History Of Anesthesia Research Articles

An unusual late complication of peridural anesthesia: The case of a subdural spinal epidermoid cyst: A case report and literature review

The peridural approach is primarily used today to provide analgesia in obstetrics and postoperative care. Peridural analgesia is not only more effective than systemic analgesia, but it also has benefits in terms of morbidity, particularly regarding postoperative respiratory complications and the shortened duration of postoperative ileus. Unlike dural tears, immediate and severe neurological complications such as hematomas or abscesses are very rare. Long-term sequelae are less well known because the relationship with epidural analgesia performed several months or years earlier is not always well established. We report a rare case of a 35-year-old patient with a history of epidural anesthesia five years ago during childbirth, who was admitted with cauda equina syndrome. MRI (magnetic resonance imaging) of the lumbar spine showed a subdural lesion at the level of L3. The patient underwent resection of the lesion, and the pathological examination of the surgical specimen concluded it was an epidermoid cyst.

AHA Announces 2025 C. Ronald Stephen, MD, Anesthesia History Essay Contest, with the Raymond C. Roy, MD, and Cornelia G. Roy Prize

AHA Announces 2025 C. Ronald Stephen, MD, Anesthesia History Essay Contest, with the Raymond C. Roy, MD, and Cornelia G. Roy Prize

Effects of video-assisted preanesthetic patient education on preanesthetic interview time; A prospective, single-blinded, randomized controlled trial.

A preanesthetic evaluation interview with an anesthesiologist is essential for patient safety, however, it is not performed adequately owing to the excessive workload of doctors. This study aimed to determine whether video-assisted preanesthetic patient education can reduce patient interview time and solve the problem of excessive labor at a relatively low cost. This study considered relatively healthy patients aged 19 to 65 years who were scheduled for elective surgery under general anesthesia. None of the patients had history of general anesthesia. Patients were randomly assigned 1:1 to Groups V and C. Group V watched the preanesthetic education video, while Group C did not. The duration of the preanesthetic evaluation interview was measured for all participants. The satisfaction of the anesthesiologist and patient with the preanesthetic evaluation procedure, anxiety of the patient, and vital signs during surgery were collected. A total of 33 patients in Group V watched the preanesthetic education video, while 31 patients in Group C did not. Group V spent significantly less time on the preanesthetic evaluation interview with an anesthesiologist than that of Group C (172.42 vs 196.68 seconds; P = .005). There was no difference in patient and anesthesiologist satisfaction between the 2 groups (P = .861 and P = .849, respectively). Patients' anxiety (P = .474), intraoperative mean blood pressure (P = .168), and heart rate (P = .934) did not differ between Groups V and C. Watching the informational video about anesthesia before preanesthetic evaluation could reduce the interview time by an average of 24 seconds, with no difference in patients' or doctors' satisfaction or anxiety compared to patients who did not watch it. Video-assisted preanesthetic patient education indicates that the load on anesthesiologists can be reduced.

Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation

BackgroundMixed reality offers potential educational advantages in the delivery of clinical teaching. Holographic artefacts can be rendered within a shared learning environment using devices such as the Microsoft HoloLens 2. In addition to facilitating remote access to clinical events, mixed reality may provide a means of sharing mental models, including the vertical and horizontal integration of curricular elements at the bedside. This study aimed to evaluate the feasibility of delivering clinical tutorials using the Microsoft HoloLens 2 and the learning efficacy achieved.MethodsFollowing receipt of institutional ethical approval, tutorials on preoperative anaesthetic history taking and upper airway examination were facilitated by a tutor who wore the HoloLens device. The tutor interacted face to face with a patient and two-way audio-visual interaction was facilitated using the HoloLens 2 and Microsoft Teams with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor completed the System Usability Scale, the tutor, technical facilitator, patients, and students provided quantitative and qualitative feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.ResultsTwelve patients and 78 students participated across 12 separate tutorials. Five students did not complete the examinations and were excluded from efficacy calculations. Student feedback contained 90 positive comments, including the technology’s ability to broadcast the tutor’s point-of-vision, and 62 negative comments, where students noted issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. The technology and tutorial structure were viewed favourably by the tutor, facilitator and patients. Significant improvement was observed between students’ pre- and post-tutorial MCQ scores (mean 59.2% Vs 84.7%, p < 0.001).ConclusionsThis study demonstrates the feasibility of using the HoloLens 2 to facilitate remote bedside tutorials which incorporate holographic learning artefacts. Students’ examination performance supports substantial learning of the tutorial topics. The tutorial structure was agreeable to students, patients and tutor. Our results support the feasibility of offering effective clinical teaching and learning opportunities using the HoloLens 2. However, the technical limitations and costs of the device are significant, and further research is required to assess the effectiveness of this tutorial format against in-person tutorials before wider roll out of this technology can be recommended as a result of this study

