A 3-month-old boy with retractive breathing from his birth was scheduled for a rigid bronchoscopic examination.
Anesthesia was induced and maintained with
sevoflurane. The examination revealed a slight
laryngomalacia which was not compatible with his severe symptom. During the procedure, no respiratory deterioration occurred. He was once extubated in the operating room, however, developed severe desaturation immediately. He was reintubated at the scene and returned to the ward being mechanically ventilated and sedated. The next day, his respiratory condition worsened gradually. Conventional drugs including
theophylline,
corticosteroid and
beta adrenergic agonist did not improve his deleterious condition. He became bradycardic and was on the verge of
circulatory collapse as his lungs were unable to ventilate. Then, we commenced inhalation of
sevoflurane using a standard
anesthesia machine, which relieved him from ventilatory crisis. Although there were some difficulties in using
anesthesia machine in the ICU, we could successfully manage
mechanical ventilation. After the beginning of
sevoflurane inhalation, his condition improved gradually. Discontinuation of
sevoflurane was difficult and it took 94 h to wean from
sevoflurane inhalation. Despite long duration of inhalation, no adverse effects of
sevoflurane were observed except transient mild increase in liver
transaminase. There have been very few reports on application of
sevoflurane inhalation for such a long period in infants with
bronchospasm. Moreover, measured serum
fluoride concentration (24.2 micromol x l(-1)) during inhalation was well below harmful level.
Sevoflurane inhalation is worth attempting and safe to treat life-threatening
bronchospasm even in infants.