ISOFLURANE THERAPY FOR STATUS ASTHMATICUS IN TWO CHILDREN

Abstract

Case 1 is a 5-year-2-month-old girl. She was admitted to another hospital for an asthma attack 3 months ago. Because of respiratory failure she was then moved to our hospital, and immediately mechanically ventilated. On the 3rd hospital day she developed subcutaneous emphysema, and was administered isoflurane. After 23 hours, this therapy was discontinued and the endotracheal tube was removed on the 4th hospital day. Case 2 is an 11-year-old girl who had been treated with MDI (metered dose inhaler) of fenoterol and regular inhalation of orciprenaline. She was brought to our hospital in severe asthmatic attack. Though she initially responded to conventional therapy, she no longer responded within several hours. She was thus mechanically ventilated together with administration of isoflurane for 85 hours and pulse therapy of corticosteroid. On the 5th hospital day, the endotracheal tube was removed. Both of above cases showed no significant side-effects of isoflurane. Case 1 improved by isoflurane rapidly, but case 2 needed the longer-term isoflurane inhalation and pulse therapy together. In case 2, inhaled β stimulants were the main treatment despite the severity of the asthma. Insufficient treatment with anti-inflammatry agents was thought to have contributed to the expression of the isoflurane effectiveness.