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An Unusual Complication With the Administration of a Volatile Anesthetic Agent for Status Asthmaticus in the Pediatric Intensive Care Unit: Case Report and Review of the Literature.

Abstract
In severe cases of status asthmaticus, when conventional therapies fail, volatile anesthetic agents remain a therapeutic option. When delivered outside of the operating room setting, specialized delivery techniques are needed to ensure the safe and effective use of volatile anesthetic agents. We present a 16-year-old adolescent with status asthmaticus who required the therapeutic administration of the volatile anesthetic agent, sevoflurane, in the pediatric intensive care unit (PICU). Although initially effective in reducing bronchospasm, progressive hypercarbia developed due to defective functioning of the carbon dioxide absorber of the anesthesia machine. This failure occurred as the soda lime compartment filled with water accumulated from circuit humidification and continuous albuterol therapy. The role of volatile anesthetic agents in the treatment of status asthmaticus in the PICU is discussed, options for delivery outside of the operating room presented, and potential problems with delivery reviewed.
AuthorsBrittany Shutes, W Joshua Frazier, Joseph D Tobias
JournalJournal of intensive care medicine (J Intensive Care Med) Vol. 32 Issue 6 Pg. 400-404 (Jul 2017) ISSN: 1525-1489 [Electronic] United States
PMID28612677 (Publication Type: Case Reports, Journal Article, Review)
Chemical References
  • Anesthetics, Inhalation
  • Calcium Compounds
  • Methyl Ethers
  • Oxides
  • Sevoflurane
  • soda lime
  • Sodium Hydroxide
Topics
  • Adolescent
  • Anesthetics, Inhalation (administration & dosage, adverse effects, pharmacokinetics)
  • Calcium Compounds (pharmacokinetics)
  • Extracorporeal Membrane Oxygenation
  • Humans
  • Intensive Care Units, Pediatric
  • Intubation, Intratracheal
  • Male
  • Methyl Ethers (administration & dosage, adverse effects, pharmacokinetics)
  • Oxides (pharmacokinetics)
  • Sevoflurane
  • Sodium Hydroxide (pharmacokinetics)
  • Status Asthmaticus (therapy)
  • Treatment Outcome

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