Skip to main content
main-content
Erschienen in: Der Anaesthesist 4/2017

31.01.2017 | Intensivmedizin

Neue technische Entwicklungen der inhalativen Sedierung

verfasst von: Dr. A. Meiser, H. Bomberg, T. Volk, H. V. Groesdonk

Erschienen in: Die Anaesthesiologie | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Seit über hundert Jahren verwenden wir das Kreisteil in Narkosegeräten. Dabei wird die gesamte Ausatemluft nach Kohlendioxidabsorption rückgeatmet. Vor 15 Jahren erfolgte die erste klinische Anwendung eines Anästhetikareflektors. Ein Reflektor arbeitet mit Pendelluft, hält spezifisch nur das Anästhetikum bei der Ausatmung fest und gibt es bei der Einatmung wieder ab. Eine hohe Reflexionseffizienz (Anzahl wieder eingeatmeter/Anzahl ausgeatmeter Anästhetikamoleküle, RE 80–90 %) bedingt einen niedrigen Verbrauch. Analog zum Frischgasfluss beim Kreisteil beschreibt die pulmonale Clearance ((1-RE) × Atemminutenvolumen) die Opposition zwischen Verbrauch und Steuerbarkeit.
Erst die Vorteile der Reflexionssysteme ermöglichten den routinemäßigen Einsatz volatiler Anästhetika auf Intensivstationen. Einfache Handhabung sowie bessere Beatmungseigenschaften von Intensiv- versus Anästhesierespiratoren sind Grundvoraussetzungen hierfür. Neben AnaConDa™ (Sedana Medical, Uppsala, Schweden) ist mit MIRUS™ (Pall Medical, Dreieich, Deutschland) nun ein zweites, technisch weiterentwickeltes Reflexionssystem kommerziell erhältlich.
Die Ausnutzung organprotektiver Effekte, die exzellente Steuerbarkeit sowie eine dosisabhängige tiefe Sedierung bei erhaltener Spontanatmung ohne nennenswerte Kumulation und Toleranzentwicklung lassen volatile Anästhetika als interessante Alternative erscheinen, insbesondere für Patienten, die eine tiefe Sedierung benötigen oder bei denen intravenöse Sedativa nicht mehr anschlagen.
Erste Untersuchungen zum Langzeitüberleben deuten darauf hin, dass tiefe intravenöse Sedierungen nachteilig sind, inhalative Sedierungen hingegen mit Vorteilen verbunden sein könnten. Prospektive Studien zur Mortalität, aber auch zum psychologischen Outcome stehen allerdings noch aus.
Literatur
1.
Zurück zum Zitat Anderson JS, Rose NR, Martin JL et al (2007) Desflurane hepatitis associated with hapten and autoantigen-specific IgG4 antibodies. Anesth Analg 104:1452–1453 (table of contents) CrossRefPubMedPubMedCentral Anderson JS, Rose NR, Martin JL et al (2007) Desflurane hepatitis associated with hapten and autoantigen-specific IgG4 antibodies. Anesth Analg 104:1452–1453 (table of contents) CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Anonymous (1907) The Roth-Drager oxygen and chloroform apparatus. Br Med J 1:1067–1068 CrossRef Anonymous (1907) The Roth-Drager oxygen and chloroform apparatus. Br Med J 1:1067–1068 CrossRef
3.
Zurück zum Zitat Baron R, Binder A, Biniek R et al (2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci 13:Doc19 PubMedPubMedCentral Baron R, Binder A, Biniek R et al (2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version. Ger Med Sci 13:Doc19 PubMedPubMedCentral
4.
Zurück zum Zitat Bellgardt M, Bomberg H, Herzog-Niescery J et al (2016) Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients: retrospective analysis. Eur J Anaesthesiol 33:6–13 CrossRefPubMed Bellgardt M, Bomberg H, Herzog-Niescery J et al (2016) Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients: retrospective analysis. Eur J Anaesthesiol 33:6–13 CrossRefPubMed
5.
Zurück zum Zitat Bomberg H, Glas M, Groesdonk VH et al (2014) A novel device for target controlled administration and reflection of desflurane – the Mirus. Anaesthesia 69:1241–1250 CrossRefPubMedPubMedCentral Bomberg H, Glas M, Groesdonk VH et al (2014) A novel device for target controlled administration and reflection of desflurane – the Mirus. Anaesthesia 69:1241–1250 CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Bomberg H, Groesdonk HV, Bellgardt M et al (2016) AnaConDa and Mirus for intensive care sedation, 24 h desflurane versus isoflurane in one patient. Springerplus 5:420 CrossRefPubMedPubMedCentral Bomberg H, Groesdonk HV, Bellgardt M et al (2016) AnaConDa and Mirus for intensive care sedation, 24 h desflurane versus isoflurane in one patient. Springerplus 5:420 CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Bosel J, Purrucker JC, Nowak F et al (2012) Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa((R)): effects on cerebral oxygenation, circulation, and pressure. Intensive Care Med 38:1955–1964 CrossRefPubMed Bosel J, Purrucker JC, Nowak F et al (2012) Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa((R)): effects on cerebral oxygenation, circulation, and pressure. Intensive Care Med 38:1955–1964 CrossRefPubMed
