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Case Report07-01-2025
Inhaled sevoflurane use for myoclonic status secondary to bupropion intoxication
- Artur Ribeiro Canasiro
, - Marcelo Park ,
- Luis Carlos Maia Cardozo Junior ,
- Giovanna Rego Vilar,
- Ludhmila Abrahão Hajjar
Abstract
Case ReportInhaled sevoflurane use for myoclonic status secondary to bupropion intoxication
Critical Care Science. 2025;37:e20250296
DOI 10.62675/2965-2774.20250296
- Artur Ribeiro Canasiro ,
- Marcelo Park ,
- Luis Carlos Maia Cardozo Junior ,
- Giovanna Rego Vilar,
- Ludhmila Abrahão Hajjar
Views40See moreABSTRACT
A 26-year-old female with a history of depression was admitted after ingesting 7.5g of bupropion. Her clinical status rapidly deteriorated into a coma and myoclonic status, which was complicated by lung aspiration. Initial treatment with high-dose midazolam and later propofol failed to control her myoclonus. Sevoflurane inhalation therapy (6.5 mg/hour) was initiated, and complete resolution of myoclonus was achieved within hours. Propofol was discontinued, and the sevoflurane dose was gradually tapered over 24 hours without myoclonus recurrence. The patient awoke agitated but neurologically intact, was extubated, and fully recovered by Day 10. This case highlights the efficacy of sevoflurane in managing refractory myoclonic status due to bupropion toxicity, especially when electroencephalogram monitoring is unavailable. Sevoflurane rapid titration and elimination allow precise sedation control and safe neurological assessment. Inhaled anesthetics may also be beneficial in other ICU scenarios, including status epilepticus, severe asthma, and hemodynamic instability. This successful outcome demonstrates the potential of sevoflurane as an alternative therapy in critical toxicological emergencies.
Views40
Abstract
Case ReportInhaled sevoflurane use for myoclonic status secondary to bupropion intoxication
Critical Care Science. 2025;37:e20250296
DOI 10.62675/2965-2774.20250296
- Artur Ribeiro Canasiro ,
- Marcelo Park ,
- Luis Carlos Maia Cardozo Junior ,
- Giovanna Rego Vilar,
- Ludhmila Abrahão Hajjar
Views40See moreABSTRACT
A 26-year-old female with a history of depression was admitted after ingesting 7.5g of bupropion. Her clinical status rapidly deteriorated into a coma and myoclonic status, which was complicated by lung aspiration. Initial treatment with high-dose midazolam and later propofol failed to control her myoclonus. Sevoflurane inhalation therapy (6.5 mg/hour) was initiated, and complete resolution of myoclonus was achieved within hours. Propofol was discontinued, and the sevoflurane dose was gradually tapered over 24 hours without myoclonus recurrence. The patient awoke agitated but neurologically intact, was extubated, and fully recovered by Day 10. This case highlights the efficacy of sevoflurane in managing refractory myoclonic status due to bupropion toxicity, especially when electroencephalogram monitoring is unavailable. Sevoflurane rapid titration and elimination allow precise sedation control and safe neurological assessment. Inhaled anesthetics may also be beneficial in other ICU scenarios, including status epilepticus, severe asthma, and hemodynamic instability. This successful outcome demonstrates the potential of sevoflurane as an alternative therapy in critical toxicological emergencies.
- Artur Ribeiro Canasiro
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Original Article05-07-2025
Sedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit
Critical Care Science. 2025;37:e20250247
Abstract
Original ArticleSedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit
Critical Care Science. 2025;37:e20250247
DOI 10.62675/2965-2774.20250247
Views145ABSTRACT
Objective:
This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit.
Methods:
This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4.
Results:
This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97).
Conclusion:
Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.
Keywords:Benzodiazepinescritical illnessEmergency service, hospitalFentanylHypnotics and sedativesintensive care unitsintubationKetaminePropofolRespiration, artificialsedationSee moreViews145Abstract
Original ArticleSedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit
Critical Care Science. 2025;37:e20250247
DOI 10.62675/2965-2774.20250247
Views145ABSTRACT
Objective:
This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit.
Methods:
This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4.
Results:
This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97).
Conclusion:
Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.
