Reversible neurologic dysfunction following isoflurane sedation in pediatric intensive care.
OBJECTIVE
To examine the relationship between prolonged isoflurane sedation and reversible neurologic dysfunction in children requiring intensive care.


METHODS
Retrospective, case note review from January 1987 to August 1993.


METHODS
Pediatric intensive care unit.


METHODS
Twenty-nine children, aged 6 months to 10 yrs, requiring endotracheal intubation and mechanical ventilation for upper airway infection.


METHODS
None.


RESULTS
Fourteen patients with laryngotracheobronchitis (croup) and 15 patients with epiglottitis required endotracheal intubation and ventilation. These children were treated with different sedative and muscle relaxant drugs, including opiates, benzodiazepines and chloral hydrate. Twelve (41%) of 29 children were sedated with isoflurane (0.25% to 1.5%) for > 24 hrs. All patients subsequently developed reversible ataxia, agitation, hallucinations, and confusion lasting < or = 72 hrs postextubation. Neurologic dysfunction was not observed in 12 patients who did not receive isoflurane nor in five patients who received isoflurane for between 1 and 15 hrs. Neurologic signs resolved in all patients before hospital discharge, and all children had normal neurologic examinations 4 to 6 wks later as outpatients.


CONCLUSIONS
A high occurrence rate of reversible neurologic dysfunction occurs when isoflurane is used as a sedative for > 24 hrs in pediatric patients.
Kelsall
A W
AW
Department of Paediatrics, Addenbrookes Hospital, Cambridge, UK.
Ross-Russell
R
R
Herrick
M J
MJ
D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000453:epidemiology; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
D007530:Isoflurane