Review Article: The Potential Role of Anesthesia in Status Asthmaticus

Roy, Thomas M.; Pruitt, Vernon L.; Garner, Paul; Heine, Michael F.

doi:10.3109/02770909209059875

Cited by 12 publications

(5 citation statements)

References 22 publications

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“…During intubation, 1-2 mg/kg IV at a rate of 0.5 mg/kg/min results in 10-15 min of general anesthesia without significant respiratory depression [82]. The bronchodilating properties are observed shortly after administration and last roughly 30 rain [83].…”

Section: Sedation and Paralysismentioning

confidence: 99%

“…The bronchodilating properties are observed shortly after administration and last roughly 30 rain [83]. Ketamine is not without risk because it can cause tachycardia and hypertension (sympathomimetic properties), lower the seizure threshold, lead to delirium (especially upon reemergence from anesthesia), and predispose to aspiration [82]. Only limited clinical data are available regarding the use of ketamine in this setting.…”

Section: Sedation and Paralysismentioning

confidence: 99%

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Medical and ventilatory management of status asthmaticus

1998

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Despite improved understanding of the basic mechanisms underlying asthma, morbidity and mortality remain high, especially in the "inner cities." The treatment of choice in status asthmaticus includes high doses of inhaled beta 2-agonists, systemic corticosteroids, and supplemental oxygen. The roles of theophylline and anticholinergics remain controversial, although in general these agents appear to add little to the bronchodilator effect of inhaled beta-agonists in most patients. Anti-leukotriene medications have not yet been evaluated in acute asthma. Other therapies, such as magnesium sulfate and heliox, have their advocates but are not recommended as part of routine care. If pharmacological therapy does not reverse severe airflow obstruction in the asthmatic attack, mechanical ventilation may be temporarily required. Based on our current understanding of ventilator-induced lung injury, optimal ventilation of asthmatic patients avoids excessive lung inflation by limiting minute ventilation and prolonging expiratory time, despite consequent hypercapnia. Unless respiratory function is extremely unstable, the use of paralytic agents is discouraged because of the increased risk of intensive care myopathy. Patients who have suffered respiratory failure due to asthma are at increased risk for subsequent death due to asthma (14% mortality at 3 years) and should receive very close medical follow-up. In general, severe asthmatic attacks can best be prevented by early intervention in the outpatient setting. In the words of Dr. Thomas Petty, "... the best treatment of status asthmaticus is to treat it three days before it occurs".

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Section: Sedation and Paralysismentioning

confidence: 99%

Section: Sedation and Paralysismentioning

confidence: 99%

Medical and ventilatory management of status asthmaticus

1998

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“…It is therefore relatively contraindicated in patients with atherosclerotic vascular disease, hypertension, increased intracranial pressure, and preeclampsia. Another drawback to the use of ketamine is its potential to lower the seizure threshold, alter mood, and occasionally cause delirium, effects that mayoccur in as much as one third of patients older than 16 yr of age (166,169,170). Ketamine increases laryngeal secretions and does not block pharyngeal and laryngeal reflexes (166); thus, particular care must be taken in the peri-intubation period to avoid laryngospasm and aspiration (171).…”

Section: Sedationmentioning

confidence: 99%

The assessment and management of adults with status asthmaticus.

Corbridge

Hall²

1995

Am J Respir Crit Care Med

180

108

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Despite advancing knowledge of the pathophysiology and treatment of asthma, asthma morbidity and mortality are on the rise. To help avert this trend, clinicians and patients must focus their attention on the early identification and treatment of asthma exacerbations. As in the words of Dr. Thomas Petty: " ... the best treatment of status asthmaticus is to treat it three days before it occurs." (7) Still, there will be asthmatics with life-threatening attacks that require careful assessment and aggressive management. Inhaled beta-agonists, systemic corticosteroids, and oxygen remain the drugs of choice in SA. Anticholinergics play a lesser role in the treatment of acute asthma, and debate continues regarding the efficacy of theophylline in this setting. Available data do not support the routine use of magnesium sulfate or antibiotics in patients with SA. Patients failing drug therapy should be considered early for intubation and mechanical ventilation. A strategy of mechanical ventilation that prolongs TE by limiting VE and decreasing inspiratory time, and that tolerates hypercapnia, avoids excessive lung hyperinflation and barotrauma and should improve the outcome of these most critically ill asthmatics. Intubated and mechanically ventilated patients should be aggressively sedated. Paralytic agents should be used only if adequate control of the cardiopulmonary status cannot be achieved by sedation alone. Minimizing the use of paralytic agents may decrease risk of myopathy and other adverse consequences of muscle paralysis. Finally, after successful treatment of a life-threatening episode of asthma, the treatment team should address prevention of future episodes of SA prior to discharge.

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“…Onset is rapid, and peak plasma concentrations are seen within 60 seconds after administration. 9 Its duration of activity after a single bolus injection is 10-15 minutes; its distribution half-life is 7-11 minutes. The drug is cleared hepatically, with a half-life of 2-3 hours.…”

mentioning

confidence: 99%

“…The drug is cleared hepatically, with a half-life of 2-3 hours. 9,10 Clinical studies have shown that ketamine alleviates bronchospastic activity and reduces airway resistance in patients with pulmonary disease. [11][12][13] Several mechanisms of action have been proposed.…”

mentioning

confidence: 99%