No profound differences were noted in terms of the duration of mechanical ventilation or mortality rates between asthmatic children (5-17 years of age) with and without exposure to volatile anesthetic agents.

A multicenter retrospective cohort study and narrative review determined the effect of volatile anesthetic agents for the management of life-threatening pediatric asthma.

With the aid of the Virtual Pediatric Systems database, the study incorporated children invasively ventilated for critical asthma with and without exposure to volatiles. Mortality and ventilation duration were the major endpoints, while the length of stay, patient characteristics, and anesthetic-associated noxious events were the secondary endpoints. A subgroup assessment was done investigating children intubated ≥two days.

Out of 203 children incorporated in this study, there were 174 (85.7%) without and 29 (14.3%) with exposure to volatiles. No differences were witnessed in the odds of mortality (1.1). Compared to participants without volatile exposure, participants receiving volatile agents witnessed a larger median difference in the odds of extracorporeal life support (9.1), length of stay (4.8), and ventilation duration (2.3).

For participants ventilated ≥two days, there were no differences in terms of acute renal failure, length of stay, mortality, ventilation duration, or arrhythmias. But, the odds of extracorporeal life support continued to be higher for participants receiving volatiles (7.6). No participant witnessed malignant hyperthermia or liver failure following volatile exposure.

Exposing children with asthma to volatile anesthetics does not considerably influence the ventilation duration and mortality rates. Thus, though volatiles might present a viable rescue treatment for serious asthma cases, further prospective and robust trials are still needed.