[A case of successfully managed acute asthmatic attack by cervical epidural block during mechanical ventilation]

A 47-year-old male suffering from an acute asthmatic attack was admitted in the morning. He was arrested on arrival. Following successful resuscitation, he was treated by using controlled ventilation with a Bennett 7200 respirator. Before starting mechanical ventilation, he was physically exhausted and had carbon dioxide retention (PaCO2 76.2 mmHg). The patient received dexamethasone 40 mg/day and theophylline 400 mg/day during the first 4 days. Despite the decrease in PaCO2 following mechanical ventilation, cycling pressure remained high (up to 50-70 cmH2O) even after 24 hours. Because of the risk of barotrauma due to high cycling pressure, we conducted cervical epidural block to reduce airway hyperreactivity to the endotracheal tube and endotracheal suctioning. Six to 10 ml of lidocaine with 1:200,000 epinephrine was administered every 1 or 2 hours. Within 4 hours after epidural block, airway pressure decreased to 30-40 cmH2O. Since then, requirements of sedative (diazepam) have decreased greatly to 10 mg/day. The patient was successfully extubated 4 days after admission. Finally, epidural block was continued for 6 days without any complication. We do not know how cervical epidural block works to reduce airway pressure. It might be beneficial to manage patients artificially ventilated during asthmatic attack.