Inhalational Anesthesia for Near-fatal Pediatric Asthma Complicated by Malignant Hyperthermia

Acute severe asthma is a commonly encountered condition in the pediatric emergency room and the pediatric intensive care unit (PICU). Its treatment involves the use of bronchodilatory agents acting on different receptors, steroids to reduce ongoing inflammation, and non-invasive or invasive mechanical ventilation to offload the increased work of breathing from the respiratory muscles. Patients refractory to these therapies may require the use of inhaled anesthetic agents and extracorporeal gas exchange (ECMO) for life-threatening asthma exacerbations. Depending on institutional protocols, the use of these therapies may vary. The use of inhaled anesthetic agents for asthma management in the PICU is infrequent and is limited to centers with specialized equipment. Commonly encountered side effects include hypotension, arrhythmias, and delirium. Malignant hyperthermia (MH) is a well-known but infrequent side effect of inhaled anesthetic use, depolarizing muscle agents, and has not been described in the PICU following the use of anesthetics for pediatric asthma.