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Bronchospasm represents the clinical manifestation of bronchial muscles contraction resulting in reduced alveolar air flow. Non-allergic mechanisms or anaphylaxis underlie the genesis of perioperative bronchospasm, a potential anaesthetic disaster. Early recognition and treatment are crucial. We report a rare incident of anaphylactic bronchospasm without hypotension during general anaesthesia. Urticaria appeared in chest and abdomen suggesting anaphylaxis. After the event resolved with bronchodilators, surgery continued uneventfully. Vecuronium was the most probable culprit but confirmation was not possible as the patient was lost to follow up. Rarely, perioperative anaphylaxis presents only with bronchospasm that requires prompt attention to avoid adverse outcome.

Background/Aim. Bronchial asthma is a disease that is characterized by the variability of the clinical picture, physical and functional status and the existence of bronchial hypersensitivity and hyperreactivity with varying degrees. Bronchial responsiveness and sensitivity are tested in patients with clinically suspected existence of asthma and normal spirometry test. The aim of the study was to analyze the patients with atopic asthma and study test results of skin sensitization to inhaled allergens, nonspecific bronchial hyperreactivity and specific hyperreactivity estimated by bronchial provocation tests with inhalant allergens. Methods. The prospective study at the Pulmonology Clinic of the Military Medical Academy in Belgrade Serbia, during 2014, included 70 male subjects aged 18–30 years, who had perennial asthma symptoms. All subjects were nonsmokers, with normal spirometry findings, with normal radiological chest findings and with no symptoms of respiratory infection over the past two months. All respondents were tested with skin prick tests with inhalant allergens and nonspecific bronchial provocation test with histamine. On the basis of histamine test, subjects were divided into two groups: the group I, in which there was a slight degree of hypersensitivity [provocation concentration of histamine causing a 20% fall in forced expiratory volume – PC20 = 6.09 ± 1.1 mg/mL], and the group II with negative histamine test (PC20 = 14.58 ± 6.34 mg/mL). Specific bronchial provocation test was performed in all patients, and the selection of the allergens was carried out based on the results of testing of skin hypersensitivity. Results. Results of skin sensitization show the highest incidence of mites Dermatophagoides pterronissinus (83.3% group I and 85.0% group II) followed by grass pollen (53.3% group I and 52.0% group II), and house dust (33.3% group I and 50.0% group II). There were no statistically significant differences in allergens between groups (p > 0.05). In both groups, spirometry findings were within normal values [forced vital capacity – FVC and forced expiratory volume 1 – FEV1 > 80% predictive value], but statistically significant difference was found in FEV1 between groups (p < 0.05). Specific bronchial provocation tests with solutions of inhaled allergens in both groups caused a significant decline in FEV1 (≥ 20%) in all patients individually. No statistically significant differences were found neither between groups, nor between individual allergens (average decline in FEV1: Group I 32.9 ± 2.4% and group II 31.5 ± 2.2%). Conclusion. There is no relationship between the degree of specific and non-specific bronchial hyperreactivity in patients with allergic asthma.

Fatal anaphylactic reactions to protamine sulfate during cardiac surgery are very rare. We report a case of catastrophic bronchial spasm due to an anaphylactic reaction to protamine. The patient was managed successfully using a bronchodilator, steroid treatment, and extracorporeal membrane oxygenation.

Rocuronium is the anesthetic agent most likely to cause anaphylaxis. Immediately after intravenous rocuronium administration, the authors experienced ventilatory impairment due to unilateral bronchospasm (left lung), which was relieved by emergency treatment. However, 80 minutes after beginning laparoscopic surgery for rectal cancer, the left lung suddenly re-collapsed under pneumoperitoneum in the Trendelenburg position. A postoperative intradermal test revealed that rocuronium, vecuronium, atracurium, succinylcholine, or thiopental could induce anaphylaxis in this patient, but it was not established whether the second incident during surgery was due to endobronchial intubation or anaphylactic bronchospasm. This case cautions that under pneumoperitoneum in the Trendelenburg position, patients suspected of being prone to anaphylactic bronchospasm should also be considered at risk of endobronchial intubation.

