In Reply.—
I need to begin my reply with a short statement about subject 2. He arrived in our intensive care unit in the state described, and I am unable to comment about his management at the other hospital.
Dr Goldberg has made several valuable comments in his letter. I certainly agree that a patient with status asthmaticus needs to be well and rapidly sedated and paralyzed if necessary to achieve intubation without excessive trauma or prolonged anoxia. The choice of agents used should take into consideration their potential effects on airway tone and mucous production and viscosity.
As I noted in my BRIEF REPORT, halothane is by no means an ideal panacea for status asthmaticus. Other agents share the potential bronchodilating effects of halothane, and, perhaps, less arrhythmogenic agents will be available in the future. The use of IV-administered β-adrenergic agents, such as isuprel by drip or terbutaline by
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