Management of Perioperative Bronchospasm

Abstract

Bronchospasm is an anesthetic emergency that can lead to disastrous outcomes if not treated promptly. An anesthetist must immediately initiate treatment if bronchospasm is suspected in order to avoid negative sequelae. The aim of this Essay is to identify the causes of bronchospasm in the perioperative period and provide methods for their early detection and management. Contractions of airway smooth muscle caused by a variety of neurotransmitters, autacoids, and hormones can cause severe bronchospasm, and so preventing entirely gas exchange and threatening the life of the individual and conversely, other neurotransmitters, autacoids, and hormones can reverse or prevent maximal contractions of airway smooth muscle, restoring airway patency and thus preserving lung capacity for gas exchange. The manifestations of bronchospasm during anaesthesia include expiratory wheeze, prolonged expiration and increased inflation pressures during intermittent positive pressure ventilation (IPPV).However, in cases of severe bronchospasm, the chest may be silent on auscultation and the diagnosis is based on the presence of increased inflation pressures. Bronchospasm may appear alone or as component of another problem such as anaphylaxis. Wheeze may occur not only due to bronchospasm but may be heard with misplacement of the endotracheal tube (in the esophagus or a bronchus) and with pulmonary edema or acute respiratory distress syndrome (ARDS). Increased inspiratory pressures may occur not only with any of these conditions but with obstruction of the natural or an artificial airway or of any component of the breathing circuit (including any respiratory filters) and decreased compliance of the lung (for example, with atelectasis) or chest (for example; haemopneumothorax, fentanyl induced rigidity).