Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

Abstract

Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

Desflurane but not sevoflurane can increase lung resistance via tachykinin pathways †

“…In addition to acetylcholine, parasympathetic efferent nerve also releases vasoactive intestinal peptide and nitric oxide, which can inhibit bronchoconstriction. 29 We still do not know the role of these substances on the partial inhibition of the first peak of R L in the vagotomy study. Although our study was focused on the vagal nerve control of lung resistance, there is evidence that desflurane can activate sympathetic nerves, 30 resulting in the inhibition of airway smooth muscle contraction.…”

Perioperative lung protection

“…According to a Japanese review of guideline-oriented management, this includes control of airway hyperresponsiveness and infection, and the aggressive use of anticholinergics in COPD and beta-2 adrenergic stimulants in asthma, as well as steroids, to limit acute exacerbations. This review also found that preoperative control with leukotriene antagonists can reduce the incidence of PCC [16]. …”

Bronchospasm triggered by spinal anaesthesia. Case report and review of the literature

“…2 In contrast, lung physiology abnormalities are minimal, despite the fact that the blockade obtained reaches thoracic levels. 4 Specifically in asthmatic patients, there appears to be a lower risk of bronchospasm under regional anaesthesia compared to general anaesthesia, the main goal being the elimination of neural reflexes caused by intubation which have been found to give rise to the contraction of the smooth muscles of the tracheobronquial tree. However, bronchospasm following spinal anaesthesia is extremely rare in healthy patients as well as in patients with bronchial disease.…”