Prolonged isoflurane anesthesia in status asthmaticus

Bierman, Morris I.; Brown, Martin; Muren, Orhan; Keenan, Richard L.; Glauser, Frederick L.

doi:10.1097/00003246-198609000-00017

Cited by 86 publications

(18 citation statements)

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“…These patients may become refractory to conventional therapies, and isoflurane is a potent bronchodilator that has been previously reported as an effective rescue therapy in adult and pediatric patients with severe bronchospasm in these most severely affected patients 6, 7, 9–11, 20 .…”

Section: Discussionmentioning

confidence: 99%

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

et al. 2012

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Introduction Children with severe bronchospasm requiring mechanical ventilation may become refractory to conventional therapy. In these critically ill patients, isoflurane is an inhaled anesthetic agent available in some centers to treat bronchospasm. We hypothesized that isoflurane is safe and would lead to improved gas exchange in children with life-threatening bronchospasm refractory to conventional therapy. Methods A retrospective review was conducted and included mechanically ventilated children treated with isoflurane in a quaternary pediatric intensive care unit for life-threatening bronchospasm from 1993–2007. Demographic, blood gas, ventilator and outcome data were collected. Results Thirty-one patients with a mean age of 9.5 years (range; 0.4 – 23 years) were treated with isoflurane from 1993–2007. Mean time to initiation of isoflurane after intubation was 13 hours (0–120 hours) and the mean maximum isoflurane dose was 1.1 % (0.3 – 2.5%). Mean duration of isoflurane administration was 54.5 hours (1 – 181), with a total mean duration of mechanical ventilation of 252 hours (33.3 – 1454.5). Isoflurane led to significant improvement in pH and pCO2 within four hours of initiation (p ≤ 0.001). Complications during isoflurane administration included hypotension requiring vasoactive infusions in 24 (77%), arrhythmia in 3 (10%), neurologic side effects in 3 (10%), and pneumothorax in 1 (3%) patient. Conclusions Isoflurane led to improvement in pH and pCO2 within four hours in this series of mechanically ventilated patients with life-threatening bronchospasm. The majority of patients in this series developed hypotension, but there was a low incidence of other side effects related to isoflurane administration. Isoflurane appears to be an effective therapy in patients with life-threatening bronchospasm refractory to conventional therapy. However, further investigation is warranted given the uncertain overall impact of isoflurane in this context.

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Section: Discussionmentioning

confidence: 99%

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

et al. 2012

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“…Less than 16% of childhood asthmatics present before the age of one year, and it is very rare that the disease is severe (Phelan 1991). This child required mechanical ventilation and although this is not the first time that isoflurane has been used in the treatment of status asthmaticus (Bierman et al 1986;Parnass et al 1987;Revel1 et al 1988;Johnston et al 1990;Otte & Fireman 1991), we believe this is the youngest reported patient in whom isoflurane has been used for this purpose.…”

Section: Discussionmentioning

confidence: 83%

Asthma and isoflurane

Griffiths¹,

Matthews²

1993

Pediatric Anesthesia

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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

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“…[8] Volatile anaesthetics accumulate very little and are largely excreted by the lungs, independent of liver and kidney elimination, which may be an important consideration in patients with end-organ dysfunction. The miscellaneous properties of bronchodilatation and anti-epileptic activity of these agents are other attractive advantages when considering sedation in patients with refractory bronchospasm[910] or epilepsy. [11] Finally, volatile anaesthetics have been shown to possess cardio and cerebroprotective properties,[1213] which may result in improved cardiac and cerebral outcomes when sedation is continued with these agents in the ICU.…”

Section: Rationale For the Use Of Volatile Anaesthetic Agents For Icumentioning

confidence: 99%

A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa^® device

Misra

Koshy

2012

Indian J Anaesth

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The intensive care unit (ICU) environment is often perceived to be hostile and frightening by patients due to unfamiliar surroundings coupled with presence of numerous personnel, monitors and other equipments as well as a loss of perception of time. Mechanical ventilation and multiple painful procedures that often need to be carried out in these critically ill patients add to their overall anxiety. Sedation is therefore required not only to allay the stress and anxiety, but also to allow for mechanical ventilation and other invasive therapeutic and diagnostic procedures to be performed. The conventional intravenous sedative agents used in ICUs suffer from problems of over sedation, tachyphylaxis, drug accumulation, organ specific elimination and often lead to patient agitation on withdrawal. All this tend to prolong the ventilatory as well as ICU and hospital discharge time, which increase the risk for infection and add to the overall increase in morbidity, mortality and hospital costs. In 2005, the anaesthetic conserving device (AnaConDa®) was marketed for ICU sedation with volatile anaesthetic agents. A number of trials have shown the effectiveness of using volatile anaesthetic agents for ICU sedation with the AnaConDa device. Compared with intravenous sedatives, use of volatile anaesthetic agents have resulted in shorter wake up and extubation time, lesser duration of mechanical ventilation and faster discharge from hospitals. This review shall focus on the benefits, technical pre-requisites and status of sedation with volatile anaesthetic agents in ICUs with the AnaConDa® device.

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Prolonged isoflurane anesthesia in status asthmaticus

Cited by 86 publications

References 0 publications

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

Asthma and isoflurane

A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa^® device

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Prolonged isoflurane anesthesia in status asthmaticus

Cited by 86 publications

References 0 publications

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

Isoflurane for Life-Threatening Bronchospasm: A 15-Year Single-Center Experience

Asthma and isoflurane

A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa® device

Contact Info

Product

Resources

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A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa^® device