AnaConDa™ and Mirus™ for intensive care sedation, 24 h desflurane versus isoflurane in one patient

Introduction: With the AnaConDa™ system, inhalational sedation in the intensive care unit has become popular. The device can be used with common intensive care unit ventilators and is inserted between the Y-piece and the patient. Liquid isoflurane or sevoflurane are delivered by a syringe pump. 90 % of anesthetic exhaled by the patient is absorbed by a reflector and resupplied during the next inspiration. The new Mirus™ system also uses a reflector. Its control unit identifies end-tidal concentrations from the flow, injects anesthetics during early inspiration, controls anesthetic concentrations automatically, and can also apply desflurane. The AnaConDa™ and Mirus™ system are certified 'conformité établi', however, little is known about the Mirus™ and case reports are still lacking.

Case description: We used the Mirus™ with desflurane for 24 h in a patient suffering from acute respiratory distress syndrome. The patient was treated with kinetic lateral rotational therapy. While deeply sedated, our patient breathed 9.0-12.0 l min(-1) spontaneously. Thereafter, awakening and wash-out were considerably shorter than after isoflurane in the same patient with AnaConDa™. There were no major problems during the sedation. However, consumption of desflurane was high.

Conclusion: Desflurane sedation with the Mirus™ seems promising, but the reflector should be improved to absorb and resupply more of the anesthetic agent.