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Inhalational Anesthesia for Near-fatal Pediatric Asthma Complicated by Malignant Hyperthermia

Davij Pasrija1, Justin Assioun2, Mohammad Sallam1

  • 1Department of Pediatric Critical Care, University at Buffalo, Buffalo, USA.

Cureus
|November 26, 2021
PubMed

Insights

Severe pediatric asthma requires advanced treatments like mechanical ventilation and, rarely, inhaled anesthetics. A rare side effect of these anesthetics, malignant hyperthermia, has not been documented in pediatric intensive care units for asthma cases.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Anesthesiology

Background:

  • Acute severe asthma is a frequent pediatric emergency requiring bronchodilators, steroids, and mechanical ventilation.
  • Refractory cases may necessitate inhaled anesthetics or extracorporeal gas exchange (ECMO).
  • Inhaled anesthetic use in pediatric intensive care units (PICUs) for asthma is uncommon and resource-dependent.

Observation:

  • Common side effects of inhaled anesthetics include hypotension, arrhythmias, and delirium.
  • Malignant hyperthermia (MH) is a known, albeit rare, complication of inhaled anesthetics and depolarizing muscle agents.
  • MH has not been previously reported in the PICU setting following anesthetic use for pediatric asthma exacerbations.

Findings:

  • This abstract highlights the infrequent use and potential side effects of inhaled anesthetics in pediatric severe asthma management.
  • It specifically notes the absence of reported malignant hyperthermia cases in this context.
  • Treatment protocols for severe pediatric asthma vary by institution.

Implications:

  • Further investigation into the safety profile of inhaled anesthetics for pediatric asthma is warranted.
  • Clinicians should be aware of potential side effects, including the theoretical risk of MH.
  • Standardized guidelines for managing refractory severe pediatric asthma may improve patient outcomes.

Keywords:
asthmaextracorporeal gas exchangeinhaled anesthetic agentsisofluranemalignant hyperthermia

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