This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Marc Goldberg, MD
Hahnemann University Philadelphia

JAMA. 1985;253(3):343-344.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The recent report by Schwartz¹ describing the use of halothane to treat status asthmaticus unresponsive to other therapy serves as a useful reminder to the medical community. However, several important clarifications should be made.

First, the initial treatment in case 2 was suboptimal. Clearly, arterial hypoxemia (Pao₂, 61 mm Hg) and hypercarbia (Pco₂, 123 mm Hg) of this magnitude, along with patient lethargy, mandate immediate mechanical ventilation. Furthermore, administration of sodium bicarbonate for the treatment of respiratory acidosis without mechanical ventilation will only produce greater hypercarbia.

Although Schwartz suggests that the use of succinylcholine is contraindicated in status asthmaticus because of histamine release, this is actually not a significant problem. Succinylcholine releases minimal amounts of histamine²; it is almost never a problem in clinical practice. A theoretical concern is its effect of activating all cholinergic autonomic receptors, thus increasing bronchospasm. A more practical . . . [Full Text PDF of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?