Intensive Care Medicine

, Volume 37, Issue 6, pp 933–941 | Cite as

Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam

  • Malcie Mesnil
  • Xavier Capdevila
  • Sophie Bringuier
  • Pierre-Olivier Trine
  • Yoan Falquet
  • Jonathan Charbit
  • Jean-Paul Roustan
  • Gerald Chanques
  • Samir Jaber



To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (IV) sedation with propofol or midazolam.


Randomized controlled trial. Sixty intensive care unit (ICU) patients expected to require more than 24 h sedation were randomly assigned to one of three groups: group S, inhaled sevoflurane; group P, IV propofol; group M, IV midazolam. All patients also received IV remifentanil for goal-directed sedation (Ramsay scale and pain score) until extubation or for a maximum of 96 h. Primary end points were wake-up times and extubation delay from termination of sedative administration. Proportion of time within Ramsay score 3–4, IV morphine consumption at 24 h post extubation, hallucination episodes after end of sedation, adverse events, inorganic fluoride plasma levels, and ambient sevoflurane concentrations were recorded.


Forty-seven patients were analyzed. Wake-up time and extubation delay were significantly (P < 0.01) shorter in group S (18.6 ± 11.8 and 33.6 ± 13.1 min) than in group P (91.3 ± 35.2 and 326.11 ± 360.2 min) or M (260.2 ± 150.2 and 599.6 ± 586.6 min). Proportion of time within desired interval of sedation score was comparable between groups. Morphine consumption during the 24 h following extubation was lower in group S than in groups P and M. Four hallucination episodes were reported in group P, five in group M, and none in group S (P = 0.04). No hepatic or renal adverse events were reported. Mean plasma fluoride value was 82 μmol l−1 (range 12–220 μmol l−1), and mean ambient sevoflurane concentration was 0.3 ± 0.1 ppm.


Long-term inhaled sevoflurane sedation seems to be a safe and effective alternative to IV propofol or midazolam. It decreases wake-up and extubation times, and post extubation morphine consumption, and increases awakening quality.


Mechanical ventilation Inhaled sedation Analgesia-sedation Weaning Extubation 



Support was provided only from institutional sources.

Conflict of interest

No conflict of interest was declared.

Supplementary material

134_2011_2187_MOESM1_ESM.doc (240 kb)
Supplementary material 1 (DOC 239 kb)


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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Malcie Mesnil
    • 1
  • Xavier Capdevila
    • 1
  • Sophie Bringuier
    • 1
    • 2
  • Pierre-Olivier Trine
    • 1
  • Yoan Falquet
    • 1
  • Jonathan Charbit
    • 1
  • Jean-Paul Roustan
    • 1
  • Gerald Chanques
    • 3
  • Samir Jaber
    • 3
  1. 1.Department of Anesthesiology and Critical Care Lapeyronie (DAR A), Montpellier I University and Montpellier University Lapeyronie HospitalInstitut National de la Santé et de la Recherche Médicale (INSERM)Montpellier, Cedex 5France
  2. 2.Department of Epidemiology and Medical BiostatisticsArnaud de Villeneuve University HospitalMontpellier, Cedex 5France
  3. 3.Department of Anesthesiology and Critical Care Saint-Eloi (DAR B), Montpellier I University and Montpellier University Saint-Eloi HospitalInstitut National de la Santé et de la Recherche Médicale (INSERM)Montpellier, Cedex 5France

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