Understanding acupuncture anesthesia from a foreign perspective： reviewing Acupuncture Anesthesia in the People's Republic of China.

"Acupuncture Anesthesia in the People's Republic of China： A Trip Report of the American Acupuncture Anesthesia Study Group" (Report for short) is the first extraterritorial systematic investigation and evaluation report in the history of acupuncture anesthesia in China. After Report was released to the public, it has not drawn much attention in China. At the moment when acupuncture anesthesia is extended to perioperative treatment, by reviewing the Report, the differences in understanding acupuncture anesthesia were analyzed from a foreign perspective. Report involves the clinical observation of surgery under acupuncture anesthesia, the analysis on the factors of acupuncture anesthesia in therapeutic effects and the relevant mechanisms, and the differences in the research methods and foci on the recognition of acupuncture anesthesia between China and foreign countries. In association with the development of acupuncture anesthesia during the past 65 years and the conclusion in Report, the paper briefly describes the development and perfection of acupuncture anesthesia, the historical verification to the conclusions in Report and the limitations in modern acupuncture anesthesia. It provides some inspiration for the development of acupuncture anesthesia, acupuncture-moxibustion medicine and life science in the future.

A Study on Pre-clinical Anaesthesia Elective in Shaping Medical Students&amp;apos; Knowledge and Career Perspectives

Anesthesiology stands out as one of the rapidly growing and highly competitive medical specialties, necessitating students to cultivate an interest in anesthesia early and prepare extensively for clinical electives. Pre-clinical electives that introduce students to anesthesia and ready them for clinical settings in the early stages of their academic journey may confer benefits and enhance their competitiveness as residency applicants. This study implemented an eight-week pre-clinical elective titled &amp;quot;The History of Anesthesia&amp;quot; for first- and second-year students at Baylor College of Medicine. Eighty-eight students participated in the elective, with thirteen completing both pre-course and post-course surveys. The survey, consisting of thirteen questions related to anesthesia interest and relevant clinical knowledge, was analyzed, and statistical significance was calculated. The survey results demonstrated significantly elevated levels of self-assessed knowledge in the post-course survey compared to the pre-course survey (p &amp;lt; .05). Notably, topics considered more clinically relevant, such as modern anesthetic techniques, regional anesthesia, and obstetric anesthesia, exhibited significantly higher average survey results in the post-course compared to the pre-course results. The implementation of pre-clinical electives focusing on success in clinical settings appears beneficial for students aspiring to apply to an anesthesiology residency. Institutions should consider exposing students to anesthetic topics earlier in their academic journey to adequately prepare them for the competitive residency application process.

