Anesthesia and the child with asthma

Doherty, Gary M.; Chisakuta, A M; Crean, Peter; Shields, Michael

doi:10.1111/j.1460-9592.2005.01602.x

Cited by 115 publications

(40 citation statements)

References 97 publications

(86 reference statements)

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“…1,3,13,14 A history of at least two family members having asthma, atopy, or smoking increases the risk for perioperative respiratory adverse events. 15 A personal history of eczema has been also considered significant in this sense.…”

Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

Update on Perioperative Management of the Child with Asthma

2012

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Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

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Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

Update on Perioperative Management of the Child with Asthma

2012

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“…Other options include intravenous magnesium or increasing concentrations of volatile anesthetics. Children who have anything other than minor bronchospasm should also receive corticosteroids if they have not already done so (22).…”

Section: Treatment Of Intraoperative Bronchospasmmentioning

confidence: 99%

Anesthesia in Children with Asthma and Rhinitis

Franceschini

Benedictis

Peroni

et al. 2011

Int J Immunopathol Pharmacol

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The incidence of asthma is increasing worldwide, but morbidity and mortality are decreasing, because of improvements in medical care. Although the incidence of severe perioperative bronchospasm is relatively low in asthmatics undergoing anaesthesia, when it does occur it may be life-threatening. Preoperative assessment of asthma should include a specialized medical hystory and physical examination as well as pulmonary function testing. Potential trigger agents should be identified and avoided. In many asthmatic patients treatment with systemic corticosteroids and bronchodilators is indicated to prevent the inflammation and bronchocostriction associated with endotracheal intubation. Nonetheless, acute bronchospasm can still occur, especially at induction and emergence, and should be promptly and methodically managed.

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“…The importance of evaluation of the relationship between asthma severity and asthma control is essential, particularly in children undergoing surgical procedure. In fact, inadequate control may lead to misinterpretation of either slight (even if symptomatic) or severe (even if well-controlled) asthma 52 .…”

Section: Preoperative Assessment Of Asthmatic Patientsmentioning

confidence: 99%