Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis

OBJECTIVE

To comprehensively assess peer-reviewed studies using volatile (VA) or intravenous (i/v) anesthetics for sedation in intensive care units (ICUs), with the hypothesis that the type of sedation may have an impact on survival and other clinically relevant outcomes.

DESIGN

Systematic review and meta-analysis of randomized and non-randomized trials.

SETTING

ICUs.

PARTICIPANTS

Critically ill and postoperative patients.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Studies comparing VA versus i/v anesthetics used in the ICU settings were independently systematically searched. Finally, 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96h) were included. VA had no impact on all-cause mortality (very low quality of evidence, Odds Ratio=0.82 [0.60-1.12], p=0.20). However, VA were associated with a reduction in duration of mechanical ventilation (p=0.03) and increase in ventilator-free days (p<0.001). VA also reduced postoperative levels of cardiac troponin (24h), time to extubation (p<0.001) and awakening (p=0.04).

CONCLUSIONS

In this meta-analysis, volatile sedation vs propofol caused the increase in ventilator-free days, the reduction in the duration of mechanical ventilation, time to extubation and the troponin release in medical or surgical ICU patients, while in surgical ICU patients the time to awakening was shortened.

[PERIOPERATIVE MANAGEMENT IN PATIENTS WITH DISEASES OF THE CARDIOVASGULAR Yb I am IN NON-CARDIAC SURGERY (Commentary on the new European guidelines "Non-cardiac surgery: evaluation and management of cardiovascular system")]

New guidelines for the perioperative management of patients with concomitant diseases of the cardiovascular system (CVS) have been published in the beginning of 2014. The guidelines were the result of joint work of the Board of experts of the European society of cardiology (ESC) and European society of anaesthesiology (ESA). Recommendations ESC/ESA-2014 thoroughly and accurately determine the algorithm of actions of the anaesthesiologist in the process of preparation and conduct of anesthesia and intensive therapy in the early postoperative period in accordance with the modern level of development of our specialty. No doubt they will be useful to all professionals involved in the process of providing medical care to patients in non-cardiac surgery with concomitant diseases of the cardiovascular system. This article, however, does not purport to be a complete summary of the cited document; it only contains, its own commentary on those provisions which are in the author's opinion the most significant and interesting.