Spinal epidural abscess mimicking chloroma

Background: Spinal epidural abscess (SEA) is a rare and generally challenging condition. It represents a challenge in terms of diagnosis and treatment due to the low incidence, vague presentation, and rapid neurologic deterioration. Case Presentation: A 40-year-old gentleman who was previously healthy was presented with a 2-week history of decreased vision associated with fever and cough one week before the eye symptoms. The patient was admitted as a case of acute promyelocytic leukemia. And was started on chemotherapy, which was complicated by septicemia and was shifted to the intensive care unit. Three weeks after admission he started to have severe non-radicular neck pain. He also had bilateral lower limb pain spasm-like in nature. Patient denies any history of trauma, weakness, numbness, saddle anesthesia or loss of sphincter control. Labs showed leukopenia, anemia and thrombocytopenia. Bone marrow result showed hypercellularity with active trilineage hematopoiesis and no immunomorphological evidence of abnormal promyelocytes or maturation arrest. He underwent C3-C4 laminectomy and evacuation of epidural pus collection. Intra-operative course was free of complication. Upon post-operative assessment he was hemodynamically stable, his neck pain was better with morphine doses and he was able to mobilize it. Conclusion: Spinal epidural abscess can mimic chloroma clinically and radiologically, however, diffusion with the images and enhancement is essential for proper assessment since a proper medical and surgical intervention is needed.

Anesthesia management in a patient who diagnosed with brugada syndrome in third preoperative evaluation

Brugada Syndrome (BS) is a rare genetic disease that can be fatal with malignant arrhythmias. It has been stated that drugs, which are frequently used in anesthesia practice, electrolytic or autonomic imbalance, fever, and infections can trigger cardiac arhythm and sudden cardiac death even in asymptomatic patients. Here we describe a patient who diagnosed with Brugada Syndrome in third preoperative evaluation. A 60-year-old male patient was scheduled for an infected knee prosthesis. The patient's preoperative laboratory findings were normal except for ECG changes. There was ST segment elevation in V1 and V2 leads in the ECG. The patient was consulted with the cardiology clinic and was evaluated as Brugada Syndrome ECG type 1. There is no consensus regarding the application and technique of anesthesia for these patients. We decided to apply general anesthesia because we could provide better hemodynamic stabilization. The patient was transferred to the intensive care unit. There were no adverse events observed during the anesthetic management and discharged from the hospital on the second postoperative day. We emphasize the importance of detailed preoperative evaluation each time, even in patients with a known anesthesia history.

A brief history of anaesthesia in South Africa

No abstract available.

The Impact of Local Pressure on Needle Puncture Pain Severity During Spinal Anesthesia in Patients with Elective Surgery Under Spinal Anesthesia: A Randomized, Single-Blinded, Controlled Clinical Trial

Background: Spinal anesthesia is one of the most common and safest methods of anesthesia. However, a challenge for patients who are candidates for spinal anesthesia is the pain caused by inserting the spinal needle. It seems possible to reduce needle pain with local pressure, based on the gate control theory in spinal anesthesia. Objectives: This clinical trial aims to evaluate the effect of applying local pressure on the intensity of pain caused by needles during spinal anesthesia. Methods: In this study, 120 adult patients aged 18 - 50 who were scheduled for elective surgery under spinal anesthesia and had an American Society of Anesthesiologists (ASA) I-III were randomly assigned to the control and intervention groups. In the intervention group, just before inserting the spinal needle, a local pressure of about 5 kg using the thumb was applied to the skin at the needle insertion point for 15 seconds. The control group received routine anesthesia. The severity of needle pain was compared between the two groups using the verbal rating scale (VRS) tool. Results: The incidence of mild pain in the intervention and control groups was 78.7% and 60%, respectively. Also, the control group experienced higher levels of moderate and severe pain compared to the intervention group. In addition, patients in the control group had a higher chance (odds ratio (OR): 3.4, 95% confidence interval (CI): 1.5 - 7.8, P = 0.039) of experiencing moderate to severe pain compared to the intervention group. Pain intensity was significantly lower in patients with a spinal anesthesia history (P = 0.028). Conclusions: Our findings showed that applying local pressure on the skin before inserting a spinal needle can effectively reduce pain during spinal anesthesia. However, further studies with a larger sample size are necessary to confirm the effects of applying local pressure to reduce needle pain during spinal anesthesia.

