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Advantages and disadvantages of potent volatile inhalation anesthetic agents (sevoflurane or isoflurane) for prolonged sedation during mechanical ventilation*

Advantages and disadvantages of potent volatile inhalation anesthetic agents (sevoflurane or isoflurane) for prolonged sedation during mechanical ventilation*
Advantages Disadvantages
  • Effective sedative effects, with rapid onset and offset allowing easy titratability
  • Reduction in dosing requirements for IV sedative-analgesic agents
  • Minimal metabolism and likely minimal organ toxicity
  • Ready availability during shortages of IV sedative and analgesic agents
  • Potentially advantageous respiratory effects (eg, bronchodilation, anti-inflammatory pulmonary effects)
  • Dose-dependent muscle relaxation
  • Scant safety data during use for prolonged periods in critically ill patients
  • Rapid consumption of anesthetic when fresh gas flow is high
  • Potential for inadequate sedation if depletion of anesthetic agent in the vaporizer is not noticed
  • Potential difficulty with connection of the anesthesia machine scavenger to a compatible waste anesthesia gas disposal (WAGD) outlet
  • Environmental damaging effect (global warming), especially with desflurane
  • Need for constant presence of an anesthesia professional due to lack of familiarity among other personnel (eg, intensivists, respiratory therapists) with use of anesthesia machines
  • Potentially undesirable systemic effects:
    • Cardiovascular (myocardial depression and vasodilation)
    • Respiratory (respiratory depression and possible airway irritation with isoflurane or especially desflurane)
    • Cerebral (dose-dependent cerebral vasodilation with increased CBF and ICP)
  • Possible increased risk of diabetes insipidus
  • Rare cases of malignant hyperthermia
IV: intravenous; CBF: cerebral blood flow; ICP: intracranial pressure.
* For more details, please refer to the UpToDate topic on intensive care ventilation with anesthesia machines.
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