Prolonged isoflurane inhalation in a patient with bronchospasm associated with lung edema

An 80-year-old female with bronchospasm associated with lung edema, who had been resistive to conventional medical treatment, was mechanically ventilated with isoflurane in oxygen for 386 hours. A total amount of isoflurane given was 277.6 MAC-hours. A serum inorganic fluoride concentration increased after isoflurane inhalation and it was 26.8 microM when serum urea nitrogen and creatinine were elevated. On the day after discontinuation of isoflurane inhalation, a peak serum inorganic fluoride concentration was 38.9 microM. After discontinuation of isoflurane inhalation, serum urea nitrogen and creatinine decreased and no clinical renal dysfunction was observed. We conclude that this subclinical renal dysfunction was due to antibiotics, advanced age, dehydration and prolonged elevation of serum inorganic fluoride concentration.