Inhaled isoflurane for life-threatening bronchospasm in children

Abstract

In this study, we present 2 pediatric cases with different responses to inhaled isoflurane therapy for refractory life-threatening bronchospasm. Case 1, a 1-year-old boy with chronic lung disease of infancy was admitted with severe dyspnea and wheezing. Since he became unresponsive to conventional therapies, namely, nebulized albuterol and ipratropium bromide, intravenous corticosteroids, and magnesium with mechanical ventilation, inhalation of 1% isoflurane was initiated. After 2 h of isoflurane inhalation therapy, his respiratory acidosis resolved and he was successfully weaned. Case 2, a 5-year-old girl with bronchiolitis obliterans syndrome, following allogeneic peripheral stem cell transplantation for B cell acute lymphoblastic leukemia, was admitted after 1 day of sudden-onset dyspnea. Along with severe bronchospasm, her hypercapnia and high peak airway pressure did not improve with conventional therapies. Therefore, isoflurane was started at 1.5%, but discontinued within 1 h due to aggravation of hypercapnia. She was eventually placed on extracorporeal membrane oxygenation. These cases highlight that isoflurane inhalation could be lifesaving for those with refractory bronchospasm, but that it should be used carefully since the patient response can vary based on the underlying disease.