9.
Zurück zum Zitat Brunt EM, White H, Marsh JW et al (1991) Fulminant hepatic failure after repeated exposure to isoflurane anesthesia: a case report. Hepatology 13:1017–1021 CrossRefPubMed Brunt EM, White H, Marsh JW et al (1991) Fulminant hepatic failure after repeated exposure to isoflurane anesthesia: a case report. Hepatology 13:1017–1021 CrossRefPubMed
10.
Zurück zum Zitat Chabanne R, Perbet S, Futier E et al (2014) Impact of the anesthetic conserving device on respiratory parameters and work of breathing in critically ill patients under light sedation with sevoflurane. Anesthesiology 121:808–816 CrossRefPubMed Chabanne R, Perbet S, Futier E et al (2014) Impact of the anesthetic conserving device on respiratory parameters and work of breathing in critically ill patients under light sedation with sevoflurane. Anesthesiology 121:808–816 CrossRefPubMed
11.
Zurück zum Zitat Chung IS, Kim JA, Kim JA et al (2013) Reactive oxygen species by isoflurane mediates inhibition of nuclear factor kappaB activation in lipopolysaccharide-induced acute inflammation of the lung. Anesth Analg 116:327–335 CrossRefPubMed Chung IS, Kim JA, Kim JA et al (2013) Reactive oxygen species by isoflurane mediates inhibition of nuclear factor kappaB activation in lipopolysaccharide-induced acute inflammation of the lung. Anesth Analg 116:327–335 CrossRefPubMed
12.
Zurück zum Zitat Englert JA, Macias AA, Amador-Munoz D et al (2015) Isoflurane ameliorates acute lung injury by preserving epithelial tight junction integrity. Anesthesiology 123:377–388 CrossRefPubMedPubMedCentral Englert JA, Macias AA, Amador-Munoz D et al (2015) Isoflurane ameliorates acute lung injury by preserving epithelial tight junction integrity. Anesthesiology 123:377–388 CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Enlund M, Wiklund L, Lambert H (2001) A new device to reduce the consumption of a halogenated anaesthetic agent. Anaesthesia 56:429–432 CrossRefPubMed Enlund M, Wiklund L, Lambert H (2001) A new device to reduce the consumption of a halogenated anaesthetic agent. Anaesthesia 56:429–432 CrossRefPubMed
14.
Zurück zum Zitat Enlund M, Lambert H, Wiklund L (2002) The sevoflurane saving capacity of a new anaesthetic agent conserving device compared with a low flow circle system. Acta Anaesthesiol Scand 46:506–511 CrossRefPubMed Enlund M, Lambert H, Wiklund L (2002) The sevoflurane saving capacity of a new anaesthetic agent conserving device compared with a low flow circle system. Acta Anaesthesiol Scand 46:506–511 CrossRefPubMed
15.
Zurück zum Zitat Ferrando C, Aguilar G, Piqueras L et al (2013) Sevoflurane, but not propofol, reduces the lung inflammatory response and improves oxygenation in an acute respiratory distress syndrome model: a randomised laboratory study. Eur J Anaesthesiol 30:455–463 CrossRefPubMed Ferrando C, Aguilar G, Piqueras L et al (2013) Sevoflurane, but not propofol, reduces the lung inflammatory response and improves oxygenation in an acute respiratory distress syndrome model: a randomised laboratory study. Eur J Anaesthesiol 30:455–463 CrossRefPubMed
16.
Zurück zum Zitat Hasan F (1998) Isoflurane hepatotoxicity in a patient with a previous history of halothane-induced hepatitis. Hepatogastroenterology 45:518–522 PubMed Hasan F (1998) Isoflurane hepatotoxicity in a patient with a previous history of halothane-induced hepatitis. Hepatogastroenterology 45:518–522 PubMed
17.
Zurück zum Zitat Hellstrom J, Owall A, Sackey PV (2012) Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery. Scand Cardiovasc J 46:262–268 CrossRefPubMed Hellstrom J, Owall A, Sackey PV (2012) Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery. Scand Cardiovasc J 46:262–268 CrossRefPubMed
18.
Zurück zum Zitat Hellstrom J, Owall A, Martling CR et al (2014) Inhaled isoflurane sedation during therapeutic hypothermia after cardiac arrest: a case series. Crit Care Med 42:e161–e166 CrossRefPubMed Hellstrom J, Owall A, Martling CR et al (2014) Inhaled isoflurane sedation during therapeutic hypothermia after cardiac arrest: a case series. Crit Care Med 42:e161–e166 CrossRefPubMed
