR encephalitis.
Gumbinger et al
Neurology 80 May 2013
Common clinical features of anti-NMDAR encephalitis are psychiatric symptoms, decreased level of consciousness, seizures, autonomic dysfunction, orofacial dyskinesias, and several types of abnormal movements. The present case report addresses the challenging management of these movement abnormalities with a volatile anesthetic in the prolonged period of intensive care treatment.
Long-term administration of isoflurane may offer an effective way of controlling dyskinetic movements caused by anti-NMDAR encephalitis.
Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa®: effects on cerebral oxygenation, circulation, and pressure.
Bösel et al
Intensive Care Med 2012
The effects of isoflurane sedation on cerebral parameters and systemic physiology parameters in neuromonitored ICU stroke patients were investigated.
19 patients were included with intracerebral haemorrhage (12), subarachnoid haemorrhage (4), and ischemic stroke (3) who were switched from intravenous propofol or midazolam to inhalative isoflurane sedation using the AnaConDa for an average of 3,5 days. After the first hour, mean ICP showed an increase that was not clinically relevant. Over an observation period of 12 h, ICP remained stable while MAP and thus CPP (cerebral perfusion pressure) showed distinct decreases in spite of a 1,5-fold increase in vasopressor administration.
It is suggested that it is possible to reach sufficient sedation levels in cerebrovascular ICU patients by applying volatile isoflurane with the AnaConDa long term without a relevant increase in ICP, if baseline ICP values are low or only moderately elevated. Multimodal neuromonitoring is strongly recommended.