1997 OPEN FORUM Abstracts
ISOFLURANE ADMINISTRATION VIA A SERVO 900C VENTILATOR FOR SEDATION OF A SIX MONTH OLD INFANT IN THE POST OPERATIVE PERIOD
Suzanne M. Durning, BA, RRT, P/P Spec., Linda A. Napoli, BS, RRT, RPFT, P/P Spec.; Theresa R. Schultz, BA, RRT, CPFT, P/P Spec.; R. I. Godinez, MD. PhD; The Children's Hospital of Philadelphia, Philadelphia, PA
Published data on the prolonged use of isoflurane in post-operative patients is available, although reports of pediatric application are limited. A 6 month old, 7.2 kg infant, born at 36 weeks gestational age, was referred to our institution for management of impending respiratory failure due to RSV bronchiolitis. She required intubation and ventilation for 7 days. After failed extubation attempts, a bronchoscopy was performed and revealed a subglottic tracheal cyst. The cyst was resected and, following a normal post-operative course, the patient was returned to the referring institution in order to be closer to home. After 12 days at the outlying hospital, she began to develop respiratory distress. She was again transferred to our institution and a bronchoscopy revealed cricoid narrowing. The patient was treated with a cricoid split. Post surgery, adequate sedation was not achieved despite the use of maximum levels of intravenous drugs. Sedation was an important issue due to the critical nature of the airway and the anticipated need for a prolonged sedation period (7 - 10 days in accordance with normal practice following a cricoid split). The patient was placed on isoflurane in an attempt to successfully manage the sedation level. The isoflurane was administered in the Pediatric Intensive Care Unit, via a Servo 900C with a Siemens Vaporizer 952, and Servo Manual Ventilation Accessory 963. The Servo Evac 180 was used for gas scavenging. Level of sedation was determined, and titration of isoflurane was performed, by an anesthesiologist/ critical care physician. Environmental testing with an infrared spectrophotometer and dosimeter assured proper function of the system. Serum fluoride levels of 0.1-0.3 mg/dL are within normal limits. No abnormalities were noted in mean inorganic fluoride concentration or serum creatinine levels. Hemodynamic status remained stable on isoflurane levels < =0.9%. After 7 days, the isoflurane was discontinued with a rapid return of the patient to a wakeful state. The patient's natural airway was deemed to be adequate and she was successfully extubated. She was discharged 18 days after this admission. Conclusion: In this patient, isoflurane administration provided a safe, effective and reliable method of sedation management.