Volatile Agents to Avoid Ventilating Asthmatics

Baigel, G.

doi:10.1177/0310057x0303100213

Cited by 13 publications

(9 citation statements)

References 16 publications

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“…Therefore, in this case, we considered that slow induction was appropriate for the prevention of epileptic seizure and reflux of gastric contents. In this case, anesthesia was maintained with sevoflurane, because it is a potent bronchodilator [9] with no effects on GER [10].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a child with Aicardi syndrome undergoing laparoscopic Nissen’s fundoplication: a case report

et al. 2010

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Aicardi syndrome (AS) is a rare congenital syndrome and is characterized by the triad of infantile spasm, agenesis of the corpus callosum, and anomaly of chorioretinal lacunae. We here report a case of a patient with AS under general anesthesia. Although there is no report in which muscle relaxants were used in AS patients, vecuronium bromide was used for artificial pneumoperitoneum in this case. Careful management is important for AS patients during an operation that significantly affects respiratory function. In addition, it is possible that muscle relaxants be administered safely in AS patients. Careful monitoring such as epileptiform electroencephalogram and bispectral index monitors may be needed for the early detection of epileptic activities.

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Section: Discussionmentioning

confidence: 99%

Anesthetic management of a child with Aicardi syndrome undergoing laparoscopic Nissen’s fundoplication: a case report

et al. 2010

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“…1 Hence, it is not surprising that many authors have recommended the administration of sevoflurane in patients with reactive airway diseases and even in those with status asthmaticus. 2,3 Phosphodiesterase 4 inhibitors and sevoflurane are thought to have independent bronchodilator properties. The current investigation, which was performed on animals with sensitized airways, showed that a new-generation roflumilast and sevoflurane produced additive airway relaxation via an increase in airway smooth muscle cyclic adenosine monophosphate levels.…”

Section: Commentmentioning

confidence: 99%

Phosphodiesterase 4 Inhibitor Roflumilast Improves the Bronchodilative Effect of Sevoflurane in Sensitized Airways

Zhou

Iwasaki

Yamakage

2015

Survey of Anesthesiology

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A lthough phosphodiesterase 4 inhibitors and the volatile anesthetic sevoflurane have independent bronchodilator qualities, the combined administration of these agents can potentially exert an additive or synergistic bronchodilator effect. Researchers tested this hypothesis and investigated the common site of this combined relaxation effect in a model of airway hyperresponsiveness with ovalbumin-sensitized guinea pigs. The 138 animals were randomized into 6 groups: sensitized, sevoflurane, rolipram 1.0, roflumilast 1.0, sevoflurane/rolipram 1.0, and sevoflurane/roflumilast 1.0. Total lung resistance in vivo, airway smooth muscle tension in vitro, and intracellular cyclic adenosine monophosphate levels were measured to assess the relaxation effect. Among the 6 sensitized groups, total lung resistance was higher in the order of sensitized > sevoflurane > rolipram1.0 > roflumilast 1.0 > sevoflurane/ rolipram 1.0 > sevoflurane/roflumilast 1.0, with an increase in acetylcholine concentration. Compared with the other 5 groups, the muscle tensions in the sevoflurane/roflumilast 1.0 group were markedly lower at carbacholine doses of 10 −7 , 10 −6 , and 10 −5 M. The cyclic adenosine monophosphate concentrations (means ± SD) in the sevoflurane/rolipram 1.0 (1.61 ± 0.34) and sevoflurane/ roflumilast 1.0 (1.50 ± 0.20) groups were higher than those in the sensitized (0.52 ± 0.15) and sevoflurane (1.12 ± 0.32) groups.The investigators concluded that the combined use of phosphodiesterase 4 inhibitors with the volatile anesthetic sevoflurane had an additive bronchodilator effect in guinea pigs sensitized with ovalbumin. The accompanying increase in cyclic adenosine monophosphate levels in sensitized airway smooth muscle might be a mechanism of this combined relaxation effect. COMMENTPatients with airway hyperreactivity (eg, chronic obstructive pulmonary disease, asthma) are being recognized increasingly throughout the globe. Many of the volatile anesthetic agents are potent bronchodilators, but there appears to be consensus that sevoflurane irritates the airway least among the volatile agents that include halothane, enflurane, isoflurane, and sevoflurane. 1 Hence, it is not surprising that many authors have recommended the administration of sevoflurane in patients with reactive airway diseases and even in those with status asthmaticus. 2,3 Phosphodiesterase 4 inhibitors and sevoflurane are thought to have independent bronchodilator properties. The current investigation, which was performed on animals with sensitized airways, showed that a new-generation roflumilast and sevoflurane produced additive airway relaxation via an increase in airway smooth muscle cyclic adenosine monophosphate levels. These findings suggest that a combination of these 2 agents might be considered to provide better protection against airway disease when patients with airway hyperreactivity require a general anesthetic. Comment by Kathryn E. McGoldrick, MD, FCAI(Hon) Disclosure: The author declares no conflict of interest.REFERENCES 1. Doi M, Ikeda K. Air...

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“…Care must be exercised with the combination of adrenergic agents such as adrenaline or salbutamol with volatile anaesthetics especially halothane as severe and even fatal dysrrhythmias may occur, particularly in the presence of hypokalaemia. 8,11 Anti-inflammatory therapy This currently is limited to the corticosteroids, which have a role in dampening the inflammatory process and in prophylaxis against future attacks. The enteral and parenteral routes are equally effective.…”

Section: Management Of Bronchospasm Beta 2 -Agonistsmentioning

confidence: 99%

Critical care clinical conundrums

Pouchet

2004

Clinical Intensive Care

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A 50-year-old postman was admitted to the Accident and Emergency (A&E) department as a trauma call. He had been found unconscious at the side of the road with his mangled bicycle nearby. Passersby noticed he had been wobbling on his cycle prior to his event, but no one had seen him fall. On admission, he had a Glasgow coma score of 3/15 with pinpoint pupils, profound hypotension and tachycardia. He was intubated and ventilated, and 2 l of warmed Hartmann's solution were administered rapidly intravenously. During the secondary survey, he was reviewed by the intensive care consultant, who noticed that he was very hot, dehydrated and vasodilated. His tympanic temperature was 41.28C. As it was one of the hottest days in the hottest summer of many years, a presumptive diagnosis of heat stroke was made. Immediate cooling measures were instituted and the warmed fluid changed to cold colloid. He was noticeably bleeding from all puncture sites and fresh frozen plasma (FFP) was ordered. He was taken quickly to the intensive care unit after a computerized tomography (CT) scan of the brain, which demonstrated no abnormalities.

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Volatile Agents to Avoid Ventilating Asthmatics

Cited by 13 publications

References 16 publications

Anesthetic management of a child with Aicardi syndrome undergoing laparoscopic Nissen’s fundoplication: a case report

Anesthetic management of a child with Aicardi syndrome undergoing laparoscopic Nissen’s fundoplication: a case report

Phosphodiesterase 4 Inhibitor Roflumilast Improves the Bronchodilative Effect of Sevoflurane in Sensitized Airways

Critical care clinical conundrums

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