Reversible neurologic dysfunction following isoflurane sedation in pediatric intensive care

To examine the relationship between prolonged isoflurane sedation and reversible neurologic dysfunction in children requiring intensive care.

Retrospective, case note review from January 1987 to August 1993.

Pediatric intensive care unit.

Twenty-nine children, aged 6 months to 10 yrs, requiring endotracheal intubation and mechanical ventilation for upper airway infection.

None.

Fourteen patients with laryngotracheobronchitis (croup) and 15 patients with epiglottitis required endotracheal intubation and ventilation. These children were treated with different sedative and muscle relaxant drugs, including opiates, benzodiazepines and chloral hydrate. Twelve (41%) of 29 children were sedated with isoflurane (0.25% to 1.5%) for > 24 hrs. All patients subsequently developed reversible ataxia, agitation, hallucinations, and confusion lasting < or = 72 hrs postextubation. Neurologic dysfunction was not observed in 12 patients who did not receive isoflurane nor in five patients who received isoflurane for between 1 and 15 hrs. Neurologic signs resolved in all patients before hospital discharge, and all children had normal neurologic examinations 4 to 6 wks later as outpatients.

A high occurrence rate of reversible neurologic dysfunction occurs when isoflurane is used as a sedative for > 24 hrs in pediatric patients.