Anaesthetic management in asthma

Abstract

Anaesthetic management in asthmatic patients has been focused on avoiding bronchoconstriction and inducing bron chodilation. However, the definition of asthma has changed over the past decade. Asthma has been defined as a clin ical syndrome characterized by an inflammatory process that extends beyond the central airways to the distal airways and lung parenchyma. With this concept in mind, and knowing that asthma is a common disorder with increasing preva lence rates and severity worldwide, a rational choice of anaesthetic agents and procedures is mandatory. Thus, we pur sued an update on the pharmacologic and technical anaesthetic approach for the asthmatic patient. When feasible, region al anaesthesia should be preferred because it reduces airway irritation and postoperative complications. If general anaesthesia is unavoidable, a laryngeal mask airway is safer than endotracheal intubation. Lidocaine inhalation, alone or combined with albuterol, minimizes histamine-induced bronchoconstriction. Propofol and ketamine inhibit bron choconstriction, decreasing the risk of bronchospasm during anaesthesia induction. Propofol yields central airway dilation and is more reliable than etomidate or thiopental. Halothane, enflurane, and isoflurane are potent bron chodilators and can be helpful even in status asthmaticus. Sevoflurane has shown controversial results in asthmatic patients. Vecuronium, rocuronium, cisatracurium, and pancuronium do not induce bronchospasm, while atracurium and mivacurium can dose-dependently release histamine and should be cautiously administered in those patients. Further knowledge about the sites of action of anaesthetic agents in the lung, allied with our understanding of asth ma pathophysiology, will establish the best anaesthetic approach for people with asthma.