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Anesthesia for adult patients with asthma

Author
Jeffrey B Dobyns, DO
Section Editor
Roberta Hines, MD
Deputy Editors
Nancy A Nussmeier, MD, FAHA
Helen Hollingsworth, MD

INTRODUCTION

Asthma is a chronic lung disease characterized by inflammation and narrowing of the airways, resulting in reversible airflow obstruction. The incidence and severity of asthma are high and increasing. Asthmatic patients often present for surgery and anesthesia and can pose challenges for the anesthesiologist, especially when endotracheal intubation is required.

Wheezing can happen at any time during anesthesia, most commonly during induction of general anesthesia after endotracheal intubation. If it occurs, it is usually transient and treated without sequelae. However, bronchospasm can be severe and may result in significant morbidity or even mortality.

This topic will discuss preoperative assessment and preparation of adult patients with asthma and intraoperative management. Evaluation and management of asthma is discussed in more depth separately. (See "An overview of asthma management" and "Diagnosis of asthma in adolescents and adults" and "Treatment of moderate persistent asthma in adolescents and adults" and "Treatment of intermittent and mild persistent asthma in adolescents and adults" and "Treatment of severe asthma in adolescents and adults" and "Treatment of acute exacerbations of asthma in adults".)

PREOPERATIVE EVALUATION

Timing and goals — We assess patients with asthma at least one week prior to elective surgery to allow time for modification of treatment, if necessary, especially for those patients who are scheduled for procedures with a high risk of postoperative pulmonary complications. Postoperative pulmonary complications are most common following thoracic surgery, upper abdominal surgery, open aortic aneurysm repair, neurosurgery, and surgery on the head and neck [1,2]. (See "Strategies to reduce postoperative pulmonary complications in adults".)

The goal of preoperative preparation is optimization of therapy to reduce the risk of perioperative pulmonary complications. Risk of such complications in well-controlled asthmatics is low, whereas poorly controlled asthma increases such risk [3,4]. The asthmatic patient should not be wheezing at the time of surgery.

                                 

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 01 00:00:00 GMT+00:00 2016.
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