Observations on the Effects of Inhaled Isoflurane in Long-term Sedation of Critically Ill Children Using a Modified AnaConDa^©–System

Abstract

Background:

Long-term intravenous sedation may present problems due to dependence and side effects.

Patients:

Medical records of children who were administered isoflurane were reviewed. 15 patients (9 boys, 6 girls) with a mean age of 11.8 month (+2.4) were analysed.

Methods:

Analgesia and sedation was given in mean 9.7+1.1 days before commencing inhalation using a modified application device (AnaConDa^©). Administration was given over a period of 7.2+1.4 days. Depth of sedation was monitored by using Comfort- and Hartwig-scores. Observations included continuous monitoring of heart-rate, pulse oxymetry, blood pressure and cerebral tissue oxygenation.

Results:

Within 4 h post administration of isoflurane a satisfactory increase in the depth of sedation was seen and kept till extubation. 6/15 patients received tracheostomies during the observation period. None of the patients observed suffered life-critical events of the modi­fied application of isoflurane proceeded without complications. Ketamine and clonidine infusion rates were significantly reduced (p<0.005) as well as the use and overall infusion rate of midazolam, γ-hydroxy butyrate, fentanyl and morphine (p<0.05).

Conclusion:

Isoflurane inhalation may provide an additional option for long-term sedation in a specific group of critically ill infants but neurodegenerative toxic effects will have to be taken into account when using volatile anesthetics at any time during infancy.

Zusammenfassung

Hintergrund:

Eine lang andauernde intravenöse Sedierung kann durch Abhängigkeit und Nebenwirkungen erheblich erschwert sein.

Patienten:

Alle medizinischen Daten von Kindern, die Isofluran erhalten haben, 15 Patienten (9 Jungen, 6 Mädchen) mit einem mittleren Alter von 11,8 Monaten (+ 2,4), wurden ausgewertet.

Methode:

Vor Beginn der Inhalation mittels eines modifizierten Applikationsgerätes (AnaConDa^©) wurden Analgetika und Sedativa im Mittel 9,7+1,1 Tage gegeben. Die Inhalation da­uerte im Mittel 7,2+1,4 Tage an. Die Sedierungstiefe wurde anhand des Comfort- und des Hartwig-Scores gemessen. Die weitere Beobachtung beinhaltete Herzfrequenz, Pulsoxymetrie, Blutdruck und zerebrale Gewebsoxygenierung.

Ergebnisse:

Innerhalb von 4 Stunden nach Beginn der Isofluran-Inhalation wurde eine zufriedenstellende Sedierungstiefe erreicht und bis zur Extubation gehalten. 6/15 Patienten erhielten im Verlauf der Beobachtungszeit ein Tracheostoma. Bei keinem Patienten wurden lebensgefährliche Komplikationen beobachtet. Die technische Durchführung verlief komplikationslos. Sowohl die Ketamin- und Clonidin- Infusionsraten wurden signifikant (p<0,005) reduziert als auch die Gesamtinfusionsmengen von Midazolam, γ-Hydroxy­butyrat, Fentanyl und Morphin (p<0,05).

Schlussfolgerung:

Die Isofluran-Inhalation ist möglicherweise eine ergänzende Option für die Langzeitsedierung kritisch kranker Kinder. Dabei müssen toxisch-neurodegenerative Effekte bei der Verwendung volatiler Anästhetika in jedem Kindesalter berücksichtigt werden.

Key words

prolonged sedation - anesthesia - AnaConDa - pediatric intensive care - isoflurane

Schlüsselwörter

lang anhaltende Sedierung - Anästhesie - AnaConDa - pädiatrische Intensivmedizin - Isofluran

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