Asthma (Adult Patients)

• Etiology/Risk Factors [72]
  • Tobacco
  • Smoking
  • Air pollutants
  • Genetics
  • Stress
  • Obesity
• Pathophysiology
  • Acute inflammation and narrowing of conducting airways characterized by reversible airway obstruction
    • Hypoxia
    • Hypercarbia
  • ↓ Forced expiratory flow
• Treatment
  • β₂ receptor agonists
  • Corticosteroids
  • Cromolyn
  • Leukotriene receptor antagonists, e.g. Montelukast, Zileuton
  • Anticholinergics
  • Antihistamines
• Primary Concerns
  • Perioperative adverse respiratory event especially in uncontrolled asthma increases anesthesia risk [73]
  • Intraoperative bronchospasm and/or laryngospasm
• Evaluation
  • Consider pulmonologist consult in moderate–severe cases
  • PFTs rarely required
  • Assess for level of control
    • Medication use
    • Triggers
    • Frequency of rescue inhaler use
    • Hospitalizations/ED visits
    • Use of oral steroids
  • Smoke exposure [74]
  • Recent URI
  • Baseline pulse oximetry
  • Symptoms
    • Wheezing
    • Dyspnea
    • Chest discomfort
• Anesthesia Management
  • Continue bronchodilators and corticosteroids
    • Consider stress dose (page 108)
  • Consider preoperative albuterol
  • Consider anticholinergic in patients who can tolerate tachycardia to dry secretions and decrease parasympathetic airway constriction
  • Volatile agents are bronchodilators
    • Avoid desflurane [75]
  • Carefully monitor ETCO₂ (Figure 6.27)
  • Consider IV lidocaine or LTA prior to intubation to reduce bronchoconstriction [76]
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