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Rapid response to isoflurane in refractory status asthmaticus
  1. M RICE,
  1. Paediatric Intensive Care Unit
  2. Guy’s Hospital, St Thomas’ Street
  3. London SE1 9RT

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    Editor,—Although the in-hospital mortality from refractory status asthmaticus is low, the treatment strategies used in the management of these patients may cause significant morbidity.1-3 Those children who require ventilation either for resuscitation or impending respiratory collapse often require the addition of “unconventional” adjuvant bronchodilator treatments, such as intravenous β2agonists,4 ketamine,5 or magnesium,6 aimed at reduction of ventilator induced volutrauma.

    Inhaled anaesthetic gases are known to produce sustained bronchodilatation in refractory status asthmaticus, possibly mediated by airway reflex blockade and a direct effect on smooth muscle.7-9 We wish to highlight the use of inhaled isoflurane in two children with severe life threatening asthma, and in particular, the importance of guiding treatment by continuous intra-arterial blood gas analysis (Paratrend 7, Biomedical Sensors, High Wycombe).10

    Patient A …

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