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Isoflurane for sedation in a case of congenital myasthenia gravis
1Department of Anaesthesia, East Glamorgan Hospital, Pontypridd, Mid Glamorgan.
Abstract:
We describe the use of isoflurane for the management of a 3-yr-old boy with congenital myasthenia gravis who required ventilation for pneumonia. While in the intensive care unit he was sedated with isoflurane for 5 days (81 MAC-h). This provided a safe, easily controllable method of sedation which avoided the use of neuromuscular blocking agents and appeared to have no significant side effects during use. However, after it was stopped the patient developed a fine, self-limiting tremor which lasted for 2 days. Previous reports of paediatric patients sedated with isoflurane suggest that prolonged exposure may result in temporary dose-dependent neurological dysfunction, including hallucinations, ataxia and non-purposeful movements.
Insights
Isoflurane provided safe, controllable sedation for a pediatric patient with congenital myasthenia gravis. While effective, a temporary tremor occurred post-cessation, highlighting potential neurological effects in children.
Area of Science:
- Pediatric Critical Care Medicine
- Anesthesiology
- Neurology
Background:
- Congenital myasthenia gravis presents significant challenges in pediatric intensive care.
- Sedation and ventilation management in these patients require careful consideration of neuromuscular function.