title: Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series.
abstract: Status asthmaticus is an acute, intractable asthma attack refractory to standard interventions that can lead to progressive respiratory failure. Successful management requires a fundamental understanding of the disease process, its clinical presentation, and proper evaluation. Treatment must be instituted early and is aimed at reversing the airway inflammation, bronchoconstriction, and hyper-reactivity that often lead to lower airway obstruction, impaired ventilation, and oxygenation. Most patients are effectively treated with standard therapy including beta2-adrenergic agonists and corticosteroids. Others necessitate adjunctive therapies and escalation to noninvasive ventilation or intubation. We will review the pathophysiology, evaluation, and treatment options for pediatric patients presenting with status asthmaticus with a particular focus on refractory status asthmaticus treated with volatile anesthetics. In addition, we include a proven approach to the management of these patients in the critical care setting, which requires close coordination between critical care and anesthesia providers. We present a case series of three patients, two of which have the longest reported cases of continuous isoflurane use in status asthmaticus. This series was obtained from a retrospective chart review and highlights the efficacy of the volatile anesthetic, isoflurane, in three pediatric patients with refractory life-threatening status asthmaticus.
authors.affiliation: Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; McGill University Health Center, Department of Anesthesia, Montreal, QC, Canada.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Carrié
authors.forename: Thomas Anthony
authors.initials: TA
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists; D018685:Anesthetics, Inhalation; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane; D008297:Male; D010372:Pediatrics / Q000379:methods; D012121:Respiration, Artificial; D013224:Status Asthmaticus / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018685:Anesthetics, Inhalation; D018927:Anti-Asthmatic Agents; D007530:Isoflurane
keywords: asthma; isoflurane for status asthmaticus; pediatrics; refractory asthma; status asthmaticus; volatile anesthetics