Leal GJA, Sánchez MJR, Azúa GRI

Language: Spanish
References: 6
Page: 14-18
PDF size: 252.06 Kb.

ABSTRACT

Introduction: sedation in critically ill patients under invasive mechanical ventilation is essential to optimize patient-ventilator synchrony and reduce metabolic stress. However, the choice of the ideal sedative remains debated. Sevoflurane and propofol, with distinct pharmacological profiles, require comparison in terms of efficacy and safety. Objective: to compare the efficacy and safety of sedation with sevoflurane versus propofol in critically ill patients under invasive mechanical ventilation at the Regional Hospital of Ciudad Madero. Material and methods: a longitudinal and comparative cohort study was conducted with 40 patients (sevoflurane n = 20, propofol n = 20), evaluating hemodynamic variables, sedation depth (RASS), norepinephrine use, complications, mortality, and recovery time. Statistical tests were applied to compare the groups. Results: sevoflurane achieved deeper sedation (100% at RASS −5 vs. 55% with propofol, p = 0.003). No significant differences were found in hemodynamic stability, kidney injury (p = 0.144), or liver injury (p = 0.307). Mortality was 42.5%, with no variations between groups (p = 0.749). Intubation duration and post-sedation recovery times were similar (p = 0.439 and p = 1.000). Conclusions: sevoflurane and propofol are safe options for sedation in critically ill patients under invasive mechanical ventilation. Sevoflurane showed advantages in sedation depth and reduced need for vasoactive agents, without increasing the risk of complications. Given the unicentric nature and sample size of the study, further research in multiple centers is recommended to confirm these findings.

REFERENCES

1. Báez-Patiño AP, Rivera-Tocancipá D. Postoperative acute kidney injury in major noncardiac surgery. Narrative review. Colomb J Anesthesiol. 2024;52(2):e1098. https://doi.org/10.5554/22562087.e1098

2. Carrillo-Esper R, Velarde-Pineda AA, Zepeda-Mendoza AD, Arellano-Ramírez A, Pérez-Calatayud A, Mendoza-Popoca CU, et al. Documento de posicionamiento: uso de sedación inhalada en el paciente críticamente enfermo. Med Crit. 2022;36(S2):s43-s64.

3. Pérez-Hernández JL, Juárez-García FI, García-Espinosa IA, Medina-Ávalos EJ, Higuera-De la Tijera MF. Lesión hepática inducida por fármacos anestésicos. Rev Mex Anestesiol. 2022;45(3):188-191. doi: 10.35366/105592

4. Flinspach AN, Raimann FJ, Kaiser P, Pfaf M, Zacharowski K, Neef V, et al. Volatile versus propofol sedation after cardiac valve surgery: a single-center prospective randomized controlled trial. Crit Care. 2024;28(1):111. doi: 10.1186/s13054-024-04899-y

5. Jung S, Na S, Kim HB, Joo HJ, Kim J. Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation. Acute Crit Care. 2020;35(3):197-204. doi: 10.4266/acc.2020.00213

6. Bharti N, Chari P, Kumar P. Effect of sevoflurane versus propofol-based anesthesia on the hemodynamic response and recovery characteristics in patients undergoing microlaryngeal surgery. Saudi J Anaesth. 2012;6(4):380-384. Disponible en: https://applications.emro.who.int/imemrf/Saudi_J_Anaesth/Saudi_J_Anaesth_2012_6_4_380_384.pdf.