Inhalative Sedation in ICU With Sevoflurane Via Anaesthetic Conserving Device Compared to Propofol

Renal Function Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00586118
• Other study ID #: ANA06104
• Secondary ID: ANA06104
• Status: Completed
• Phase: N/A
• First received: December 21, 2007
• Last updated: January 3, 2008
• Start date: December 2006
• Est. completion date: December 2007

Study information

• Verified date: December 2007
• Source: Klinikum Ludwigshafen
• Contact: n/a
• Is FDA regulated: No
• Health authority: Germany: Federal Institute for Drugs and Medicinal Devices (BfArM), Bonn, Germany
• Study type: Observational

Clinical Trial Summary

The evaluation of the presented study will work on the practicability of inhalative sedation on the ICU, potential benefits and limitations of the ACD system in a postoperative sedated patient population in comparison to a standard intravenous sedation regimen with propofol, and focus on renal and hepatic function, cardioprotection and pharmacoeconomics

Description:

A goal-oriented sedation complies the ability to sedate the patient as deeply as necessary, and allow a modern ventilation regimen with early spontaneous breathing and a pain-free cooperative patient. The ideal sedative agent - with a short duration of action, predictable wake-up times, low drug toxicity, haemodynamic stability and less side effects, and a rational pharmacoeconomic impact nowadays - has still to be found. Inhalative anaesthetics show these properties, but until the introduction of AnaConDa© (Anesthetic Conserving Device, ACD) in 2005, the use of volatile anaesthetics on the intensive care unit (ICU) required specific evaporating devices or scavenging systems. The ACD, a modified heat- moisture filter, is connected to the breathing circuit of conventional ICU ventilators and a syringe pump delivers the volatile anaesthetic to the ACD where it is vaporized through a rod. Most of the exhaled gas is absorbed in a charcoal filter's membrane and reflected to the patient in the following inspiration. Randomised, controlled and comparative studies to the use of volatile anaesthetics in ICU via this innovative device are still missing. Isoflurane has been studied in small patient populations and in comparison to midazolam, while Sevoflurane - a newer volatile agent with short action, brief elimination time, and low hepatic biodegradation - has only been studied intraoperatively and in short-term sedation. This is the first prospective, randomised, clinical study on the feasibility of sevoflurane via the ACD for sedation in ICU patients until 72 hours in comparison to a standard intravenous sedation with propofol. The investigation will work on potential benefits and limitations of the use of volatile agents on the ICU, the quality of sedation (Richmond Agitation Sedation Scale, BIS), infusion rate stability of sevoflurane and respiratory parameters, short-term recovery (time from discontinuation of infusion until following verbal commands and extubation), haemodynamics, renal and hepatic function and adverse side effects.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 120
• Est. completion date: December 2007
• Est. primary completion date: December 2007
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• 18-80 years

• elective operative procedure, and indication for admission to the ICU for postoperative sedation

• ASA I-III

• weight 50-120 kg

• Haemoglobin > 10 g/dl

• ability and acceptance to agree to the study participation

Exclusion Criteria:

• malignant hyperthermia

• muscle diseases or weakness

• liver insufficiency (ASAT, ALAT > 40 U/min)

• pancreas insufficiency

• emergencies

• women in child bearing age and missing negative pregnancy test, pregnancy or lactation

• diseases from the central nervous system (such as M. Parkinson and multiple sclerosis)

• increased intracranial pressure, head trauma

• pre-existing delirium, agitation and psychiatric derangements

• alcohol and drug abuse (including opioid abuse)

• allergy to any of the study agents

• refusal from the patient to participate in the study

• participation in another study project.

Study Design

Observational Model: Case Control, Time Perspective: Prospective

Related Conditions & MeSH terms

• Cardioprotection
• Hepatic Function
• Recovery From Sedation
• Renal Function
• Sevoflurane Consumption

Intervention

Drug:
• Sevoflurane
Sevoflurane sedation, 0.5-1 Vol%, continuously via syringe pump, up to 72 hours in ICU
• Propofol
Propofol, 1.5-3 mg/kgBW/h, continuously via syringe pump, up to 72 hours

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
Klinikum Ludwigshafen	Universitätsmedizin Mannheim

References & Publications (3)

Berton J, Sargentini C, Nguyen JL, Belii A, Beydon L. AnaConDa reflection filter: bench and patient evaluation of safety and volatile anesthetic conservation. Anesth Analg. 2007 Jan;104(1):130-4. — View Citation

Sackey PV, Martling CR, Granath F, Radell PJ. Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med. 2004 Nov;32(11):2241-6. — View Citation

Sackey PV, Martling CR, Nise G, Radell PJ. Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device. Crit Care Med. 2005 Mar;33(3):585-90. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Extubation time		Termination of sedation to extubation	No
Secondary	Consumption of anaesthetics		until discharge from hospital	Yes
Secondary	Renal function		until discharge from hospital	Yes
Secondary	Hepatic function		until discharge from hospital	Yes
Secondary	Cardioprotection		until discharge from hospital	Yes
Secondary	Costs		until discharge from hospital	Yes