Sevoflurane Therapy for Severe Refractory Bronchospasm in Children

Abstract

Inhaled sevoflurane therapy decreases the levels of PaCO2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.

Sevoflurane improves respiratory mechanics and gas exchange in a case series of infants with severe bronchiolitis‐induced acute respiratory distress syndrome

“…This study was not designed to explore the mechanisms underlying the beneficial effects that sevoflurane had on these children. Nonetheless, they can be postulated analyzing its pharmacologic proprieties: sevoflurane is an inhalational anesthetic agent with powerful bronchodilation properties, and as demonstrated in status asthmaticus, it reduces/resolves severe bronchoconstriction refractory to conventional treatment . Furthermore, it provides an excellent sedation and therefore improves patient‐ventilator adaptation .…”

“…Halogenated agents, thanks to their powerful bronchodilatory and sedative effects, have been used as a last resort for the treatment of life-threatening asthma in the adult and pediatric population [8][9][10][11][12][13]. Among halogenates, sevoflurane provides faster induction and recovery, lower accumulation and causes minimal cardiac depression [14].…”

A Contemporary Approach to the Treatment of Perioperative Bronchospasm

“…It has been shown to be as effective as isoflurane in protecting against bronchospasm in dogs [57]. It is a well-accepted rescue therapy for patients with life-threatening bronchospasm [58]. It is beneficial in ICUs because it can be used as a sedative and as a bronchodilator at the same time.…”

Assessment of Preoperative Risk in Children

“…predlažu prijeoperacijsku primjenu inhalacije salbutamola, uvod u anesteziju propofolom in-travenski, uz održavanje anestezije sevofl uranom, manje invazivnom tehnikom održavanja dišnog puta te iskusnog anesteziologa. [36][37][38][39][40][41][42] Osim aktivne respiratorne infekcije, astma ovisna o terapiji kortikosteroidima, bronhalna hiperreaktivnost, ali i KOPB koji se danas počinje shvaćati kao bolest što se razvija od rane dječje dobi te restriktivna plućna bolest smatraju se visokorizičnim čimbenicima u procjeni prema NARCO-SS-u. 24,43,44 Preporučuje se dijete koje ima astmu procijeniti dva tjedna prije zahvata da bi se omogućila eventualna modifi kacija uobičajene terapije.…”