Sevoflurane in Status Asthmaticus: A Case Report and Literature Review.

Background: Sevoflurane and other inhaled anesthetics are gradually entering provider awareness as rescue therapies for patients in refractory status asthmaticus. This paper documents a case report and a literature review involving the use of sevoflurane to treat status asthmaticus.

Case presentation: A 27-year-old man presented to the emergency room in acute hypoxic respiratory failure due to status asthmaticus, refractory to multiple therapies and requiring intubation. He was successfully extubated following sevoflurane administration in the operating room, and his care was complicated by transient hypotension. A multidisciplinary effort was critical in ensuring successful and timely therapy.

Methods: We performed a literature review using the search terms "sevoflurane," "status asthmaticus," "acute asthma," and "asthma" in PubMed and Google Scholar. Our search returned a total of 1825 results, of which 1772 covered other topics and 53 discussed the use of sevoflurane for treatment of status asthmaticus. Eighteen articles were duplicates, and 2 were not available in English translation. Two additional sources were found by following citations within texts.

Results: We found 22 articles describing the use of sevoflurane to treat status asthmaticus, covering 30 total patient cases. All cases described resolution of status asthmaticus following sevoflurane administration. In 2 cases, sevoflurane was administered via mask to awake patients. Hypotension was a noted complication in 1 case.

Conclusion: Although not yet considered standard of care, sevoflurane has been extensively documented as a successful treatment for refractory status asthmaticus in multiple case reports. Administration of this therapy often requires multidisciplinary coordination. Hypotension is one noted adverse effect. However, further study is needed to investigate best practices and possible complications.