Inhaled sevoflurane sedation in the intensive care unit. A case report and narrative literature review

This article aims at reviewing, in recent literature, the interest and good practice of using volatile sedation with sevoflurane in an intensive care setting. Although rarely used in the intensive care unit (ICU) compared to intravenous sedation, inhaled sedation may be a good alternative to insure comfort to ICU patients. Current literature demonstrates that sevoflurane, administrated through a specifically designed device, the AnaConDa, provides safe and good quality sedation to those patients. Long-term inhaled sevoflurane sedation (ISS) (>96 hours) would be associated to lower agitation, improved pain control, and lower mortality than intravenous sedation. The properties of sevoflurane may be of further advantage in specific intensive care situations such as bronchospasm, postoperative sedation after cardiothoracic surgery, or in agitated patients due to alcohol or other drugs withdrawal. Other studies suggest superiority of ISS in case of pulmonary arterial hypertension, chronic obstructive pulmonary disease, and acute respiratory distress syndrome. We here illustrate our literature review with a case of severe bronchospasm successfully managed using ISS. © Acta Ancesthesiologica Belgica, 2018.