Safety and Feasibility of AnaConDa™ to Deliver Inhaled Isoflurane for Sedation in Patients Undergoing Elective Postoperative Mechanical Ventilation: A Prospective, Open-label, Interventional Trial (INSTINCT I Study)
Atul P Kulkarni, Shilpushp Jagannath Bhosale, Kushal Rajeev Kalvit, Tarun Kumar Sahu, Rakesh Mohanty, Meshach M Dhas, Gautam Gondal, Swapna Charie, Anjana Shrivastava, Jigeeshu V Divatia, for the INhaled SedaTion IN CriTically ill patients – (INSTINCT) study group
Citation Information :
Kulkarni AP, Bhosale SJ, Kalvit KR, Sahu TK, Mohanty R, Dhas MM, Gondal G, Charie S, Shrivastava A, Divatia JV, for the INhaled SedaTion IN CriTically ill patients – (INSTINCT) study group. Safety and Feasibility of AnaConDa™ to Deliver Inhaled Isoflurane for Sedation in Patients Undergoing Elective Postoperative Mechanical Ventilation: A Prospective, Open-label, Interventional Trial (INSTINCT I Study). Indian J Crit Care Med 2022; 26 (8):906-912.
Aim: Sedation is essential during invasive mechanical ventilation, and conventionally intravenous analgesic and sedative drugs are used. Sedation with inhaled anesthetics using anesthesia conserving device (ACD) is an alternative. There is no data on the safety and ease of use of AnaConDa™ from India.
Materials and methods: After IEC approval and informed consent, we used AnaConDa™-S for Isoflurane sedation in 50 hemodynamically stable (need for <0.5 µg/kg/min of Noradrenaline infusion), ASA I and II patients aged 18–80 years, undergoing elective mechanical ventilation for up to 24 hours after elective oncosurgeries. Patients with mental obtundation (GCS <14), or if pregnant, were excluded. The primary outcome was time spent between RASS scores of -3 and -4, while secondary outcomes were incidence of delirium, technical problems with AnaConDa™, and adverse systemic effects of isoflurane. Bolus doses of isoflurane 0.2–0.5 mL were given if the Richmond agitation sedation scale (RASS) score was not achieved.
Results: Fifty patients received isoflurane infusion for a median of 720 (IQR 630–900) minutes, and all remained in the target sedation range. Median time to awakening [19 (IQR, 5–85) minutes], to follow simple verbal commands [20 (IQR 5–180) minutes], and extubation after stopping the infusion of isoflurane was quick [100 (10–470) minutes]. All patients remained hemodynamically stable. None of the patients had delirium.
Conclusion: Target sedation levels were achieved with initial boluses of isoflurane using AnaConDa™-S. Isoflurane sedation delivery using AnaConDa™-S is safe and feasible.
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