Chest
Volume 97, Issue 3, March 1990, Pages 698-701
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Clinical Investigations in Critical Care
Isoflurane Therapy for Status Asthmaticus in Children and Adults

https://doi.org/10.1378/chest.97.3.698Get rights and content

Two adults and two children with life-threatening asthma refractory to maximal standard therapy were treated with the inhalational anesthetic agent isoflurane. In each case, the temporal response to the initiation of therapy was striking. All patients survived and none experienced adverse reactions attributable to the drug. Rapid therapeutic benefit, minimal side effects, absence of cumulative toxicity, and ease of administration are factors supporting the use of isoflurane for patients with severe asthma.

Section snippets

CASE 1

A 20-year-old woman with a seven-year history of asthma was admitted to the hospital with a history of worsening bronchospasm for one week following a flu-like illness. She had been using albuterol, ipratropium, and beclomethasone inhalers without improvement. She was transferred to our Intensive Care Unit (ICU) owing to increasing respiratory distress. On admission to the ICU, her heart rate (HR) was 120 beats per minute, respiratory rate (RR) was 18 breaths per minute, and blood pressure (BP)

DISCUSSION

Isoflurane produces bronchodilation through β-adrenergic receptor stimulation, direct relaxation of bronchial smooth muscle, antagonism of the action of acetylcholine and histamine, and interference with hypocapnic bronchoconstriction.6 Thus, a patient who is already receiving maximum doses of standard bronchodilators may show an additional response. As our case reports suggest, isoflurane acts rapidly and may be lifesaving while high-dose corticosteroids take effect. In contrast, ketamine, an

ACKNOWLEDGMENTS

We wish to thank Sylvia Goruk for assistance in preparing this manuscript.

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Manuscript received November 7, 1988; revision accepted August 18.

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