OBJECTIVE: Evaluate whether exhaled nitric oxide may serve as a marker of intraoperative bronchospasm. INTRODUCTION: Intraoperative bronchospasm remains a challenging event during anesthesia. Previous studies in asthmatic patients suggest that exhaled nitric oxide may represent a noninvasive measure of airway inflammation. METHODS: A total of 146,358 anesthesia information forms, which were received during the period from 1999 to 2004, were reviewed. Bronchospasm was registered on 863 forms. From those, three groups were identified: 9 non-asthmatic patients (Bronchospasm group), 12 asthmatics (Asthma group) and 10 subjects with no previous airway disease or symptoms (Control group). All subjects were submitted to exhaled nitric oxide measurements (parts/billion), spirometry and the induced sputum test. The data was compared by ANOVA followed by the Tukey test and Kruskal-Wallis followed by Dunn's test. RESULTS: The normal lung function test results for the Bronchospasm group were different from those of the asthma group (p

Abstract This simulation is designed for junior anesthesia trainees to experience the physiological repercussions of a pediatric patient with significant bronchospasm during a general anesthetic. The simulation functions as a tool for training, evaluating, and reinforcing material learned in the classroom and operating room. Trainees with different backgrounds and experiences can utilize this simulation module for further learning about the complications of pediatric anesthesia. This supplemental simulation-based learning module allows for training that reduces patient risk by giving learners a chance to become aware of the condition before treating a real patient, is observable and repeatable, and allows for the freedom to make mistakes and reflect upon different actions in the future. The module includes an instructor's guide, the simulation scenarios, a technical guide, a debriefing document, and an evaluation form. The scenario is used for practice, evaluation, and self-identification of weaknesses in the learner's knowledge base in regard to perioperative management of the pediatric patient. Several anesthesia residents participated in this scenario, with frequent revisions and updates made based on feedback. In our simulation center, we expect to run these scenarios about 15 times annually for our CA-1 class, although in other institutions where pediatric anesthesia rotations are done later in training, the scenarios may be used for more senior trainees.

Background: Cardiovascular and respiratory effects of adrenergic agonists used in diseases like chronic obstructive pulmonary disease (COPD), and β-blockers used in glaucoma generate competitive antagonism on the same adrenergic receptor when used simultaneously with the aggravation that the β-blockers can precipitate bronchospasm. Objective: Determine de frequency of coprescription and potential risk of interaction between bronchodilators and topical antiglaucomatous β-blockers for glaucoma in a database of Colombian patients. Methods: Cross-sectional study in patients older than 40 years treated for bronchial disorders and glaucoma between January 1 and October 31, 2012. We used information about 6.2 million population database of individuals enrolled in Health System of Colombia. In the database it was assessed all prescription records of topical β-blockers and any bronchodilators and the frequency of potential risk of developing drug-induced bronchospasm. The identified patients were informed to the physician responsible to the health attention. Results: We found 1756 patients were receiving topical β-blockers and bronchodilators. Most were women (63.2 %), mean age 73.3 ± 11.1 years, in 61 cities. The antiglaucoma drugs more employees were: timolol (67.5 % of patients), timolol/dorzolamide (18.8 % of patients) and bronchodilators: salbutamol (43.8 % of patients) and ipratropium (41.8 % of patients). The more frequent risk associations of bronchospasm were: salbutamol + timolol (n = 890, 50.6 % of patients), ipratropium bromide + timolol (n = 827, 47.1 %) salbutamol + timolol + dorzolamide (n = 258, 14.6 % of patients) and ipratropium bromide + timolol + dorzolamide (n = 255, 14.5 % of patients). Conclusions: The database research of Negative Outcomes Associated with Medication is useful to know problems in prescription of many therapies. There are potential interactions between antiglaucoma drugs and bronchodilators that increase the risk of precipitating bronchospasm in patients who present asthma, COPD and glaucoma in Colombia. Implementing strategies that link drug dispensers and medical insurers can reduce risks associated with the medication.

En esta revisión bibliográfica se presentan los factores que contribuyen a la hiperreactividad de las vías aéreas durante la anestesia. Se presenta una actualización de las acciones de los agentes anestésicos empleados en nuestro medio, así como el tratamiento utilizado en esta complicación. El objetivo fundamental es ofrecer a los anestesiólogos, los elementos necesarios para una mejor conducción anestésica de los pacientes con hiperreactividad de las vías aéreas. Se enfatiza además en la importancia de las medidas preventivas y en el tratamiento inmediato que permita contrarrestar esta complicaciónThose factors contributing to hyperreactivity of the airways during anesthesia are presented in this bibliographic review. An updating is made of the action of the anesthetics used in our setting and the treatment given to this complication is explained. The main objective is to provide anesthesiologists with the necessary elements for a better anesthetic conduction of the patients with hyperreactivity of the airways. It is underlined the importance of taking preventive actions and of immediate treatment to face this complication