Intraoperative Bronchospasm

this topic was given recently as 'what are the differential diagnosis of intraoperative Bronchospasm and what is its management?"



 The differential diagnosis of intraoperative bronchospasm are

preexisting Bronchospastic Disease asthma Chronic obstructive pulmonary disease Bronchopulmonary dysplasia Bronchospasm Induced Under Anesthesia Tracheal intubation Surgical stimulation under light plane of anesthesia Hypersensitivity reactions (histaminoid, anaphylactoid or anaphylactic) Aspiration of gastric contents Mainstem bronchial intubation or carinal irritation by endotracheal tube Pulmonary edema (cardiogenic or negative pressure) Conditions Mimicking Bronchospasm (increased peak inspiratory pressure, decreased tidal volume, wheezing) Kinked tracheal tube or breathing system Secretions Obstruction of the tube by overinflated or herniated cuff Pneumothorax (simple or tension)

What Therapeutic Approaches Are Used to Prevent Bronchospasm?

▪ PREVENTION

Preoperative identification of patients who are likely to develop perioperative bronchospasm helps to optimize the medical condition

▪ TIMING OF ELECTIVE SURGERY

Smoking cessation is the  most effective  way for most people to reduce the risk of  perioperative pulmonary complications.

 The surgical site is the most important predictor,Upper abdominal and thoracic surgery represents the greatest risk.

Elective surgery scheduled 6-8 weeks post cessation of smoking

Eradication of infection,physiotherapy to enhance drainage of sputum.

Start on steroids and bronchodilators 3-5days in advance

Option of regional anesthesia whereever possible

Minimal stimulation of airway

Anxiolytics and antihistaminics prior to surgery

Diagnosis of intraopearative Bronchospasm

Wheeze,increase in peak inflation pressure,decreasing exhaled tidal volume,slow rising capnogragh

Therapeutic Approach to Intraoperative Bronchospasm

1) Rule out mechanical causes for wheezing such as tube obstruction, mainstem bronchial intubation, pneumothorax 2) Deepen the anesthetic using volatile or IV anesthetics,  3) stop surgical stimulation 4) Nebulized β2 agonists (albuterol) up to 10 puffs and steroids IV lidocaine 1.5 mg/kg, 5) Adjust the ventilator settings to achieve adequate oxygenation, yet minimize the peak and mean inflation pressures 6) Consider neuromuscular blockade 7) Intravenous corticosteroids, hydrocortisone 2-4 mg/kg 8) Consider deep extubation, postoperative ventilatory support