The following is the summary of “Prolonged sedation with sevoflurane in comparison to intravenous sedation in critically ill patients – A randomized controlled trial” published in the January 2023 issue of Critical Care by Soukup, et al.

In the ICU, volatile anesthetics are typically administered for sedation intensive-care-unit (ICU).  But there is still a lack of proof for extended use. Therefore, researchers compared the effectiveness and safety of sevoflurane and intravenous sedation in a randomized controlled experiment. Patients requiring sedation in the intensive care unit for at least 48 hours were randomly assigned to receive either sevoflurane (S) or propofol/midazolam in this prospective, randomized-controlled phase-IIb monocentric clinical study (P). The Richmond Agitation Sedation Scale was used to measure how well patients were sedated. 

Time to spontaneous breathing and extubation, opioid consumption, hemodynamics, ICU and hospital length of stay (LOS), and adverse events were all monitored once sedation was discontinued. 89 people met the criteria for randomization. Both sevoflurane (n=39) and propofol (n=40) provided an equivalent level of sedation. The time to recover spontaneous breathing was significantly shorter with sevoflurane (26 minutes vs. 375 minutes, P<0.001). 

While there was no difference in hemodynamics, LOS, or the occurrence of adverse events, opioid needs were reduced in propofol-sedated patients (remifentanil:400 μg/h vs. 500 μg/h, P=0.007; sufentanil:40 μg/h vs. 30 μg/h, P=0.007). The quality of sedation is equivalent to a propofol-based sedation regime, however intensive care unit patients who are sedated with sevoflurane for more than 48 hours may regain spontaneous breathing more quickly. Long-term sedation with sevoflurane may be non-inferior to propofol in this patient population, and it is likely safe.

Source: sciencedirect.com/science/article/pii/S0883944122002805