Use of the anaesthetic conserving device in the Intensive Care

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Patients who are post cardiac surgery, and frequently patients after other prolonged surgery require mechanical ventilation in the ICU until they are stable for extubation. The majority of these patients require some sedation, mainly for endotracheal tube tolerance, cough suppression and to allow routine procedures be performed. Currently , intravenous sedatives are used in our ICU. The use of inhalational agents such as Sevoflurane and Isoflurane in the intensive care setting, has been widely described in the literature. The advantage of these agents are that they are easily titrated to effect, the level of sedation can be easily monitored, and as they are exceted by the lungs, and not by the liver and kidneys, may be more advantageous in patients with hepatic or renal impairment. Furthermore more, they have been shown to have a cardioprotective effect on those post cardiac surgery in particular and reduce the morbidity and mortality in this group. In our study, we will enrol 10 patients post CABG surgery to receive Isoflurane via the Anaesthetic Conserving Device (AnaConDa) until the time of extubation. We believe that the time to extubation following cessation of sedation will be shorter compared to those receiving intravenous sedation. We will measure troponin levels, which is a marker of cardiac injury, and compare the levels in those receiving inhalational sedation compared to intravenous sedation. Patients’ cardiac and respiratory status will be carefully monitored in the ICU setting, and their sedation scores measured. We believe we can reduce the amount of intravenous sedation used in this group.

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