Sedaconda ACD-S for sedation with volatile anaesthetics in intensive care

1.1 Sedaconda anaesthetic conserving device‑S (Sedaconda ACD‑S) is recommended as a cost‑saving option for delivering inhaled sedation in an intensive care setting when the volatile anaesthetics isoflurane or sevoflurane are being considered.

1.2 Further research is recommended to identify any health conditions or groups of patients that would benefit more from inhaled sedation with Sedaconda ACD‑S than from standard care. Please see the section on further research for more details.

Why the committee made these recommendations

Sedaconda ACD‑S is used in intensive care settings when people need inhaled sedation. The evidence for Sedaconda ACD‑S includes people with a wide range of conditions. But there were not enough people for each condition in the studies to identify who would particularly benefit from inhaled sedation with Sedaconda ACD‑S. Although there is no published evidence for Sedaconda ACD‑S in children, the committee accepted that the results from the adult studies will be generalisable to children. So, further research is recommended to identify the groups that could benefit from using the technology.

Cost modelling shows that, over 30 days, Sedaconda ACD‑S is cost saving compared with intravenous propofol sedation by £3,833.76 per adult. In children, Sedaconda ACD‑S is also cost saving compared with intravenous midazolam sedation, by £2,837.41 per child. These savings are from reduced time on mechanical ventilation, which may shorten the length of time in intensive care for the patient. Sedaconda ACD‑S was cost saving when the length of time a person spent in intensive care after being taken off mechanical ventilation was reduced by only a few hours (when non‑ventilated days in intensive care was only a few hours, 2.5 to 5 hours).

Evidence suggests that time to people waking up from sedation is shorter with inhaled sedation (using Sedaconda ACD‑S) than with intravenous sedation, but that a reduction in time on mechanical ventilation is uncertain. It is also uncertain if using Sedaconda ACD‑S shortens a person's length of stay in intensive care. Because these are the key drivers of cost savings, the cost analysis results are also uncertain. Even with these uncertainties, Sedaconda ACD‑S is still cost saving in both children and adults and shows promise as an option for use in intensive care settings for sedation with volatile anaesthetics, when sedation with isoflurane or sevoflurane is being considered.

Volatile anaesthetic drugs are potent greenhouse gases. Sedaconda ACD‑S may be associated with a lower consumption of volatile drugs compared with other delivery and scavenging systems for volatile sedation.