Intraoperative bronchospasm
-
Upload
selva-kumar -
Category
Health & Medicine
-
view
746 -
download
0
Transcript of Intraoperative bronchospasm
![Page 1: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/1.jpg)
BRONCHOSPASM DURING INDUCTION
WHAT SHALL I DO..?
![Page 2: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/2.jpg)
PRAY GOD THAT THIS SITUATION DOESN’T ARISE….
![Page 3: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/3.jpg)
IN WHICH PATIENTS IT CAN OCCUR..?
BRONCHIAL ASTHMA
COPD
URI – esp IN CHILDREN
SMOKERS
Non allergic etiology – 79%Allergic cause - 21%
![Page 4: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/4.jpg)
IN WHICH SITUATIONS IT CAN OCCUR…?
UNDER PREPARED PATIENTS WITH WHEEZING
GASTRIC ASPIRATION
LIGHTER PLANE – PREMATURE ATTEMPT
ANAPHYLAXIS
![Page 5: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/5.jpg)
HOW TO DIAGNOSE….?
TIGHT BAG
FALLING OXYGEN SATURATION
FALLING EtCO2 LEVEL
NORMAL/REDUCED/NO CHEST MOVEMENT
WHEEZE / NO BREATH SOUNDS
![Page 6: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/6.jpg)
HOW TO DIAGNOSE..?
COVER - WESTHORPE
C1 – COLOUR, CUTANEOUS MANIFESTATION FOR ALLERGYC2 – CAPNOGRAPHYO1 – LOW SpO2, CHECK ROTA METER,O2 SOURCEV1 - VENTILATION BY HAND, OBSERVE COMPLIANCE AND AUSCULTATEV2- CHECK VAPORISER FOR FLUID LEVEL, GAS LEAKSE1 – CHECK E.T.TE2 – EQUIPMENT RELATED CAUSESR1 – REVIEW ALL MONITORS
![Page 7: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/7.jpg)
WHY BRONCHOSPASM IS FEARED..?
The narrowing of airway is so much that air entry sometimes become impossible….
![Page 8: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/8.jpg)
1.Rapid de-saturation2.Increasing airway resistance3.Worsening lung compliance4.Decreased venous return5.Falling cardiac output6.Severe hypotension and collapse
![Page 9: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/9.jpg)
WHAT SHOULD BE DONE..?
ASSESS THE SITUATION
![Page 10: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/10.jpg)
ASSESSING THE SITUATION:ELECTIVE SURGERY:
MILD SPASM SEVERE SPASM
TREAT & PROCEEDTREAT AND POSTPONE THE SURGERY
CONSIDER EXTUBATION
![Page 11: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/11.jpg)
EMERGENCY SURGERY
MILD SPASM SEVERE SPASM
TREAT AND PROCEEDWITH THE SURGERY
ASSESSING THE SITUATION:
![Page 12: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/12.jpg)
HOW TO TREAT…?100% OXYGEN – Switch to Bain circuit
INHALED β2 AGONIST –Salbutamol Nebulizer, metered dose inhaler5 mg ( 5ml of 0.5%) or 8 to 10 puffs
INTRAVENOUS DRUGS – ETOPHYLLINE?AMINOPHYLLINE
STEROIDSMethyl prednisolone ( 1 mg / kg)
NEBULISED IPRATROPIUM 0.5 mg in 5 ml
![Page 13: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/13.jpg)
How to attach the nebuliser to the Breathing circuit….?
![Page 14: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/14.jpg)
A simple way of attaching the nebulizer circuit if T adaptor is not available….
![Page 15: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/15.jpg)
TREATMENT – contd….
Whether to deepen the anaesthesia withinhalational agent or lighten the patient..?
![Page 16: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/16.jpg)
STABLE HAEMODYNAMICS:
Give Halothane/isoflurane/sevoflurane
If spasm is severe- go for intravenous anaestheticsketamine/propofol
TREATMENT – contd…
![Page 17: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/17.jpg)
TREATMENT – contd….
ROLE OF ADJUVANTS:
oKETAMINE – 10 -20 mg bolus , 1to 3mg/kg/hour
oMAGNESIUM – 50 mg/kg to a maximum of 2G
oXYLOCARD – 100mg bolus
o? ADRENALINE – useful in anaphylaxis
Consider extubation in resistant cases as a treatment modality….
![Page 18: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/18.jpg)
![Page 19: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/19.jpg)
HOW TO PREVENT SPASM DURING INDUCTION..?
NO ELECTIVE SURGERY IN A PATIENT WITH WHEEZE
ADEQUATE PREPARATION
STOP SMOKING
IF POSSIBLE – SELECT REGIONAL ANAESTHESIA
ROLE OF STEROIDS
44% of bronchospasm incidence occur during intubation – Westhorpe et al
![Page 20: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/20.jpg)
HOW TO PREVENT SPASM DURING INDUCTION..?GIVE A GOOD PRE-MEDICATIONALWAYS USE ATROPINE/GLYCOPYROLATEANXIOLYTICS IN THE WARD OXYGEN SUPPLEMENTATIONINDUCTION- SMOOTH BY USING LIBERAL DOSESWITCH ON INHALATIONAL AGENT FROM THE BEGINNINGUSE XYLOCARD?XYLOCAINE SPRAYPROPOFOL or KETAMINE INDUCTION
![Page 21: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/21.jpg)
HOW TO PREVENT SPASM DURING MAINTENANCE…?
REGIONAL ANAESTHESIA WITH G.A
CONSIDER SIMPLE NERVE BLOCKS
WOUND INFILTRATION
ADEQUATE ANALGESIA
36% bronchospasm incidence occur during maintenance phase - Westhorpe
![Page 22: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/22.jpg)
HOW TO PREVENT SPASM DURING EXTUBATION..?
Tricky situationIf the type of surgery permits,
deeper plane of extubationXylocard, low dose ketamineGood post-operative analgesia and
oxygenation
The rest of 20% of cases occur during this phase of anaesthesia
![Page 23: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/23.jpg)
Summary:Bronchospasm during induction can occur because of 2 reasons
1.Non-allergic airway hyperreactivity 2.As a part of anaphylactic syndrome
Needs urgent intervention as the vitals will deteriorate rapidly
A systematic approach helps in the early diagnosis
Inhalational β2 agonists is the mainstay of treatment
![Page 24: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/24.jpg)
Summary..:
In resistant cases, adjuvants like ipratropium, magnesium have a role to play
As lighter plane of anaesthesia triggers spasm, patient has to be in deeper plane
Inhalational agents like halothane,sevoflurane possess broncho-dilating property
Adequate preparation, good analgesia and depth of anaesthesia help in avoiding this situation
![Page 25: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/25.jpg)
Concluding…..
Prevention is better than cure
![Page 26: Intraoperative bronchospasm](https://reader036.fdocuments.us/reader036/viewer/2022062412/58e766031a28ab5b2a8b61e1/html5/thumbnails/26.jpg)
Thank you
dr.r.selvakumarprofessor of anaesthesiologyk.a.p.viswanatham govt medical collegetrichy