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Prolonged Inhalational Sedation Using Sevoflurane: Evaluation of Inorganic Fluoride Levels and Kidney Function

Kerstin D Röhm1, MD, Swen N Piper2, MD, and Joachim Boldt1, MD

Inhalational sedation in the intensive care unit has become increasingly common in mechanically ventilated patients since technical improvements in the form of the Anaesthetic Conserving Device (AnaConDa ® , Sedana Medical, Uppsala, Sweden) were introduced. This evaporator and reflector system enables the low-flow administration of volatile anaesthetics. In terms of their pharmacological properties, volatile anaesthetics possess nearly all the ideal features of a sedative agent – rare adverse events, a lack of metabolite accumulation, and its ability to rapidly adjust the depth of anaesthesia – but their impact on organ function during prolonged administration has rarely been studied. Sevoflurane is the most commonly used volatile agent in the operation room, but suggestions of a potential association with renal impairment caused by inorganic fluorides have been repeatedly made since its approval. In this review, past experiences of sevoflurane exposure and renal function as well as recent findings of the effects of sevoflurane inhalational sedation in postsurgical critical care patients are described. Adv Anaesthesiol Crit Care 2009;1(2):53–6.

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