Management of the Obstetric Patient with Status Asthmaticus

Elsayegh, Dany; Shapiro, Janet

doi:10.1177/0885066608324295

Cited by 35 publications

(10 citation statements)

References 34 publications

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“…Women whose asthma does not respond to or worsens despite maximal bronchodilator therapy in the emergency or hospital setting should be considered for ICU admission [ 23 ]. A series of five cases of status asthmaticus in pregnancy was reported from an inner city hospital in New York, NY, USA, in 2008 [ 24 ]. Three cases occurred early in pregnancy (6 weeks, 9 weeks and 14 weeks gestation), with the other two later in pregnancy (27 weeks and 28 weeks gestation).…”

Section: Asthma Exacerbations and Healthcare Utilisation During Pregnmentioning

confidence: 99%

Managing asthma in pregnancy

Murphy

2015

Breathe

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Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis.Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (FeNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according to FeNO and added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice.Key pointsAsthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy.Educational aimsTo identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.

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Section: Asthma Exacerbations and Healthcare Utilisation During Pregnmentioning

confidence: 99%

Managing asthma in pregnancy

Murphy

2015

Breathe

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“…Ventilation of the lungs used a low respiratory rate, a volume assist-control mode, and inhaled b2 agonists; patients were sedated with propofol and fentanyl and some received neuromuscular blocking agents. 65 Methods of bronchodilation have different approaches in different countries. In Australia and New Zealand, there have long been advocates of the i.v.…”

Section: Discussionmentioning

confidence: 99%

Inhaled and intravenous treatment in acute severe and life-threatening asthma

Sellers

2013

British Journal of Anaesthesia

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Management of life-threatening acute severe asthma in children and adults may require anaesthetic and intensive care. The inhaled route for drug delivery is not appropriate when only small respiratory gas volumes are shifted; the i.v. route may be associated with greater side-effects. Magnesium sulphate i.v. has a place in acute asthma management because it is a mild bronchodilator, and has a stabilizing effect on the atria which may attenuate tachycardia occurring after inhaled and i.v. salbutamol. If intubation and ventilation are required, a reduction in bronchoconstriction by any means before and during these procedures should reduce morbidity. This narrative review aims to show strengths and weakness of the evidence, present controversies, and forward opinions of the author. The review contains a practical guide to the setting up, use and efficiency of nebulizers, metered dose inhalers, and spacers (chambers). It also presents a commonsense approach to the management of severe asthmatics in whom delay in bronchodilatation would cause clinical deterioration. When self-inhaled agents have had no effect, i.v. drugs may help avoid intubation and ventilation. The review includes suggestions for the use of inhaled anaesthetics, anaesthetic induction, and brief notes on subsequent ventilation of the lungs.

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“…The effect of asthma on maternal and fetal with asthma aggravations include: low birth weight, preterm labor and delivery, preeclampsia, hyperemesis gravidarum, oligohydramnios, congenital malformations, gestational diabetes, high risk of cesarean section, and perinatal mortality. These complications were thought to associate with recurrent hypoxia particularly in poorly controlled asthma [43].…”

Section: Status Asthmaticusmentioning

confidence: 99%

Recent Updates and Guidelines in Anesthetic Management of Obstetric Emergencies

Hamoda

Rahman

Khashaba

et al. 2019

Benha Journal of Applied Sciences

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The pregnant mother is subjected to major changes in her anatomy and physiology to can feed and accommodate the growing baby. Such changes initiate subsequently after gestation have an influence on body organs. It is essential to discriminate between normal physiological changes and pathological changes. The anesthetist is considered a substantial part in the management of risky pregnancies, and must be a member of the multidisciplinary team who is assigned to concern for seriously ill parturient. Considerations must be taken to physiological modifications during treatment. The aim of this work is to highlight the risk factors and etiology of obstetric emergencies and how to manage them based on recent updates and guidelines.

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Management of the Obstetric Patient with Status Asthmaticus

Cited by 35 publications

References 34 publications

Managing asthma in pregnancy

Managing asthma in pregnancy

Inhaled and intravenous treatment in acute severe and life-threatening asthma

Recent Updates and Guidelines in Anesthetic Management of Obstetric Emergencies

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