Severe bronchospasm during epidural anaesthesia

Abstract

SummaryA case of severe bronchospasm occurring during epidural anaesthesia in a patient undergoing Caesarean section is described. The aetiology of the bronchospasm may have been related to sympathetic nervous blockade allowing unopposed parasympathetically mediated bronchoconstriction. Key wordsAnaesthetic techniques, regionae epidural. Complications; bronchospasm.Bronchospasm during anaesthesia is an undesirable, and sometimes serious, complication; it may be so intense that oxygenation of the patient becomes impossible and death may ensue. Bronchospasm is well described in the literature as a complication of general anaesthesia, but there has only been one case reported of its occurrence during spinal anaesthesia [l]. This case report details a patient who developed acute severe bronchospasm during epidural anaesthesia. Case historyA 38-year-old woman with a 10-year history of asthma presented for elective lower segment Caesarean section. Her past medical history included an emergency Caesarean section 7 years earlier, which was performed under general anaesthesia, and 2 years ago she underwent an elective Caesarean section under epidural anaesthesia without any complication.The current pregnancy had been uneventful and the patient's asthma was well controlled with only a mild wheeze which was treated with salbutamol tablets (4 mg three times daily). She was scheduled for elective lower segment Caesarean section because of previous surgery, cephalopelvic disproportion and possible intra-uterine growth retardation. The patient had agreed to the Caesarean being performed under epidural anaesthesia.Pre-operative examination was unremarkable, except for mild expiratory rhonchi. Pre-operative medication consisted of oral salbutamol4 mg on the night before and on the morning of the operation. Routine prophylaxis against pulmonary acid aspiration syndrome consisted of two doses of oral ranitidine 150 mg and 30 ml of 0.3 M sodium citrate.On arrival in the operating theatre, the patient appeared calm and relaxed. Patient monitoring included electrocardiograph, and noninvasive arterial pressure measurement (Dinamap). Baseline values were heart rate 90 beat.min-l, arterial blood pressure 130/80 mmHg and respiratory rate 16 breath.min-l. Auscultation of the chest revealed mild expiratory rhonchi. Whilst the epidural was being established the patient received 1 1 of compound sodium lactate solution. With the patient in the left lateral position, and using loss of resistance to saline, the epidural space at the L , , interspace was identified with a 18 G Tuohy needle. A lateral-eyed epidural catheter was inserted 4 cm into the space in a cephalad direction and 3 ml of 0.5% bupivacaine was injected as a test dose. After 5 min, and with no evidence of intrathecal or intravascular administration, a further 14 ml of bupivacaine mixed with fentanyl 50 pg was injected incrementally over 25 min. The onset of sensory block (analgesia to a 25 g short bevelled needle) was recorded. Bilateral loss of sensation at the T, dermatome lev...

Effects of high thoracic epidural anaesthesia on the peripheral airway reactivity in dogs

“…4) blockade on airway resistance are not well understood. It is generally believed that the development of severe bronchoconstriction during epidural anaesthesia is due to a blockade of the innervating sympathetic nerve to the lungs and/or a decrease in circulating adrenaline (1)(2)(3). This contrasts with our findings which demonstrated that the blockade of neural sympathetic outflow by epidural anaesthesia was not relevant to peripheral airway resistance, neither at rest nor during a bronchoconstrictive challenge in dogs.…”

Thoracic epidural analgesia started after cardiopulmonary bypass

“…Patients were not studied if they had ingested aspirin within the preceding 10 days, if they were receiving heparin or warfarin or if coagulation study results were outside the normal range. Obese patients (body mass index >30 kg.m -2 ) and those with neurological disease, poor left ventricular function (ejection fraction <40%) or reversible airways obstruction (which can be exacerbated by the use of high epidural blockade [9]) were also not studied. Baseline pre-operative respiratory function was determined the evening before surgery by respiratory spirometry (forced expired volume in 1 s: FEV 1 , forced vital capacity: FVC) and peak expiratory flow (PEF).…”

CARDIAC ARREST IN A POSTOPERATIVE CARE UNIT. LITERATURE REVIEW OF PULMONARY PERIOPERATIVE CRITICAL SITUATIONS - Paro cardiaco en unidad de cuidado postoperatorio. Revisión de la literaturade situaciones críticas pulmonares preoperatorias.

“…El propofol se considera es el agente de elección para la inducción de la anestesia en los asmáticos (39) , y la ketamina también tiene propiedades broncodilatadoras (40) . El uso de la anestesia regional no reduce las complicaciones postoperatorias pulmonares en asmáticos asintomáticos, mientras que es ventajoso en pacientes sintomáticos (41) . La terapia debe ser dirigida hacia la optimización de la oxigenación y el diagnóstico apropiado necesita ser establecido, dado que "no todo lo que sibila es asma".…”