Intraoperative Bronchospasm - Guidelines for Crises in Anaesthesia ❶ Call for help and inform theatre team of problem. ❷ Give 100% oxygen. ❸ Stop surgery / other stimulation. ❹ Fully expose the chest and perform a rapid systematic examination: • Inspect, percuss, palpate, auscultate. • Absence of wheeze may indicate severe bronchospasm with no air movement. ❺ Deepen anaesthesia: • Bronchospasm may be a consequence of light anaesthesia. • Inhalational anaesthetic agents are bronchodilators. • Avoid isoflurane or desflurane if possible – airway irritant if increased rapidly. ❻ Exclude malpositioned or obstructed tracheal tube or supraglottic airway • Consider whether there could be endobronchial or oesophageal intubation. ❼ If anaphylaxis suspected → 3-1 ❽ If airway soiling/aspiration suspected airway see Box A. ❾ Treat bronchospasm (Box B). First line is salbutamol by metered dose inhaler or by nebuliser; i.v. route is second line. Other drugs at clinician discretion. ❿ Consider alternate diagnoses causing or mimicking bronchospasm (Box C). ⓫ Use appropriate ventilation strategy (Box D). ⓬ If raised airway pressure and/or desaturation persists, consider → 2-2 Hypoxia/desaturation/cyanosis. ⓭ Obtain a chest X-ray as soon as clinically safe to do so. ⓮ Plan appropriate placement for post-procedure care. Drugs: Salbutamol, Ipratropium, Adrenaline, Magnesium, Ketamine, Aminophylline, Hydrocortisone By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
