Publications

Abstract

How to cite this article: Krishna B. Inhaled Anesthetics for Sedation in ICU: Widening Horizons! Indian J Crit Care Med 2022;26(8):889–891.

Keywords: AnaConDa, Benzodiazepine, Inhaled sedation

Sedation is an integral part of therapy for critically ill patients in the intensive care unit (ICU). Analgesia and sedation are prescribed to alleviate pain and anxiety, permit invasive procedures, prevent ventilator asynchrony and reduce stress, and thereby myocardial oxygen consumption.1 Several International bodies have laid down guidelines that recommend analgo-sedation or analgesia-first sedation in critically ill patients to prevent pain, agitation, and delirium.2,3 Intravenous sedatives like benzodiazepines (midazolam, lorazepam, and diazepam), propofol, and ketamine are commonly combined with opioids to achieve analgo-sedation and in addition, have an opioid-sparing effect.4

An ideal sedative drug must be free of side effects and should have rapid onset of action with a titratable dose–response relationship, with quick recovery time to facilitate easy weaning from mechanical ventilation.

Benzodiazepines are popular sedatives in the ICU, because of their wide availability, potency, and low cost. But there is evidence to demonstrate that continuous use of benzodiazepines in critically ill patients can lead to the accumulation of harmful metabolites due to impaired hepatorenal function resulting in oversedation, prolonged ventilator days and even mortality.5,6 There are also concerns of delirium, tolerance, and long-term consequences like neuropsychiatric disorders.7 Prolonged use of propofol as a sedative is associated with propofol infusion syndrome, hemodynamic instability, and hypertriglyceridemia. Dexmedetomidine has recently been considered as a better sedative drug offering light sedation with analgesia and is beneficial in preventing delirium.8 But at a higher cost and with adverse effects like bradycardia and hypotension, and often the need for a second drug if deeper sedation is required.