Incidence and risk factors associated with negative postoperative behavioral changes in children undergoing painless gastroscopy

ObjectiveTo investigate the incidence of and risk factors associated with negative postoperative behavioral changes (NPOBCs) in children undergoing painless gastroscopy.MethodsInclusion criteria: ASA I–II and outpatients aged 6–12 years undergoing painless gastroscopy. Exclusion criteria: history of surgery or anesthesia, children with developmental or intellectual abnormalities, refusal to participate, preoperative abdominal pain score > 3 points, history of chronic abdominal pain of > 3 months duration, and serious intraoperative complications. On the 1st, 14th, and 30th day after the gastroscopy, the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) was used to assess NPOBCs in children.ResultsA total of 1,670 children were included in this prospective observational cohort study. The incidence rates of NPOBCs were 14.13%, 4.55%, and 2.14% on the 1st, 14th, and 30th day after gastroscopy, respectively. The risk factors for the first day were female sex (OR 1.34, 95% CI 1.00–1.79), parental anxiety (OR 2.23, 95% CI 1.75–3.12), and severe anxiety in children (OR 2.83, 95% CI 1.96–4.07). The risk factors on the 14th day were parental anxiety (OR 3.71, 95% CI 2.19–6.29), a parental educational level above high school (OR 1.65, 95% CI 1.00–2.70), and severe anxiety in children (OR 11.87, 95% CI 5.85–24.07). The risk factors on the 30th day were female sex (OR 2.99, 95% CI 1.41–6.34), being an only child (OR 4.42, 95% CI 2.18–8.95), a parental educational level above high school (OR 2.66, 95% CI 1.27 NPOBCs 5.56), and severe anxiety in children (OR 6.84, 95% CI 2.84–16.49).ConclusionIn children undergoing painless gastroscopy, the incidence rates of NPOBCs on the 1st, 14th, and 30th day were 14.13%, 4.55%, and 2.14%, respectively. The risk factors for NPOBCs were severe anxiety in children, female sex, parental anxiety, and a parental educational level above high school. In particular, severe preoperative anxiety in children was a persistent risk factor for NPOBCs within 30 days.

A Brief History of Anesthesia in Somaliland.

A Brief History of Anesthesia in Somaliland.

2023 Anesthesia History Association Annual Spring Meeting

Article| April 2023 2023 Anesthesia History Association Annual Spring Meeting ASA Monitor April 2023, Vol. 87, e3. https://doi.org/10.1097/01.ASM.0000925040.05684.a3 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation 2023 Anesthesia History Association Annual Spring Meeting. ASA Monitor 2023; 87:e3 doi: https://doi.org/10.1097/01.ASM.0000925040.05684.a3 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: oklahoma, recreation, tourism We welcome you to the 2023 Anesthesia History Association Annual Spring Meeting, to be held in Oklahoma City, Oklahoma, from Thursday, April 20 through Saturday, April 22! This year's event is sure to be a great one with a variety of speakers and activities. In addition to learning about the history of anesthesia, you will also be exposed to some of the history of the state of Oklahoma. Register now at ahahq.com/2023-annual-meeting to secure your spot! We look forward to seeing you there. Hotel accommodations information Colcord Hotel (colcordhotel.com) 15 North Robinson Avenue Oklahoma City, Oklahoma 73102 (405) 601-4300 Book your reservations now (asamonitor.pub/3GQnhPc). You do not currently have access to this content.

2023 Anesthesia History Association Annual Spring Meeting

Article| March 2023 2023 Anesthesia History Association Annual Spring Meeting ASA Monitor March 2023, Vol. 87, 34. https://doi.org/10.1097/01.ASM.0000922048.86953.da Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation 2023 Anesthesia History Association Annual Spring Meeting. ASA Monitor 2023; 87:34 doi: https://doi.org/10.1097/01.ASM.0000922048.86953.da Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: oklahoma, recreation, tourism We welcome you to the 2023 Anesthesia History Association Annual Spring Meeting, to be held in Oklahoma City, Oklahoma, from Thursday, April 20 through Saturday, April 22! This year's event is sure to be a great one with a variety of speakers and activities. In addition to learning about the history of anesthesia, you will also be exposed to some of the history of the state of Oklahoma. Register now at ahahq.com/2023-annual-meeting to secure your spot! We look forward to seeing you there. Hotel accommodations information Colcord Hotel (colcordhotel.com) 15 North Robinson Avenue Oklahoma City, Oklahoma 73102 (405) 601-4300 Book your reservations now (asamonitor.pub/3GQnhPc). You do not currently have access to this content.

