Abstract
Background. The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.Methods. The literature search was limited to PubMed, Sage Journals and CINAHL databases, using the terms »anaesthetic conserving device«, »volatile anaesthetic reflection filter«, »AnaConDa« independently and in connection with the terms »sedation« and intensive care unit«. Included are articles published up until December 2014.Results. Use of inhalation sedation with the Anaesthetic Conserving Device enables faster transition to spontaneous breathing and a shorter awakening time than with intravenous sedation. Even short-term inhalation sedation of patients after open heart procedures has a cardioprotective effect and reduces troponin T values. Despite increased concentrations of inorganic fluoride in serum after sevoflurane exposure, no clinical studies to date have shown its nephrotoxic effect, even after long-term (48 h) sedation. The Anaesthetic Conserving Device is accurate in maintaining target values of volatile anaesthetics. However, increased dead space volume was found in several studies, exceeding the internal volume of the Anaesthetic Conserving Device.Conclusion. Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment.
Highlights
Effective sedation and analgesia are indispensable elements of treating patients in intensive care units (ICU) in order to reduce pain, anxiety, and agitation during mechanical ventilation and when other invasive diagnostic and therapeutic interventions are performed. [1,2] Current guidelines for analgesia and sedation of patients in ICU favour the use of intravenous forms of sedation. [3] Propofol and midazolam are the most often used drugs for sedation of critically ill patients; the literature highlights numerous adverse effects of such intravenous anaesthetics. [4,5]Compared to most intravenous anaesthetics, volatile anaesthetics, such as sevoflurane and isoflurane, offer better control of sedation since they do not accumulate or develop tolerance
Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment
The Anaesthetic Conserving Device (ACD, AnaConDaTM) is a modified heat and moisture exchanger, which is inserted between the Y-piece of the breathing circuit and the endotracheal tube (ET-tube) and can be used with any type of ICU ventilator [17,18] without a heated humidifier
Summary
Compared to most intravenous anaesthetics, volatile anaesthetics, such as sevoflurane and isoflurane, offer better control of sedation since they do not accumulate or develop tolerance. [15] The principle of the charcoal filter was further developed, leading to the creation of a device for inhalation sedation AnaConDaTM (Anaesthetic Conserving Device; Sedana Medical, Uppsala, Sweden), which enables sedation and analgesia of patients in ICU with isoflurane and sevoflurane. The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.
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