Perioperative corticosteroids for intermittent and mild persistent asthma

Abstract

Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwent surgery between January 1990 and January 1999. All patients were treated with corticosteroids during the perioperative period, consisting of a course of oral prednisolone 10–20 mg/day for 1–2 days pre-operatively, methylprednisolone 80–125 mg 2 h before the operation, followed by 80 mg methylprednisolone just after the operation. The incidence of perioperative bronchospasm was evaluated based on medical records. Airway hyperresponsiveness to inhaled methacholine was determined in six other asthmatics before and after a similar regimen of perioperative corticosteroids treatment. Only three cases (4.0%) developed mild asthma during the perioperative period. No evidence of adverse effects of corticosteroids was noted in any case. The use of the same therapeutic regimen in another six asthmatics significantly suppressed airway hyperresponsiveness to inhaled methacholine. Our results suggest that perioperative corticosteroids are effective in preventing perioperative bronchospasm in stable asthmatics during surgery under general anesthesia by suppressing airway hyperresponsiveness.