Evaluating patients' choice of general and spinal anesthesia for elective cesarean section and associated factors: a descriptive study.

In this descriptive study, pregnant women who had the ability to undergo both spinal and general anesthesia were referred to public and private hospitals in (Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences). A questionnaire recorded the patient's demographic data, education and occupation, history of anesthesia, choice of anesthetic method, and reason for selection. A total of 384 women were included in the study, of whom 60% selected general anesthesia and 40% selected spinal anesthesia. Among the reasons for not choosing spinal anesthesia, most common were fear of injury to the spinal cord (64.3%) and fear of seeing and hearing during the surgery (53.3%), and among the reasons for not choosing general anesthesia, most common were fear of not waking (54.3%) and a desire to be alert at the time of infant birth (40.7%). Most of the women with a history of spinal anesthesia selected spinal anesthesia (53%), and 62% of those without a history of spinal anesthesia selected general anesthesia. Factors such as age, nonmedical staff advice, and being employed were significantly correlated with the choice of anesthesia (P<0.005). The rate of general anesthesia selection was higher than spinal anesthesia. More attention and efforts are required to educate patients regarding the method of anesthesia prior to the surgery.

The history of pediatric anesthesia

The beginnings of pediatric anesthesiology go back to the middle of the 19th century and it is associated with a rural physician Crawford W. Long, MD, who in the 1842 recorded the first case of giving diethyl ether anesthesia to an eight-year-old boy. The start of development of contemporary pediatric anesthesia is considered to be in 1930, which marked two periods of progress. In the first period, anesthesia techniques and accessories adjusted to different children?s ages were developed. In the second period, modern anesthetic medications and supervision were introduced into everyday clinical practice in order to better protect vital organs and their functions in the child?s body. The first multidisciplinary pediatric intensive care unit at the Children?s Hospital of Gothenburg in Sweden was established in 1955. Dr. Branka Mitrovic is considered to be the founder of pediatric anesthesiology in Serbia, as she founded the Department of Anesthesiology and Reanimation at the University Children?s hospital in 1955. The history of pediatric regional anesthesia began after its introduction in adults, which occurred after the invention of cocaine in 1884. The Ministry of Health of the Republic of Serbia approved a specialization in pediatric anesthesiology in 2018. The development of pediatric anesthesia is fascinating because it completely followed the development of pediatric surgery. Modern pediatric anesthesiology is entirely prepared to meet the needs of the most complex surgical interventions, as well as the treatment of critically ill children, and significantly contributes to better treatment outcomes of pediatric surgical patients.

History of local anesthesia

The history of local anesthesia involves three separate inventions: the pharmacological agent, the local anesthetic, the syringe, and the hollow needle. Each evolved separately and has its history. They were assembled for the first time in 1827 as a syringe with a needle, and in 1884, in combination with cocaine as the first anesthetic injected locally. This is part of the Encyclopedia of the History of Dentistry.