Keywords:Benzodiazepinescritical illnessEmergency service, hospitalFentanylHypnotics and sedativesintensive care unitsintubationKetaminePropofolRespiration, artificialsedationSee more
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Original Article10-25-2021
A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit
- Teresa Raquel Andrade,
- Jorge Ibrain Figueira Salluh ,
- Raphaela Garcia,
- Daniela Farah,
- Paulo Sérgio Lucas da Silva, [ ... ],
- Marcelo Cunio Machado Fonseca
Abstract
Original ArticleA cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit
Revista Brasileira de Terapia Intensiva. 2021;33(3):428-433
DOI 10.5935/0103-507X.20210068
- Teresa Raquel Andrade,
- Jorge Ibrain Figueira Salluh ,
- Raphaela Garcia,
- Daniela Farah,
- Paulo Sérgio Lucas da Silva,
- Danielle F. Bastos,
- Marcelo Cunio Machado Fonseca
Views78ABSTRACT
Objective:
To build a cost-effectiveness model to compare the use of propofol versus midazolam in critically ill adult patients under mechanical ventilation.
Methods:
We built a decision tree model for critically ill patients submitted to mechanical ventilation and analyzed it from the Brazilian private health care system perspective. The time horizon was that of intensive care unit hospitalization. The outcomes were cost-effectiveness per hour of intensive care unit stay avoided and cost-effectiveness per hour of mechanical ventilation avoided. We retrieved data for the model from a previous meta-analysis. We assumed that the cost of medication was embedded in the intensive care unit cost. We conducted univariate and probabilistic sensitivity analyses.
Results:
Mechanically ventilated patients using propofol had their intensive care unit stay and the duration of mechanical ventilation decreased by 47.97 hours and 21.65 hours, respectively. There was an average cost reduction of US$ 2,998.971 for propofol when compared to midazolam. The cost-effectiveness per hour of intensive care unit stay and mechanical ventilation avoided were dominant 94.40% and 80.8% of the time, respectively.
Conclusion:
There was a significant reduction in costs associated with propofol use related to intensive care unit stay and duration of mechanical ventilation for critically ill adult patients.
Keywords:AdultartificialCost-effectivenesscritical illnessintensive care unitsMidazolamPropofolRespirationSee moreViews78Abstract
Original ArticleA cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit
Revista Brasileira de Terapia Intensiva. 2021;33(3):428-433
DOI 10.5935/0103-507X.20210068
- Teresa Raquel Andrade,
- Jorge Ibrain Figueira Salluh ,
- Raphaela Garcia,
- Daniela Farah,
- Paulo Sérgio Lucas da Silva,
- Danielle F. Bastos,
- Marcelo Cunio Machado Fonseca
Views78ABSTRACT
Objective:
To build a cost-effectiveness model to compare the use of propofol versus midazolam in critically ill adult patients under mechanical ventilation.
Methods:
We built a decision tree model for critically ill patients submitted to mechanical ventilation and analyzed it from the Brazilian private health care system perspective. The time horizon was that of intensive care unit hospitalization. The outcomes were cost-effectiveness per hour of intensive care unit stay avoided and cost-effectiveness per hour of mechanical ventilation avoided. We retrieved data for the model from a previous meta-analysis. We assumed that the cost of medication was embedded in the intensive care unit cost. We conducted univariate and probabilistic sensitivity analyses.
Results:
Mechanically ventilated patients using propofol had their intensive care unit stay and the duration of mechanical ventilation decreased by 47.97 hours and 21.65 hours, respectively. There was an average cost reduction of US$ 2,998.971 for propofol when compared to midazolam. The cost-effectiveness per hour of intensive care unit stay and mechanical ventilation avoided were dominant 94.40% and 80.8% of the time, respectively.
Conclusion:
There was a significant reduction in costs associated with propofol use related to intensive care unit stay and duration of mechanical ventilation for critically ill adult patients.
Keywords:AdultartificialCost-effectivenesscritical illnessintensive care unitsMidazolamPropofolRespirationSee more
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Review Article08-01-2013
Perceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2013;25(2):155-161
Abstract
Review ArticlePerceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2013;25(2):155-161
DOI 10.5935/0103-507X.20130027
Views76See moreA significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside.
Views76Abstract
Review ArticlePerceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2013;25(2):155-161
DOI 10.5935/0103-507X.20130027
Views76See moreA significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside.
Propofol Archives - Critical Care Science (CCS)
