Volatile agents for ICU sedation?

Excerpt

Sedation is a standard part of critical care and was unchallenged from 1960 to 2000. Classical sedation approaches are associated with significant post-traumatic stress traits [1]. Because of poor pharmacokinetics/pharmacodynamics and planning problems, patients in the intensive care unit (ICU) spend one-third of their duration of stay being ventilated after the resolution of the problem mandating intubation [2, 3]. The aim of sedation in the ICU is to make the patient calm and tolerant to the critical care therapies, in particular mechanical ventilation. Recently several approaches have proven beneficial for patient care and the healthcare system: prospective trials have shown that daily interruptions of sedation are associated with a decrease in length of ventilation and decrease in ICU stay [4]. If a spontaneous breathing trial is used in addition to daily sedation interruption, the 1-year survival is improved [5] without an increase in psychological consequences [6]. Recent data suggest that no sedation at all may be better [7]. This move has been made possible by the improvement in ventilator algorithms, which are increasingly flexible in dealing with variable patient efforts. Over the last 10 years, the pendulum has moved toward a decrease in sedation with proactive strategies [8]. In this frame, the quest for the ideal sedation agent is continuing. The ideal sedative agent should be fast acting, have a rapid onset, not be organ dependent in terms of degradation, not have metabolically active or toxic by-products, have little cardiovascular effects, and be cheap. Over the last 30 years, midazolam, propofol [9], and dexmedetomidine [10, 11] have been rolled out with the promise of being better than the previous generation of drugs. …