Reversible neurologic dysfunction following isoflurane sedation in pediatric intensive care

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Neurology
• Anesthesiology

Background:

• Upper airway infections frequently necessitate mechanical ventilation in pediatric intensive care.
• Sedation is crucial for managing intubated children, but potential side effects require careful consideration.

Purpose of the Study:

• To investigate the association between prolonged isoflurane sedation and the development of reversible neurologic dysfunction in critically ill children.
• To determine the threshold for isoflurane exposure associated with adverse neurological outcomes.

Main Methods:

• A retrospective review of case notes was conducted for 29 children (aged 6 months to 10 years) admitted to a pediatric intensive care unit.
• Patients required endotracheal intubation and mechanical ventilation due to upper airway infections.
• Data on sedative agents, duration of sedation, and post-extubation neurological status were analyzed.

Main Results:

• Twelve of 29 children (41%) received isoflurane sedation for over 24 hours.
• All children sedated with isoflurane for >24 hours developed reversible neurological symptoms including ataxia, agitation, hallucinations, and confusion, lasting up to 72 hours post-extubation.
• No neurological dysfunction was observed in children who did not receive isoflurane or received it for <15 hours.

Conclusions:

• Prolonged isoflurane sedation (>24 hours) in pediatric patients is associated with a high incidence of reversible neurological dysfunction.
• These neurological effects appear to be transient, with full resolution before hospital discharge and normal follow-up examinations.
• The findings suggest careful consideration of sedation duration and agent choice when using isoflurane in pediatric intensive care settings.