| Popis: |
Optimal perioperative care requires and understanding of anesthetic techniques and agents and their pertinence to the care of the asthmatic patient. Airway management and potential triggering of bronchospasm requires careful selection of the type of airway utilized during intraoperative care requiring general anesthesia. The selection of anesthetic agents that induce and maintain anesthesia, as well as the perioperative method of analgesia, will bear on the extent to which asthma is exacerbated or quiescent during the perioperative period. Regional anesthesia is an option for care of the asthmatic undergoing surgery; however any patient undergoing a regional technique of anesthesia may, during the intraoperative course, require general anesthesia. For this reason, even patients undergoing regional anesthesia must have been optimized to limit asthmatic symptoms and signs to assure optimal outcome. Preoperative preparation is essential for optimal perioperative care of the asthmatic patients. All intraoperative wheezing is not necessarily caused by asthma, or even bronchospasm; incorrect endotracheal tube position, secretions in the airway, and other factors must be considered. Acute bronchospasm occurs during general anesthesia and may require specific intervention, including correction of airway management, administration of bronchodilators during anesthesia, adjustment of the inhaled agents and depth of anesthesia, and occasionally the intraoperative administration of intravenous steroids. Postoperative management of asthma entails post anesthesia care unit, intensive care unit, and ward care requiring interaction of anesthesiologist, primary care providers, respiratory therapist, nursing personnel, and sometimes specialty consultation. Inadequate reversal of muscle relaxation, in conjunction with asthma exacerbation is to be avoided because the mechanical weakness of muscles of respiration, in concert with bronchospasm, is acutely debilitating. Emergency intubation of the asthmatic patient will require expert airway management and the administration of pharmacologic agents to maintain stability of the patient during this crisis. Special circumstances sometimes indicate the use of inhalation anesthesia for management of the most refractory cases of status asthmaticus. |
