An Unusual Complication With the Administration of a Volatile Anesthetic Agent for Status Asthmaticus in the Pediatric Intensive Care Unit: Case Report and Review of the Literature

Abstract

In severe cases of status asthmaticus, when conventional therapies fail, volatile anesthetic agents remain a therapeutic option. When delivered outside of the operating room setting, specialized delivery techniques are needed to ensure the safe and effective use of volatile anesthetic agents. We present a 16-year-old adolescent with status asthmaticus who required the therapeutic administration of the volatile anesthetic agent, sevoflurane, in the pediatric intensive care unit (PICU). Although initially effective in reducing bronchospasm, progressive hypercarbia developed due to defective functioning of the carbon dioxide absorber of the anesthesia machine. This failure occurred as the soda lime compartment filled with water accumulated from circuit humidification and continuous albuterol therapy. The role of volatile anesthetic agents in the treatment of status asthmaticus in the PICU is discussed, options for delivery outside of the operating room presented, and potential problems with delivery reviewed.

Volatile anesthetic agents for life‐threatening pediatric asthma: A multicenter retrospective cohort study and narrative review

“…15,53 Vaporizers and circuits may require replacement during anesthesia administration and therefore backup systems should be maintained as circuit failure can lead to rapid deterioration or retention of exhaled carbon dioxide. 27 Due to the possibility of malignant hyperthermia after volatile exposure, it is important for providers to establish protocols for early identification and train team members to provide emergent treatment (eg, location of malignant hyperthermia carts and the preparation of differing constitutions of dantrolene).…”

“…[12][13][14] Data supporting the use of volatile agents are limited to single-center case series. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Yet, prolonged exposure to anesthesia may increase the risk of organ toxicities such as impaired myocardial function, renal insufficiency, hepatic failure, encephalopathy, and life-threatening malignant hyperthermia. 32,33 Furthermore, the logistics of delivering anesthesia outside of the operating room are limited by the availability of vaporizing attachments, anesthetic conserving devices, exhaled gas scavenging systems, and readily available providers both capable and familiar with anesthetic administration in this context.…”