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Prolonged administration of isoflurane to pediatric patients during mechanical ventilation

J H Arnold1, R D Truog, S A Rice

  • 1Department of Anesthesia, Children's Hospital, Boston, Massachusetts 02115.

Anesthesia and Analgesia
|March 1, 1993
PubMed

Insights

Isoflurane effectively sedates pediatric patients on mechanical ventilation, even for extended durations. While some experienced withdrawal symptoms, significant organ toxicity was not observed, indicating a favorable safety profile.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care

Background:

  • Opioid-based sedation is common in pediatric mechanical ventilation.
  • Prolonged sedation can lead to tolerance and withdrawal.
  • Alternative sedation strategies are needed.

Purpose of the Study:

  • To evaluate the effectiveness and safety of isoflurane for sedation in pediatric patients requiring mechanical ventilation.
  • To assess potential toxicities associated with prolonged isoflurane use.

Main Methods:

  • Prospective study of ten pediatric patients (3 weeks to 19 years) requiring mechanical ventilation.
  • Continuous isoflurane sedation administered for a mean duration of 131 minimum alveolar concentration (MAC)-hours.
  • Monitoring of inorganic fluoride (F-) concentrations, serum creatinine, osmolality, and creatinine clearance.

Main Results:

  • Mean peak inorganic fluoride (F-) concentration was 11.0 microM; only one patient exceeded 20 microM.
  • No significant abnormalities in serum creatinine or osmolality were observed.
  • One patient showed a persistent decrease in creatinine clearance (>20%) after prolonged isoflurane exposure.
  • Five patients (receiving ≥70 MAC-hours) exhibited an abstinence syndrome (movement, agitation).

Conclusions:

  • Isoflurane provides effective sedation for pediatric patients on mechanical ventilation for prolonged periods.
  • Significant adverse effects on cardiovascular, hepatic, or renal function were not observed.
  • Potential for abstinence syndrome exists with prolonged isoflurane exposure, requiring careful monitoring.

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