PROLONGED ADMINISTRATION OF ISOFLURANE TO PEDIATRIC-PATIENTS DURING MECHANICAL VENTILATION

We undertook a prospective study of the effectiveness and potential to xicities of isoflurane sedation in pediatric patients undergoing mecha nical ventilation. All patients undergoing mechanical ventilation who required large doses of opioids for sedation were considered eligible. Ten patients (ages 3 wk to 19 yr) received continuous isoflurane seda tion for a mean duration of 131 minimum alveolar concentration (MAC)-h ours (range 13-497 MAC-hours). The mean peak inorganic fluoride (F-) c oncentration was 11.0 muM, and the highest F- concentration was 26.1 m uM after 441 MAC-hours. Only one patient had a measured F- concentrati on greater than 20 muM. No abnormalities were noted in serum creatinin e or osmolality. Creatinine clearances were available for five patient s who received a mean of 193 MAC-hours of isoflurane (range 33-497 MAC -hours), and only one patient had a persistent decrease from baseline of more than 20%. Five patients demonstrated an abstinence syndrome wh ich consisted of nonpurposeful movements and extreme agitation. All of these patients had received at least 70 MAC-hours of isoflurane. Our experience indicates that isoflurane can effectively provide sedation to pediatric patients for prolonged periods without significant advers e effects on cardiovascular, hepatic, or renal function.