Comparison among complications of common intravenous anesthetic drugs during general anesthesia for patients undergoing surgery in Sulaimani city

Background: A portion of patients exhibit subsequent cognitive impairment, including memory deficits, after undergoing anesthesia. Despite the wide use and long history of anesthesia, the mechanisms of action that cause loss of consciousness and some of the side-effects, such as temporary amnesia, are not understood. Methodology: A descriptive cross-sectional study was conducted among patients undergoing surgery in Sulaimani city, and involved 368 patients. Data, in form of questionnaire, have been collected between October 15, 2021 to February 15, 2022. (SPSS) Version 22 was used to analyzed the data. Results: In this study, 185 (50.3%) were males and 183 (49%) were females, respiratory problem in the form of apnea found in (30.3%) of patients who received (propofol, fentanyl, atracurium) compared to (6.4%) of those patients who received (propofol, (ketamine and fentanyl), atracurium) this difference was significant (P-value < 0.001), (30.3%) of patients who received (propofol, fentanyl, atracurium) (5.4%) of patients who received (thiopental, fentanyl, atracurium) and p value (< 0.001). (28.7 %) of patients who received (propofol, fentanyl, atracurium) recovered late compared to (2.3 %) of patients who received (propofol, (ketamine and fentanyl), atracurium) the difference was significant (P-value < 0.001). systolic blood pressure dropped to below 120 mmhg in (64%) patients and diastolic blood pressure dropped to below 80 mmhg in (62.8%) of patients, who received (propofol, (ketamine and fentanyl), atracurium) and compared to systolic blood pressure that dropped to below 120 mmhg in (74.3%) of patients (74.3%) of patients and diastolic blood pressure dropped to below 80 mmhg in (74.3%) of patients who received (Thiopental, fentanyl, atracurium), the differences were significant (P-value < 0.001). Finally, SpO2 level of (24.3%) of patients, who received (Propofol, (ketamine and fentanyl), atracurium), dropped to below 95% while the SpO2 level of (8.2 %) of patients who received (propofol, fentanyl, atracurium), dropped to below 95% whereas the SpO2 level of (74.3%) of patients, who received (Thiopental, fentanyl, atracurium), dropped to below 95%, these differences were significant with (P-value < 0.001). Conclusion: this study concluded that (propofol, fentanyl, atracurium) can cause respiratory problem in the form of apnea and delay recovery more than the other two sets of anesthetic drugs, while (Thiopental, fentanyl, atracurium) have effect on lowering SpO2 level more than the others sets of anesthetic drugs.

Evaluating the Safety of Transcarotid Artery Revascularization under Local Anesthesia Prior to Coronary Artery Bypass Grafting Surgery

Controversy exists regarding the timing of intervention for patients with critical coronary artery disease awaiting coronary artery bypass and severe carotid artery stenosis. Transcarotid artery revascularization (TCAR) is a minimally invasive revascularization alternative through direct transcervical carotid access that minimizes the chance of arch manipulation and consequent antegrade embolic stroke rate. While the TCAR procedure can be performed under local anesthesia (monitored anesthesia care, MAC) vs general anesthesia, the hemodynamic benefits of local anesthesia in patients with severe CAD are significant. Patients receiving staged TCAR-CABG have high-risk cardiovascular disease and require accurate perioperative neurological and hemodynamic evaluation that can be safely provided with local anesthesia. In this retrospective single-center study, 14 patients were systematically identified to have undergone staged TCAR prior to CABG surgery from December 2018 to October 2021. All patients underwent TCAR with local anesthesia and minimal sedation. Relevant patient demographics, medical and surgical history, preoperative covariates, and type of anesthesia administered were obtained from patients' charts. Carotid artery disease was confirmed by either carotid duplex imaging or computed tomography angiography (CTA) of the head/neck. Staged TCAR-CABG interventions were performed on 14 patients (64% male; mean age 65.0 years). No major adverse cardiac events were reported including transient ischemic attack (TIA), stroke, myocardial infarction, or TCAR-related death in the interval between their TCAR and CABG as well as in a 12-month follow-up period. One patient required to return to the operating room (OR) for evacuation of a neck hematoma. This study demonstrated high success rate of TCAR under local anesthesia prior to CABG (100%) with no incidence of perioperative stroke, myocardial infarction (MI), or death at 1-month, 6-month, and 12-month follow-up intervals. The authors support the use of staged TCAR-CABG with local anesthesia as a safe and promising treatment option for patients with high-grade cardiac disease, high risk of stroke, or multiple comorbidities that preclude a CEA.

