[Status asthmaticus treated with inhaled isoflurane and intravenous isoproterenol]

We report the case of an 18-year-old man with status asthmaticus who was treated with inhaled isoflurane and intravenous isoproterenol. The patient was intubated and mechanical ventilation was began immediately after admission to the hospital. He received intravenous methylprednisolone and aminophyline, and frequent inhalation of isoproterenol aerosol. However, his respiratory status deteriorated: peak inspiratory pressure increased markedly, and right pneumothorax, right lower lobe atelectasis, and hypotension developed. He was then given isoflurane by inhalation and a continuous intravenous infusion of isoproterenol, which was followed by marked improvement in his respiratory and hemodynamic status. Isoflurane can be effective in patients with status asthmaticus, and it does not increase the arrhythmogenicity of catecholamines. Intravenous administration of isoproterenol can also be useful in the treatment of patients with status asthamticus. The combination of isoflurane with intravenous isoproterenol may be useful when status asthmaticus is hard to control with conventional therapy.