MANAGEMENT OF CRISES DURING ANESTHESIA AND SURGERY. PART III: Bronchospasm &amp; Laryngospasm

Salam N Asfar

doi:10.33762/bsurg.2012.55557

Abstract

Bronchospasm usually manifests during anaesthesia as an expiratory wheeze, prolonged expiration and/or increased inflation pressures during intermittent positive pressure ventilation (IPPV). Wheeze may be audible either with or without auscultation, but can only be present if there is gas flow in the patient’s airways. Thus, in cases of severe bronchospasm, the chest may be silent on auscultation and the diagnosis may rest on correct assessment of increased inflation pressures 1 . Other signs include; low oxygen saturation, change in capnogram, hypoventilation and hypotension 2 .

Highlights

Bronchospasm usually manifests during anaesthesia as an expiratory wheeze, prolonged expiration and/or increased inflation pressures during intermittent positive pressure ventilation (IPPV)
In cases of severe bronchospasm, the chest may be silent on auscultation and the diagnosis may rest on correct assessment of increased inflation pressures[1]
Emergency management *100% oxygen *Stop stimulation and surgery *Deepen anaesthesia *If intubated exclude oesophageal or endobronchial position *If mask or laryngeal mask consider laryngospasm, regurgitation, vomit and aspiration *Give adrenaline or salbutamol. *If you can not ventilate via endotracheal tube consider: Misplaced, kinked, blocked tube or circuit, pneumothorax, aspiration, anaphylaxis and pulmonary oedema. *Consider possible obstruction distal to the tube: Try to push a small tube past it or push the obstruction down one bronchus and ventilate the other lung *Magnesium sulphate[3] (1.2–2 g i.v.) can be helpful in difficult cases; it is cheap, available, and can suppress tachyarrhythmias

Summary

Introduction

Bronchospasm usually manifests during anaesthesia as an expiratory wheeze, prolonged expiration and/or increased inflation pressures during intermittent positive pressure ventilation (IPPV). In cases of severe bronchospasm, the chest may be silent on auscultation and the diagnosis may rest on correct assessment of increased inflation pressures[1]. Causes: 1- During induction of anaesthesia: *Bronchospasm due to airway irritation *Anaphylaxis *Misplacement of endotracheal tube *Aspiration of gastric contents *Pulmonary oedema (following failed intubation) *Unknown, possibly allergy

Results

Conclusion