WEBINAR ON DEMAND Use Of Volatile Anaestheticsin Critically ill Patients

Managing sedation is an important challenge in Intensive Care Units worldwide. Critically ill patients are often attached to multiple machines and infusions, unable to talk and often delirious and although reassurance, explanation and non- pharmacological approaches are commonly applied, patients will require pharmacological interventions.

Moreover, in critically ill patients, unpredictable pharmacokinetics and pharmacodynamics secondary to drug interactions, organ dysfunction, inconsistent absorption and protein binding, hemodynamic instability, and drug accumulation can lead to adverse events.

Over-sedation, due to the administration of commonly used agents (i.e. benzodiazepines, propofol), due to reduced metabolism and clearance, eventually impact awakening times, duration of mechanical ventilation, hemodynamic stability and even mortality. Drug tolerance, withdrawal, propofol infusion syndrome, delirium and long-term neuropsychiatric disorders (depression, anxiety and post-traumatic stress disorders) are additional issues in the ICU.

On the other side, halogenates (sevoflurane, desflurane, isoflurane) have a number of potential advantages including: onset of action, no significant concerns of drug tolerance or tachyphylaxis, rapid offset aided by drug clearance via simple pulmonary exhalation with low levels of hepatic metabolism (sevoflurane 5%, isoflurane 0.2%, desflurane 0.02%), anti- inflammatory lung effects, and production of no significant active metabolites. In light of these considerations, halogenated may be considered for mechanically ventilated patients in the ICU.

The aim of this live webinar is to address the following issues regarding inhalation anesthetics in critically ill patients: role of these form of sedation in mechanically ventilated patients with respiratory failure, pharmacodynamic and pharmacokinetic of halogenates, pharmacologic properties of halogenates and their interaction with the immune system (reduction of pro- inflammatory cytokines in the lungs), pollution issues in the working areas.

Scientific Coordinator: Stefano Romagnoli

Discussant: Guglielmo Consales