20.
Zurück zum Zitat Jerath A, Panckhurst J, Parotto M et al (2016) Safety and efficacy of volatile anesthetic agents compared with standard intravenous Midazolam/Propofol sedation in ventilated critical care patients: a meta-analysis and systematic review of prospective trials. Anesth Analg. doi: 10.​1213/​ane.​0000000000001634​ Jerath A, Panckhurst J, Parotto M et al (2016) Safety and efficacy of volatile anesthetic agents compared with standard intravenous Midazolam/Propofol sedation in ventilated critical care patients: a meta-analysis and systematic review of prospective trials. Anesth Analg. doi: 10.​1213/​ane.​0000000000001634​
22.
Zurück zum Zitat Jung C, Granados M, Marsol P et al (2008) Use of sevoflurane sedation by the AnaConDa device as an adjunct to extubation in a pediatric burn patient. Burns 34:136–138 CrossRefPubMed Jung C, Granados M, Marsol P et al (2008) Use of sevoflurane sedation by the AnaConDa device as an adjunct to extubation in a pediatric burn patient. Burns 34:136–138 CrossRefPubMed
23.
Zurück zum Zitat Kofke WA, Young RS, Davis P et al (1989) Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology 71:653–659 CrossRefPubMed Kofke WA, Young RS, Davis P et al (1989) Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology 71:653–659 CrossRefPubMed
24.
25.
Zurück zum Zitat Kusuma HR, Venkataramana NK, Rao SA et al (2011) Fulminant hepatic failure after repeated exposure to isoflurane. Indian J Anaesth 55:290–292 CrossRefPubMedPubMedCentral Kusuma HR, Venkataramana NK, Rao SA et al (2011) Fulminant hepatic failure after repeated exposure to isoflurane. Indian J Anaesth 55:290–292 CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat L’her E, Dy L, Pili R et al (2008) Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study. Respir Care 53:1295–1303 PubMed L’her E, Dy L, Pili R et al (2008) Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study. Respir Care 53:1295–1303 PubMed
27.
Zurück zum Zitat Maltais F, Sovilj M, Goldberg P et al (1994) Respiratory mechanics in status asthmaticus. Effects of inhalational anesthesia. Chest 106:1401–1406 CrossRefPubMed Maltais F, Sovilj M, Goldberg P et al (1994) Respiratory mechanics in status asthmaticus. Effects of inhalational anesthesia. Chest 106:1401–1406 CrossRefPubMed
28.
Zurück zum Zitat Meiser A, Laubenthal H (2005) Inhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit. Best Pract Res Clin Anaesthesiol 19:523–538 CrossRefPubMed Meiser A, Laubenthal H (2005) Inhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit. Best Pract Res Clin Anaesthesiol 19:523–538 CrossRefPubMed
29.
Zurück zum Zitat Meiser A, Sirtl C, Bellgardt M et al (2003) Desflurane compared with propofol for postoperative sedation in the intensive care unit. Br J Anaesth 90:273–280 CrossRefPubMed Meiser A, Sirtl C, Bellgardt M et al (2003) Desflurane compared with propofol for postoperative sedation in the intensive care unit. Br J Anaesth 90:273–280 CrossRefPubMed
30.
Zurück zum Zitat Meiser A, Bellgardt M, Belda J et al (2009) Technical performance and reflection capacity of the anaesthetic conserving device – a bench study with isoflurane and sevoflurane. J Clin Monit Comput 23:11–19 CrossRefPubMedPubMedCentral Meiser A, Bellgardt M, Belda J et al (2009) Technical performance and reflection capacity of the anaesthetic conserving device – a bench study with isoflurane and sevoflurane. J Clin Monit Comput 23:11–19 CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Meiser A, Bellgardt M, Vogelsang H et al (2010) Functioning of the anaesthetic conserving device: aspects to consider for use in inhalational sedation. Anaesthesist 59:1029–1040 CrossRefPubMed Meiser A, Bellgardt M, Vogelsang H et al (2010) Functioning of the anaesthetic conserving device: aspects to consider for use in inhalational sedation. Anaesthesist 59:1029–1040 CrossRefPubMed
32.
Zurück zum Zitat Mesnil M, Capdevila X, Bringuier S et al (2011) Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 37:933–941 CrossRefPubMed Mesnil M, Capdevila X, Bringuier S et al (2011) Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 37:933–941 CrossRefPubMed
33.
Zurück zum Zitat Mirsattari SM, Sharpe MD, Young GB (2004) Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 61:1254–1259 CrossRefPubMed Mirsattari SM, Sharpe MD, Young GB (2004) Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 61:1254–1259 CrossRefPubMed
