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Anesthesia Patients With Asthma

Pre-operation / Pre-anesthesia Assessment
History about whether patients had received previous anesthesia is very important to know if there are things that need special attention, for example: allergies, nausea, vomiting, itching or shortness of breath after the surgery, so that we can design the next anesthetic well.
Physical examination
State of dentition examination, action open mouth, the tongue is relatively large is very important to know whether the action would make it difficult laryngoscopy intubation. Another routine systemically check about the general course should not be missed such as inspection, palpation, percussion and auscultation of all organ systems of patients. Examination of inspection, palpation, percussion and auscultation on the cardiopulmonary system is a major clinical examination of much help in the assessment of asthma. With this examination can be known frequency of breathing, respiratory pattern, presence of wheezing / ronchi.
ECG examination
In addition to knowing about the state / heart disease, especially the picture ECG can also determine the influence of lung function.
Radiological examination
Includes images of the thorax and CT-scan (if necessary). This examination is not to assess lung function disorders but it is important for supporting the diagnosis of pulmonary disease, signs of lung hyperinflation and congestive heart disease, also to help determine abnormalities in the mediastinal cavity (CT-scan).
Laboratory examination
Include routine blood tests, blood gas analysis of blood sugar.
Pulmonary Physiology Tests
  • Without tools: although simple but can provide information on respiratory function and are useful as an assessment of "fronss for operation" such as the ability to climb stairs without shortness of breath while talking. Snider match test: the ability to hold breath for 30 seconds.
  • Using a spirometer.

Physical Status Classification
Classification is commonly used to assess a person's physical fitness is derived from The American Society of Anaesthesiologist (ASA). Physical classification is not a forecasting tool ratio of anesthesia, because the side effects of anesthesia can not be separated from the side effects of surgery.
  • Class I   : Patients healthy organic, physiological, psychiatric, biochemistry.
  • Class II  : Patients with mild or moderate systemic disease.
  • Class III : Patients with severe systemic disease, so that routine activities are limited.
  • Class IV : Patients with severe systemic disease can not perform routine activities and the disease is life threatening at any moment.
  • Class V  : dying patient who is expected with or without surgery her life would not be more than 24 hours
  • In Cito or emergency surgery is usually imprinted letter E.

Pre-Operative Preparation
Laryngeal reflexes decreased during anesthesia. Regurgitation of gastric contents and impurities contained in the airway is a major risk in patients undergoing anesthesia. To minimize this risk, all patients scheduled for elective surgery should dipantangkan of oral input (fasting) during a certain period before induction of anesthesia.

Perioperative Management
For anesthesia and elective surgery in patients with a history of asthma, then asthma should be controlled and the patient was not suffering from an infection or severe wheezing attacks. If a patient takes medication on a regular basis, then the drug should not be stopped. Particular attention should be given pad of patients who use steroids, systemically or by inhaler.
Bronchospasme may be induced by anxiety, pain, drugs, endotracheal intubation, foreign body or irritation. Drugs that are contraindicated are: tubocurarrine and anticolinesterase, Sodium thiopental (Pentothal™), morphine, papaverin, trimethaphan and beta blockers.
Many drugs that can be used as a premedication such as diazepam, pethidine, promethazine and atropine, an estimated free from bronchospatic activity. Bronchodilator and steroid therapy is continued.

Anesthesia Techniques
Whenever possible, choose regional anesthesia with continuous epidural block with a low of 1% lidocaine (analgesia only) so that the respiratory muscles are not disrupted.
If general anesthesia is required then given premedication with antihistamines such as promethazine together with hydrocortisone 100 mg. What is important to avoid laryngoscopy and intubation with a shallow anesthesia, because it can cause bronchospasm. Ketamine is good enough for intravenous induction, because it is a bronchodilator. For a brief action, you should use a face mask after induction techniques and avoid intubation. Use of oxygen with a concentration of 30% or more for air inspiration. If intubation is required, then deepened with inhalation anesthesia, and then do the intubation without muscle relaxants. In the anesthetized patient in laryngoscopy can be done without causing bronchospasm when intubated. Vecuronium may be administered as a muscle relaxant is good because it does not release histamine. Ether and halothane is bronchodilator good, but ether has the advantage, that is if there is bronchospasm, epinephrine (0.5 mg subcutaneously) can be administered safely (but this is dangerous if given in conjunction with halothane or trichlorethylene, because it can cause heart rhythm disturbances due to effects of catecholamines). As an alternative to epinephrine, aminophylline 250 mg can be administered intravenously slowly to mature; drug is compatible with all inhaled medication.
At the end of the action when using intubation, extubation done on his side and with anesthesia in, because stimulation of the larynx can cause bronchospasm.

Post Operative Care
Provision of adequate analgesia postoperative care is vital. Adequate oxygenation. Maintenance intravenous fluids. Usually anti-asthma drugs are still needed. Form of steroid drugs given intravenously as a temporary substitute for oral medications and inhalers brochodilator nebulizer as a substitute if the patient can not breathe in, or not yet maximal lung function after surgery. In the event of failure of achieving adequate ventilation and oxygenation after surgery, the patient to go to Intensive Care Unit (ICU).

Tags : Anesthesia and Asthma, Anesthesia With Asthma, Ketamine and asthma,

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