Sevoflurane is a widely used volatile anesthetic agent. Sevoflurane is primarily used for general anesthesia and less commonly used for sedation. Nonetheless, sevoflurane sedation offers a versatile and valuable option for patients undergoing various medical procedures, from diagnostic imaging studies to minor surgical interventions.
Sevoflurane exerts its effects through modulation of neurotransmitter activity in the central nervous system 1. As a halogenated ether, sevoflurane enhances gamma-aminobutyric acid (GABA) receptor activity, resulting in potentiation of inhibitory neurotransmission and suppression of neuronal excitability. Additionally, sevoflurane may interact with other neurotransmitter systems, including glutamate receptors, contributing to its anesthetic properties 2.
A significant benefit of sevoflurane is that it offers rapid onset and offset. Additionally, it offers minimal cardiovascular depression. Unlike some anesthetic agents, sevoflurane typically maintains hemodynamic stability, making it suitable for patients with compromised cardiac function or hemodynamic instability. Sevoflurane produces predictable sedation, characterized by minimal respiratory depression and preserved airway reflexes, which reduces the risk of airway obstruction or respiratory compromise. Finally, because healthcare providers can easily adjust the concentration of sevoflurane, the depth of sedation can be modulated to the desired level, ranging from mild anxiolysis to deep sedation, while maintaining patient safety and comfort.
While sevoflurane sedation offers numerous advantages, several considerations should be evaluated1. To promptly detect hypoventilation and airway obstruction, it is essential to continuously monitor respiratory parameters, including oxygen saturation, end-tidal carbon dioxide, and respiratory rate. Proper equipment for administration and scavenging of sevoflurane vapor should be available, along with appropriate ventilation systems to minimize occupational exposure and environmental pollution. Additionally, ideal candidates for sevoflurane sedation include cooperative patients without significant respiratory compromise or underlying cardiovascular instability. Patients with a history of malignant hyperthermia or sensitivity to volatile anesthetics are unsuitable for sevoflurane administration. Finally, adequate training and proficiency in administering sevoflurane sedation are essential for healthcare providers to ensure safe and effective patient care. Providers should be knowledgeable about dosing, monitoring, and management of potential complications.
Sevoflurane sedation finds wide-ranging applications in various medical procedures 3,4. Sevoflurane sedation is commonly used for pediatric patients undergoing magnetic resonance imaging (MRI), computed tomography (CT), or other diagnostic imaging studies to enable motion control and optimize image quality. Sevoflurane sedation can also facilitate minor surgical interventions, such as dental procedures, endoscopic examinations, and skin surgeries, providing effective analgesia and sedation without the need for general anesthesia. It also may be beneficial for sedation of pediatric patients, elderly individuals, or patients with intellectual or developmental disabilities, offering rapid recovery and minimal side effects.
Sevoflurane sedation represents a valuable option for patients undergoing various medical procedures, offering rapid onset, smooth titration, and predictable recovery. While ongoing research continues to refine the best use of sevoflurane 5, with proper monitoring and precautions, sevoflurane sedation can provide safe and effective sedation for a wide range of clinical scenarios, enhancing patient comfort and procedural outcomes.
References
1. Sevoflurane – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534781/. (Accessed: 28th March 2024)
2. Sevoflurane: Uses, Interactions, Mechanism of Action | DrugBank Online. Available at: https://go.drugbank.com/drugs/DB01236. (Accessed: 28th March 2024)
3. Kim, K. & Kim, S. Application of sevoflurane inhalation sedation in dental treatment: a mini review. J. Dent. Anesth. Pain Med. 21, 321 (2021). doi: 10.17245/jdapm.2021.21.4.321
4. Jabaudon, M., Zhai, R., Blondonnet, R. & Bonda, W. L. M. Inhaled sedation in the intensive care unit. Anaesth. Crit. Care Pain Med. 41, 101133 (2022). DOI: 10.1016/j.accpm.2022.101133
5. Blondonnet, R. et al. Design and Rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) Randomized Controlled Trial. J. Clin. Med. 11, 2796 (2022). doi: 10.3390/jcm11102796.
