Isoflurane rescue therapy for bronchospasm reduces intracranial pressure in a patient with traumatic brain injury.
To assess the unusual use of a volatile anaesthetic for treatment of life-threatening bronchospasm in a patient with traumatic brain injury (TBI).



Case report.



This study presents a previously healthy 30-year-old man with severe TBI and bronchospasm-induced acute hypercapnia. He was treated with inhaled isoflurane in combination with monitoring of intracranial pressure (ICP) and regional cerebral blood flow (rCBF).



Three-day-long isoflurane treatment resolved drug-refractory bronchospasm, decreased airway pressure and improved gas exchange, even at a low end-tidal concentration (0.3-0.5 vol%). Although rCBF was increased by 18 ml min(-1) 100 g(-1) during isoflurane treatment, there was a significant decrease in ICP (21 (SD = 3) mmHg, 9 (SD = 5) mmHg, 2 (SD = 3) mmHg; during pre-treatment, treatment and post-treatment, respectively; p < 0.001). Improved autoregulation due to lower partial pressure of carbon dioxide, restoration of carbon dioxide reactivity, isoflurane-induced regional differences in rCBF and improved microcirculation may have been responsible for the prompt and long-lasting normalization of ICP. The patient had no TBI-related disability at 6 months post-injury.



Isoflurane at a low dose can be an effective and safe treatment option for drug-refractory bronchospasm in a patient with traumatic intracranial hypertension, provided that multimodality neuromonitoring is used.
a Clinical Department of Anaesthesiology and Intensive Therapy , Centre for Intensive Therapy, University Medical Centre Ljubljana , Ljubljana , Slovenia.
Primoz
P
Gradisek
a Clinical Department of Anaesthesiology and Intensive Therapy , Centre for Intensive Therapy, University Medical Centre Ljubljana , Ljubljana , Slovenia.
Simon
S
Dolenc
D000328:Adult; D018685:Anesthetics, Inhalation / Q000494:pharmacology / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000503:physiopathology; D001986:Bronchial Spasm / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D006801:Humans; D006935:Hypercapnia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007427:Intracranial Pressure / Q000187:drug effects*; D007530:Isoflurane / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D007530:Isoflurane
Cerebral blood flow (CBF); head injury; hypercapnia; mechanical ventilation; multimodality neuromonitoring; volatile anaesthetic