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Case Reports in Medicine
Volume 2010, Article ID 746263, 4 pages
http://dx.doi.org/10.1155/2010/746263
Case Report

Long-Term Isoflurane Therapy for Refractory Bronchospasm Associated with Herpes Simplex Pneumonia in a Heart Transplant Patient

1Department of Anaesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
2Department of Anesthesia and Perioperative Care, UCSF Mount Zion Hospital, University of California San Francisco, 1600 Divisadero Street, C-447, San Francisco, CA 94115, USA
3Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, 81377 Munich, Germany

Received 19 August 2010; Accepted 11 November 2010

Academic Editor: Piotr K. Janicki

Copyright © 2010 C. Hornuss et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 47-year-old man with a history of heart transplant was admitted after severe traumatic brain injury and seizures. During mechanical ventilation, the patient developed bronchospasm that severely compromised respiratory function that led to cardiac arrest. After resuscitation, application of isoflurane through the Anaesthetic Conserving Device (AnaConDa) in the ICU successfully treated bronchospasm, provided adequate sedation, and enabled appropriate ventilation and diagnostic bronchoscopy. A subsequent bronchoalveolar lavage revealed a high amount of Herpes simplex DNA. Herpes simplex pneumonia was diagnosed and treated with acyclovir. Isoflurane treatment was applied for twelve days total without side effects on renal and cerebral function. The patient recovered quickly after the termination of sedation. At discharge, he was fully awake without focal neurological deficiency and his long-term outcome was excellent. This case demonstrates that isoflurane is a treatment option in life-threatening cases of bronchospasm and a safe option for long-term sedation.