Volatile anesthetics in the intensive care unit

The use of volatile anesthetics as an alternative sedation modality in the intensive care unit (ICU) has gained traction over the last several years. Volatile agents such as sevoflurane and isoflurane possess favorable pharmacokinetic and pharmacodynamic properties that make them suitable choices for titration of sedation in patients requiring mechanical ventilation. Several studies have continued to demonstrate their efficacy and safety particularly when assessing wake-up times and times to extubation in contrast to various intravenous sedatives. Leveraging the pharmacodynamic properties of the volatile agents may also be beneficial in certain disease states. As there are devices currently available to enable delivery of volatile anesthetics to patients in the ICU, ongoing studies exist to determine how to best use this sedation modality. This review outlines the recent evidence and discusses perspectives on volatile-based sedation for critically ill patients.