Prolonged use of isoflurane in a patient with tetanus

We describe a patient with tetanus, who received isoflurane for sedation to facilitate controlled mechanical ventilation. Isoflurane was administered for 34 days, resulting in a sustained serum inorganic fluoride ion concentration in excess of 50 mumol litre-1 and a peak serum inorganic fluoride ion concentration of 87 mumol litre-1. Although these concentrations are potentially nephrotoxic, no toxicity was evident clinically.