Patients Who Needs Sedation After Head & Neck Surgery
Conditions
Brief summary
Sedation in the ICUs is very common. There is no ideal sedative yet, so research has been conducted to replace propofol and midazolam, which are the most commonly used sedatives in ICUs, by inhalation anesthetics. The investigators will sedate the patients who undergo head & neck surgery with tracheostomy for several days using sevoflurane, a kind of inhalation agent, via anesthetic conserving device. The objective of this study is to confirm the end-tidal sevoflurane concentration for inducing moderate sedation (RASS -2\ -3). In addition, the investigators compare the volatile sedation with the IV(intravenous) sedation to see if the volatile sedation could reduce the amount of post-operative opioid consumption. * RASS: Richmond Agitation-Sedation Scale * RASS: Richmond Agitation-Sedation Scale
Detailed description
When patients, who need mechanical ventilation for several days after head & neck surgery, enters the ICU, the investigators induce moderate sedation (RASS -2\ -3). End-tidal sevoflurane (etSEVO) concentration is adjusted to 0.5Vol% within 30 minutes. Sedation level is evaluated every 5 minutes. After 30 minutes, the investigators check that the sedation goal is achieved. Following the up & down method, if the moderate sedation (RASS -2\ -3) or the deep sedation (RASS -4\ -5) is achieved at the etSEVO concentration of 0.5vol% after 30 minutes of sedation, the next patient's target etSEVO concentration is reduced to 0.4vol%. On the contrary to this, if only light sedation (RASS above -1) is achieved, the next patient's target etSEVO is increased to 0.6vol%. This process is repeated to find the appropriate etSEVO concentration at the beginning of sedation, which induces sedation of RASS -2\ -3. In retrospective analysis, the investigators compared the prospective study group with propofol intravenous sedation group. \* RASS: Richmond Agitation-Sedation Scale
Interventions
DRUGSedate using sevoflurane via anesthetic conserving device(ACD, Anaconda®) after surgery
The investigators sedate the patients in the ICU for several days after head & neck surgery using sevoflurane via anesthetic conserving device in sevoflurane group.
DRUGSedate using propofol.
Retrospectively, the investigators compare the sevoflurane group with intravenous sedation group using propofol.
Sponsors
Yonsei University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who needs sedation in the ICU for several days after head & neck surgery * ASA class I\ III * Adult patients over 20 years old * Patients who can read and understand the informed consent
Exclusion criteria
* Patients who do not agree to participate in the study * Past history or Family history of malignant hyperthermia * End stage renal disease (eGFR\<30 or dialysis) * Moderate to severe liver disease (AST, ALT \> 200IU/L) * Pregnant women * Patients who cannot read and understand the informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Optimal end-tidal sevoflurane concentration to induce moderate sedation of RASS -2~-3 in patients who undergo head & neck surgery with tracheostomy | After the first 30 minutes after sedation with sevoflurane via anesthetic conserving device | Investigators will find the initial concentration of sevoflurane for proper sedation by the Dixon's up and down method. |
Secondary
| Measure | Time frame |
|---|---|
| Compare the sevoflurane group and the intravenous sedation group: Compare the ICU stay | within the 3 days (plus of minus 3 days) after surgery |
| Compare the sevoflurane group and the intravenous sedation group: Compare the hospital day | within the 3 days (plus of minus 3 days) after surgery |
| Compare the sevoflurane group and the intravenous sedation group: Compare the incidence of delirium, hypotension | within the 3 days (plus of minus 3 days) after surgery |
| Compare the sevoflurane group and the intravenous sedation group: Compare the remifentanil infusion dose | within the 3 days (plus of minus 3 days) after surgery |
Countries
South Korea
Outcome results
None listed