Halothane, an Effective Infrequently Used Drug, in the Treatment of Pediatric Status Asthmaticus: A Case Report

Abstract

Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7). Halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.

Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series

“…In this series, isoflurane led to a significant improvement in pH and PCO 2 within 4 h of initiation and there were no lasting side effects . Other case reports at other institutions exist describing the dramatic reversal of severe refractory asthma with the use of VAs with minimal side effects in smaller numbers of patients .…”

“…The treatment of children with severe SA and respiratory failure with volatile anesthetics (VAs) is another useful alternative. The VAs have been shown in asthma to rapidly reverse bronchoconstriction, markedly improve gas exchange and peak inspiratory pressure, and possibly decrease the incidence of ventilator‐induced lung injury . In a retrospective review from a tertiary care children's hospital, 10 children with 11 episodes of severe asthma refractory to conventional medical management were successfully treated with isoflurane over a 5‐year period .…”

Sevoflurane therapy for life-threatening asthma in children

“…Theoretically, sevoflurane is associated with nephrotoxicity related to the release of fluoride during metabolism, but clinical signs of nephrotoxicity are rare. 8 Hepatotoxicity is an important adverse effect of the other volatile anaesthetics, related to immune-mediated hepatitis caused by trifluoroacetic acid (TFA), a metabolic product. Sevoflurane is metabolized in a different way than the other agents and does not produce TFA and thereby does not cause hepatotoxicity.…”

Adjunct Therapies for Refractory Status Asthmaticus in Children

“…Multiple case reports present successful application of inhaled anesthetics to children and young adults with refractory status asthmaticus, [105][106][107][108][109][110][111][112] but no clinical trials exist comparing this therapy with other adjunct therapies. Retrospective reviews demonstrate that the initiation of these gases is consistently associated with a decrease in P aCO 2 around 20 mm Hg and concomitant rise in pH of about 0.1 within a few hours of administration.…”

“…Retrospective reviews demonstrate that the initiation of these gases is consistently associated with a decrease in P aCO 2 around 20 mm Hg and concomitant rise in pH of about 0.1 within a few hours of administration. 105,108,111,[113][114][115] The largest case series to date includes 31 children over a 15-y period, in which children received isoflurane for a mean duration of 55 h (range 1-181 h) and were invasively ventilated for a mean of 252 h (range 16 -1,444 h). The majority (77%) of these children developed hypotension requiring vasopressor support, but all survived without long-term sequelae.…”