Current state of critically ill patients sedation with volatile anesthetics. Its role in renal and hepatic toxicity

SummaryThe anesthetic-conserving device (AnaConDa™) facilitated, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients using ICU ventilators. To date, its use is currently time-limited by clinicians due to the potential renal and hepatic toxicity associated with the production of plasma fluoride after its metabolism, despite its advantages. We reviewed the available human and animal studies literature examining the use of volatile anesthetics as sedative agents and its role in renal and/or hepatic toxicity. We have very few studies concerning the prolonged administration of sevoflurane through the AnaConDa™ and its effect on renal and hepatic function. All of them agree that high levels of inorganic fluoride do not lead to renal or hepatic damage. Currently, the available information regarding prolonged sevoflurane sedation through AnaConDa™ is low. High concentrations of inorganic fluoride derived from the metabolism of halogenated agents are not harmful. According to recently published studies, volatile anesthetics on the ICU could adopt a permanent position in various intensive care analog-sedation concepts (even in long-term sedation) in future optimizing the treatment process.