Zastosowanie systemu „AnaConDa” do analgosedacji sewofluranem chorych po operacjach kardiochirurgicznych

Jakub Śmiechowicz, Jarosław Terpiński, Andrzej Kübler

Summary
Background. Volatile anaesthetics offer several advantages when used to sedate ICU patients. The Anaesthetic Conserving Device (ACD) "AnaConDa” (Hudson RCI, Upplands, Väsby, Sweden) enables easy and economical administration of sevoflurane and isoflurane during mechanical ventilation with a standard ICU ventilator. The purpose of the study was to evaluate the usefulness of sevoflurane administered via the ACD for sedation after cardiac surgery. Methods. Six patients who had undergone cardiac surgery, received sevoflurane delivered with a syringe pump to the ACD, which was placed between the endotracheal tube and the breathing circuit of a Bennett 7200ae ventilator. Expiratory gas concentrations and vital signs were monitored using the Datex AS/3 system. The depth of sedation was assessed by the modified Ramsay scale and bispectral index (BIS). Results. Adequate sedation was achieved in all patients. Sevoflurane was delivered at a rate of 0.5 to 6.0 ml h^-1 over 170 to 410 minutes, producing end-tidal concentrations between 0.2 and 1.9 % (most of the time between 0.4 and 0.9%). Mean sevoflurane consumption during sedation was in the range of 1.18 to 3.17 ml h^-1. The Ramsay sedation score varied from 6 to 2. Mean BIS values correlated inversely with the depth of sedation, although the range varied widely. Haemodynamic parameters remained within acceptable limits. Most of the patients could be extubated within 1 hour after sevoflurane had been stopped. Conclusions. Relatively low end-tidal sevoflurane concentrations produced adequate sedation in the majority of patients, without compromising cardiovascular function. The recovery was smooth and the time to extubation depended mainly on the residual effects of opioids. Because of wide fluctuations in BIS values, we do not regard this index as a reliable tool for assessment of sedation in the ICU.

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