Inhaled volatile anesthetics in the intensive care unit

Table 2 Indications, advantages, and disadvantages of volatile anesthetics in the intensive care unit

Indication	Agents studied	Advantages	Disadvantages
Short-term postoperative	Desflurane, isoflurane, sevoflurane	Quick awakening; Faster extubation; Titratability; Minimal drug interactions; Minimal metabolism; Provides analgesia	No benefit on ICU length of stay; Reduces blood pressure
Prolonged sedation during mechanical ventilation	Isoflurane, sevoflurane	Faster return to spontaneous breathing; Titratability; Minimal drug interactions; Minimal metabolism; Provides analgesia	Special equipment required in ICU; Reduces blood pressure
Status asthmaticus	Isoflurane, sevoflurane	Bronchodilation	Reduces blood pressure
Status epilepticus	Isoflurane, desflurane	Sustained EEG burst suppression	May increase intracranial pressure through cerebral vasodilation
ARDS	Isoflurane, sevoflurane	Lung protective; Anti-inflammatory	Special equipment required in ICU; Reduces blood pressure
COVID-19	Isoflurane, sevoflurane	Decreased sedative, NMBA requirements	Special equipment required in ICU; Reduces blood pressure
Other high sedative requirements (burn, alcohol or opioid use at baseline)	Isoflurane, sevoflurane	Decreased inflammation in burns; Decreased sedative requirements	Not proven in literature, hypothesis generating at this time

ARDS: Acute respiratory distress syndrome; COVID-19: Coronavirus infectious disease 2019; EEG: Electroencephalogram; ICU: Intensive care unit; NMBA: Neuromuscular blocking agent.