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Anesthesia for the child with asthma or recurrent wheezing

Authors
Britta Regli-von Ungern-Sternberg, MD, PhD
Adrian Regli, MD
Section Editor
Andrew Davidson, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Asthma is a chronic inflammatory lung disease characterized by symptoms of cough, wheezing, dyspnea and chest tightness, partially or completely reversible airway narrowing, and increased airway responsiveness to a variety of stimuli. Increased airway responsiveness is also seen in children with recurrent acute wheezing due to causes other than asthma (eg, allergies, viral infections). Asthma and recurrent wheezing are common childhood illnesses; pediatric patients with these conditions commonly present for anesthesia and surgery and can pose challenges for the anesthesiologist. Children with these conditions are at increased risk for perioperative respiratory adverse events, including laryngospasm and bronchospasm.

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

This topic will discuss preoperative assessment and preparation of pediatric patients with asthma and recurrent wheezing, as well as intraoperative management. Evaluation and management of asthma in children is discussed in more depth separately. (See "Asthma in children younger than 12 years: Initiating therapy and monitoring control" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Virus-induced wheezing and asthma: An overview" and "Approach to wheezing in infants and children".)

PREOPERATIVE EVALUATION

When possible, we prefer to assess patients with asthma one to two weeks prior to elective surgery to allow time for modification of treatment, if necessary. The goal of preoperative preparation is optimization of therapy to reduce the risk of perioperative respiratory adverse events (PRAE).

Asthma severity and control — The history given by the patient or caregiver at the time of preoperative evaluation can help determine the severity and level of medical control of asthma and predict the likelihood of perioperative bronchospasm. Important historical points to emphasize during preoperative evaluation, in addition to a complete preoperative history, include:

                                  

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Literature review current through: Nov 2016. | This topic last updated: Tue Jan 05 00:00:00 GMT 2016.
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