34.
Zurück zum Zitat Misra S, Koshy T (2012) A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa((R)) device. Indian J Anaesth 56:518–523 CrossRefPubMedPubMedCentral Misra S, Koshy T (2012) A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa((R)) device. Indian J Anaesth 56:518–523 CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Nickel EA, Benken I, Bartels U et al (2007) AnaConDa as last resort treatment. Case report of a chronic obstructive pulmonary disease. Anaesthesist 56:587–591 CrossRefPubMed Nickel EA, Benken I, Bartels U et al (2007) AnaConDa as last resort treatment. Case report of a chronic obstructive pulmonary disease. Anaesthesist 56:587–591 CrossRefPubMed
36.
Zurück zum Zitat Purrucker JC, Renzland J, Uhlmann L et al (2015) Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa(R): an observational study. Br J Anaesth 114:934–943 CrossRefPubMed Purrucker JC, Renzland J, Uhlmann L et al (2015) Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa(R): an observational study. Br J Anaesth 114:934–943 CrossRefPubMed
37.
Zurück zum Zitat Sackey PV, Martling CR, Granath F et al (2004) Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med 32:2241–2246 CrossRefPubMed Sackey PV, Martling CR, Granath F et al (2004) Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med 32:2241–2246 CrossRefPubMed
38.
Zurück zum Zitat Shehabi Y, Chan L, Kadiman S et al (2013) Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 39:910–918 CrossRefPubMedPubMedCentral Shehabi Y, Chan L, Kadiman S et al (2013) Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 39:910–918 CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Sturesson LW, Malmkvist G, Bodelsson M et al (2012) Carbon dioxide rebreathing with the anaesthetic conserving device, AnaConDa(R). Br J Anaesth 109:279–283 CrossRefPubMed Sturesson LW, Malmkvist G, Bodelsson M et al (2012) Carbon dioxide rebreathing with the anaesthetic conserving device, AnaConDa(R). Br J Anaesth 109:279–283 CrossRefPubMed
40.
Zurück zum Zitat Sturesson LW, Bodelsson M, Johansson A et al (2013) Apparent dead space with the anesthetic conserving device, AnaConDa(R): a clinical and laboratory investigation. Anesth Analg 117:1319–1324 CrossRefPubMed Sturesson LW, Bodelsson M, Johansson A et al (2013) Apparent dead space with the anesthetic conserving device, AnaConDa(R): a clinical and laboratory investigation. Anesth Analg 117:1319–1324 CrossRefPubMed
41.
Zurück zum Zitat Sturesson LW, Bodelsson M, Jonson B et al (2014) Anaesthetic conserving device AnaConDa: dead space effect and significance for lung protective ventilation. Br J Anaesth 113:508–514 CrossRefPubMed Sturesson LW, Bodelsson M, Jonson B et al (2014) Anaesthetic conserving device AnaConDa: dead space effect and significance for lung protective ventilation. Br J Anaesth 113:508–514 CrossRefPubMed
42.
Zurück zum Zitat Thomasson R, Luttropp HH, Werner O (1989) A reflection filter for isoflurane and other anaesthetic vapours. Eur J Anaesthesiol 6:89–94 PubMed Thomasson R, Luttropp HH, Werner O (1989) A reflection filter for isoflurane and other anaesthetic vapours. Eur J Anaesthesiol 6:89–94 PubMed
43.
Zurück zum Zitat Thomson H, Harper NJ, Parkes A (2007) Use of the AnaConDa anaesthetic delivery system to treat life-threatening asthma. Anaesthesia 62:295–296 CrossRefPubMed Thomson H, Harper NJ, Parkes A (2007) Use of the AnaConDa anaesthetic delivery system to treat life-threatening asthma. Anaesthesia 62:295–296 CrossRefPubMed
44.
Zurück zum Zitat Villa F, Iacca C, Molinari AF et al (2012) Inhalation versus endovenous sedation in subarachnoid hemorrhage patients: effects on regional cerebral blood flow. Crit Care Med 40:2797–2804 CrossRefPubMed Villa F, Iacca C, Molinari AF et al (2012) Inhalation versus endovenous sedation in subarachnoid hemorrhage patients: effects on regional cerebral blood flow. Crit Care Med 40:2797–2804 CrossRefPubMed
Metadaten
Titel
Neue technische Entwicklungen der inhalativen Sedierung
verfasst von
Dr. A. Meiser
H. Bomberg
T. Volk
H. V. Groesdonk
Publikationsdatum
31.01.2017
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 4/2017
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-017-0269-5

Weitere Artikel der Ausgabe 4/2017

Der Anaesthesist 4/2017 Zur Ausgabe

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update AINS und bleiben Sie gut informiert – ganz bequem per eMail.