Julian Bo ¨sel Jan C. Purrucker Frank Nowak Julian Renzland Petra Schiller Eva Benveniste Pe ´rez Sven Poli Benjamin Brunn Werner Hacke Thorsten Steiner Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa Ò : effects on cerebral oxygenation, circulation, and pressure Received: 7 May 2012 Accepted: 12 August 2012 Published online: 25 October 2012 Ó Copyright jointly held by Springer and ESICM 2012 This article is discussed in the editorial available at: doi:10.1007/s00134-012-2711-0. Electronic supplementary material The online version of this article (doi:10.1007/s00134-012-2708-8) contains supplementary material, which is available to authorized users. J. Bo ¨sel ( ) ) Á J. C. Purrucker Á F. Nowak Á J. Renzland Á B. Brunn Á W. Hacke Á T. Steiner Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany e-mail: julian.boesel@med.uni- heidelberg.de Tel.: ?49-6221-5639145 Fax: ?49-6221-565654 P. Schiller Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany E. B. Pe ´rez Department of Intensive Care, Hospital Germans Trias i Pujol, University of Barcelona, Bardalona-Barcelona, Spain S. Poli Department of Neurology, University of Tu ¨bingen, Postfach 2669, 72016 Tu ¨bingen, Germany T. Steiner Department of Neurology, Frankfurt Hoechst Hospital, Gotenstr. 6-8, 69252 Frankfurt am Main, Germany Abstract Purpose: The anes- thetic-conserving device AnaConDa Ò , a miniature vaporizer, allows volatile sedation in the inten- sive care unit (ICU). We investigated the effects of isoflurane sedation on cerebral and systemic physiology parameters in neuromonitored ICU stroke patients. Methods: Included in the study were 19 consecutive ventilated patients with intracerebral hemorrhage (12), subarachnoid hem- orrhage (4), and ischemic stroke (3) who were switched from intravenous propofol or midazolam to inhalative isoflurane sedation for an average of 3.5 days. During the sedation transi- tion, the following parameters were assessed: mean arterial pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and cerebral frac- tional tissue oxygen extraction (FTOE), as well as systemic cardio- pulmonary parameters and administered drugs. Results: After the first hour, mean ICP showed an increase of 2.1 mmHg that was not clinically relevant. Likewise, MFV did not change. MAP and CPP, however, decreased by 6.5 and 6.3 mmHg, respectively. FTOE was reduced slightly from 0.24 to 0.21 (p = 0.03). Over an observation per- iod of 12 h, ICP remained stable, while MAP and thus CPP showed distinct decreases (CPP: -10 mmHg at 6 h, p \ 0.001; -7.5 mmHg at 12 h, p = 0.005, when compared to preswitch levels) despite a 1.5-fold increase in vasopressor administra- tion. Conclusions: We suggest that that it is possible to reach sufficient sedation levels in cerebrovascular ICU patients by applying volatile isoflurane long-term without a rele- vant increase in ICP, if baseline ICP values are low or only moderately elevated. However, caution should be exercised in view of isoflurane’s decreasing effect on MAP and CPP. Multimodal neuromonitoring is strongly recommended when apply- ing this off-label sedation method. Keywords Volatile anesthetics Á Isoflurane Á AnaConDa Ò Á Stroke Á Sedation Á Analgesia Intensive Care Med (2012) 38:1955–1964 DOI 10.1007/s00134-012-2708-8 ORIGINAL