Perioperative management of patients with asthma during elective surgery: A systematic review

Bayable, Samuel Debas; Melesse, Debas Yaregal; Lema, Girmay Fitiwi; Ahmed, Seid Adem

doi:10.1016/j.amsu.2021.102874

Cited by 17 publications

(11 citation statements)

References 28 publications

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“…The results of regression analysis showed that COPD is one of the independent risk factors for PPCs. This is consistent with previous studies [ 32 , 33 ]. Elderly patients over 70 years old who undergo thoracic surgery often have multiple comorbidities.…”

Section: Discussionsupporting

confidence: 94%

Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study

Feng,

Jia,

Zhao

et al. 2024

BMC Surg

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Background The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. Methods The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. Results 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. Conclusion Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.

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Section: Discussionsupporting

confidence: 94%

Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study

Feng,

Jia,

Zhao

et al. 2024

BMC Surg

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“…The proposed mechanisms for volatile anesthetics include activating the β-adrenergic receptors, inhibiting acetylcholine and histamine release, and directly depressing airway reflexes and inducting bronchial smooth muscle relaxation that reverses the underlying airway bronchoconstriction [ 46 , 48 ]. Halothane, isoflurane, and enflurane are effectual bronchodilators and can be used in patients with status asthmaticus; however, sevoflurane has revealed controversial results in asthmatic patients [ 49 , 50 ]. Furthermore, halothane, isoflurane, and sevoflurane are asthmatic surgical patients’ best induction and maintenance agents [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…Halothane, isoflurane, and enflurane are effectual bronchodilators and can be used in patients with status asthmaticus; however, sevoflurane has revealed controversial results in asthmatic patients [ 49 , 50 ]. Furthermore, halothane, isoflurane, and sevoflurane are asthmatic surgical patients’ best induction and maintenance agents [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

General Anesthesia in Early Childhood Significantly Reduces Asthma Incidence and Clinical Visits: A Nationwide Population-Based Cohort Study

Yang

Chang

et al. 2023

Children

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Few studies have focused on the consequence of exposure to general anesthesia (GA) in children’s early life with the risk of asthma and disease outcomes. The present study examines the correlation between exposure to GA under three years old and the subsequent course of asthma in a nationwide population-based cohort study. Our cases were acquired from Taiwan’s National Health Insurance Research Database (NHIRD). Children under three years old with either GA exposure or not during in-patient treatment from 1997 to 2008 were included. The study group was age- and sex-matched with a ratio of 1:2 to create the control group for comparison. The cohort included 2261 cases with GA and 4522 cases without GA as a control group. The incidence of asthma onset was significantly reduced in patients with GA exposure under 3 three years old (hazard ratio 0.64 (95% confidence interval 0.57~0.72), p < 0.001). In addition, regardless of whether the asthmatic clinical visits were before or after GA exposure, asthma onset patients before GA exposure have significantly fewer clinical visits than those without GA exposure (both p < 0.001, respectively). Using the Kaplan–Meier method, we also demonstrated that GA exposure was associated with favorable clinical visits in patients with asthma, whether their asthma was onset before GA (p = 0.0102) or after GA exposure (p = 0.0418) compared to non-GA-exposed controls. In the present study, we demonstrated that children with early GA exposure under three years old were at a reduced risk of developing asthma compared to the general population. Furthermore, we first reported that GA exposure significantly reduced clinical visits in patients with asthma regardless of whether their asthma onset was before or after GA exposure. It is indicated that GA exposure at a younger age could have potential clinical benefits for asthma than non-GA-exposed controls.

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“…If the rescue is not timely, the condition can easily evolve into hypoxic-ischemic encephalopathy and even cardiac arrest. Silent lung generally has 2 causes: (I) airway hyperresponsiveness, such as a history of asthma, chronic obstructive pulmonary disease, smoking, respiratory tract infection ( 3 ); (II) perioperative trigger factors, including the stimulation of endotracheal intubation, irritant inhalation anesthetics (e.g., desflurane), the stimulation of airway secretions and blood, histamine releasing drugs (e.g., muscle relaxants and morphine), non-steroidal anti-inflammatory drugs, and cholinesterase inhibitors (e.g., neostigmine). Another cause of silent lung is severe bronchospasm caused by an allergic reaction ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Successful adrenaline treatment of perioperative severe bronchospasm combined with a silent lung: two case reports

Liu

Hong

Peng

et al. 2022

Transl Cancer Res TCR

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Background Silent lung is a rare and potentially fatal disease. It is a critical sign of strong bronchospasm or extensive mucus plug blockage, which can result in the obvious weakening of breathing sounds or even disappearance of breathing sounds. Silent lung has an acute onset and rapid progress, which seriously threatens the life of patients. It needs early diagnosis, timely and effective treatment to reverse the persistent severe bronchospasm of patients. If not handled in time, silent lung can cause rapid onset of severe hypoxemia, hypoxic brain injury, and even cardiac arrest. Few studies have been reported on the causes and specific treatments for silent lungs. Case Description We report 2 rare cases of silent lung in this article and summarize the pathogenesis, inducing factors, clinical manifestations of perioperative silent lung. We also review the literature and discuss our solutions and propose other possible solutions for the treatment of silent lung emergencies in clinical settings in order to provide reference for clinical practice of anesthesiologists. Of the patients, 1 displayed a sudden decrease in ventilation volume, an increase in airway resistance, and was changed to pure oxygen. The manual ventilation failed, and there was no fluctuation of the thorax and no respiratory sound during auscultation. Cardiopulmonary resuscitation (CPR) was initiated when cardiac arrest was imminent after hypoxia. The other patient had high airway resistance after anesthesia-induced endotracheal intubation, could not be ventilated, and the carbon dioxide (CO 2 ) waveform at the end of breathing disappeared. Conclusions Both patients had severe bronchospasm; that is, silent lung. The 2 patients improved after hand-controlled ventilation and the administration of adrenaline and methylprednisolone, and ultimately recovered ventilation.

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Perioperative management of patients with asthma during elective surgery: A systematic review

Cited by 17 publications

References 28 publications

Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study

Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study

General Anesthesia in Early Childhood Significantly Reduces Asthma Incidence and Clinical Visits: A Nationwide Population-Based Cohort Study

Successful adrenaline treatment of perioperative severe bronchospasm combined with a silent lung: two case reports

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