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Review
. 2024 Mar 9;13(1):90746.
doi: 10.5492/wjccm.v13.i1.90746.

Inhaled volatile anesthetics in the intensive care unit

Erin D Wieruszewski  1 , Mariam ElSaban  2 , Patrick M Wieruszewski  1 , Nathan J Smischney  3
Affiliations
Review

Inhaled volatile anesthetics in the intensive care unit

Erin D Wieruszewski et al. World J Crit Care Med. .

Abstract

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry, providing intensivists with multiple options to tailor therapy. Furthermore, their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy, mitigating risks associated with conventional sedation modalities. Despite the amounting enthusiasm for the use of these therapies, barriers to widespread utilization include expanding equipment availability, staff familiarity and training of safe use. This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology, administration considerations in intensive care settings, complication considerations, and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

Keywords: Anesthesia; Critical care; Mechanical ventilation; Sedation; Sedative; Volatile anesthetics.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Volatile anesthetic mechanism of action. A: Excitatory neural synapse; B: Inhibitory neural synapse augmented by volatile anesthetic. Created with BioRender.com.
Figure 2
Figure 2
Depiction of how extracorporeal membrane oxygenation works in acute respiratory failure[17]. Citation: Wieruszewski PM, Ortoleva JP, Cormican DS, Seelhammer TG. Extracorporeal Membrane Oxygenation in Acute Respiratory Failure. Pulm Ther 2023; 9: 109-126 [PMID: 36670314 DOI: 10.1007/s41030-023-00214-2].
Figure 3
Figure 3
Example of a malignant hyperthermia kit for the intensive care unit.
See this image and copyright information in PMC

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