Asthma and isoflurane

Abstract

We present a case report of a young child who had developed severe asthma by the age of 18 months and, in whom an acute exacerbation, required successful prolonged mechanical ventilation with isoflurane when conventional treatment had failed.An 18-month-old boy weighing 14.6 kg, was diagnosed as asthmatic at the age of two months and had been admitted on numerous occasions to the local district general hospital (DGH) with acute episodes of wheezing. These had resolved with conventional treatment and, in between attacks, he was maintained on inhaled Betap (p2) agonists and steroids, although he was rarely completely free of a wheeze.Eight days prior to admission to the paediatric intensive care unit (PICU) at this hospital, he had again presented to the local DGH with an acute attack, which initially responded to nebulized salbutamol, ipratropium bromide and intravenous hydrocortisone. After four days of this therapy however, he started to deteriorate and therefore he was additionally treated with intravenous aminophylline. Four days later he was admitted as an emergency to our PICU having failed to improve.On arrival he was deeply cyanosed with an oxygen saturation measured by pulse oximeter (Sp,;) of 72% in oxygen at a flow rate of 2 Iemin-' via nasal catheters. His temperature was38.4"C and he was on