ISOFLURANE FOR SEDATION IN A CASE OF CONGENITAL MYASTHENIA-GRAVIS

We describe the use of isoflurane for the management of a 3-yr-old boy with congenital myasthenia gravis who required ventilation for pneumo nia. While in the intensive care unit he was sedated with isoflurane f or 5 days (81 MAC-h). This provided a safe, easily controllable method of sedation which avoided the use of neuromuscular blocking agents an d appeared to have no significant side effects during use. However, af ter it was stopped the patient developed a fine, self-limiting tremor which lasted for 2 days. Previous reports of paediatric patients sedat ed with isoflurane suggest that prolonged exposure may result in tempo rary dose-dependent neurological dysfunction, including hallucinations , ataxia and non-purposeful movements.