Preoperative Optimization of the Asthmatic Patient

Introduction. Asthma is a common upper respiratory condition among patients across the developmental spectrum. The condition is estimated to affect over 300 million people worldwide with prevalence rate and condition severity continually increasing.1 With such a high prevalence rate worldwide, it is common to encounter asthmatic patients in need of elective surgery.1 Bronchospasm is a common pathophysiologic feature of asthma. During a bronchospasm, the smooth muscle of the airway contracts and narrows the diameter of the airway.1 As a result, a significant impedance to airflow can result. The obstruction to airflow makes ventilation difficult if not impossible. Patients who experience intraoperative bronchospasm are at increased risk for postoperative morbidity and mortality.1 Given the severe implications of intraoperative bronchospasm, the anesthetic care of the asthmatic patient should focus on preoperative assessment and optimization in order to mitigate the risk of intraoperative bronchospasm and postoperative pulmonary complications. The purpose of pursuing this topic is to educate anesthesia providers about the complications resulting from intraoperative bronchospasm and to provide guidelines for preventing bronchospasm during the surgical period. Case presentation. A recent case of intraoperative bronchospasm involved a 77-year-old, female, ASA 4 inpatient. The patient had significant medical history including asthma and COPD. The scheduled procedure was a closed reduction of the left hip with percutaneous pinning. During the preoperative assessment the patient was identified, the planned procedure and surgeon were confirmed, all allergies and medications were reviewed, medical and anesthetic history were reviewed, and a physical exam was conducted. During the preoperative interview the patient confirmed a history of reactive airway disease, but reported that her asthma was well-controlled with current medications and denied any recent exacerbations. The patient did not receive any preoperative medications other than analgesics for pain control. The patient was taken to the operating room for surgery and was preoxygenated prior to anesthetic induction. The patient was induced with IV propofol, fentanyl, and lidocaine. Succinylcholine was subsequently administered to achieve optimal conditions for intubation. The patient was successfully endotracheally intubated and sevoflurane administered for anesthetic maintenance. Prior to incision, the ventilator alarms were triggered by high peak pressures and low tidal volumes. Manual ventilation was initiated, but was found to be difficult, leading to a progressive oxygen desaturation. As bronchospasm was suspected, albuterol was administered endotracheally. The patient responded well to the bronchodilator, ventilation became easier, and the oxygen saturation improved. Once the patient was stabilized, the hip surgery continued without further incident. However, at the conclusion of the surgery and just prior to emergence, the patient experienced another severe bronchospasm. Again, albuterol and epinephrine treatment were initiated until the patient respiratory status stabilized again. The patient remained intubated and was transferred to ICU to allow for further pulmonary stabilization prior to extubating. Discussion. A literature review was conducted on the anesthetic management of the asthmatic patient undergoing surgery. The current literature emphasizes the importance of comprehensive assessment and pharmacologic optimization of the asthmatic patient during the preoperative period as the most efficacious method for reducing poor post-operative pulmonary outcomes. Bronchodilatory beta 2 adrenergic agents such as albuterol or salbutamol effectively reduce the incidence of intraoperative bronchospasm. The findings suggest that the intraoperative problems related to bronchospasm encountered in the presented case may have been avoidable. As discussed, the prevalence of asthma is significant among surgical patients. With a high number of asthmatic patients receiving general anesthesia for surgery, prevention of intraoperative bronchospasm is important for improving outcomes among this patient population. Based on the current literature, the recommendation for practice would be to preoperatively treat all asthmatic patients, regardless of the perceived severity of their asthma, with a bronchodilatory agent prior to surgery in an effort to reduce the incidence of intraoperative bronchospasm. Future research on the topic should consider the costs associated with added length of hospital stay and additional treatment following an intraoperative bronchospasm. Prevention of an asthma exacerbation during the preoperative period is likely the most cost-effective approach to managing a patient with reactive airway disease. Keywords Bronchodilators, bronchospasm, asthma, optimization