Asthma Flashcards
List the clinical manifestations of asthma.
Dyspnea, eosinophilia, nonproductive or productive cough,
wheezing, chest tightness
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 182.
Define status asthmaticus.
Status asthmaticus is a life-endangering bronchospasm that is
unresponsive to treatment.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 186.
What are the two components to the treatment of
asthma?
- Treatments that aim to “control” the airway so that acute
airway narrowing is less frequent. This treatment includes
theophylline, systemic and inhaled corticosteroids, and
antileukotrienes. 2. Treatments that aim to “relieve” or rescue
acute bronchospasm, such as beta-adrenergic agonists and
anticholinergic drugs.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 185.
What are the three main characteristics of asthma?
Asthma is characterized by reversible expiratory airflow
obstruction, airway hyperreactivity, and chronic inflammation of
the airways.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 361.
Describe the treatment for status asthmaticus.
Inhaled or nebulized Beta-2 agonists are given repeatedly every
15-20 minutes, supplemental O2 is given to help maintain an
oxygen saturation greater than 90%, and IV corticosteroids are
administered. Due to the time it takes for corticosteroid effects
to be seen, they should be initiated early in the treatment of
status asthmaticus.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 186.
What is the difference between extrinsic and intrinsic
asthma?
Intrinsic asthma is caused by factors such as placement of an
endotracheal tube, inhalation of irritants, exposure to cold, and
exercise. Extrinsic asthma is due to triggers that activate the
immune system such as inhaling allergens that stimulate the
release of IgE antibodies.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice.
What are the two most common arterial blood gas
findings in the asthmatic patient?
Respiratory alkalosis and hypocarbia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 184.
The degree of expiratory airflow obstruction can be
directly measured by what two pulmonary function
tests?
The maximum mid-expiratory flow rate (FEF 25%-75%), and the
forced expiratory volume in 1 second (FEV1). Patients
necessitating hospitalization and treatment of asthma typically
present with maximum mid-expiratory flow rates of 20% or less
than normal and a FEV1 of less than 35% of normal.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 183.
What is the primary goal of the preoperative
evaluation in regards to the asthmatic patient?
To design an anesthetic that attenuates or prevents expiratory
airflow obstruction.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 186.
What undesirable effects can result from
administering anticholinergic medications to an
asthmatic patient?
Airway secretions can become more viscous, thus making their
removal more difficult
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 187.
What are some treatments for intraoperative
bronchospasms due to asthma?
Beta-2 agonist therapy, increasing the depth of anesthetic with
a volatile agent, corticosteroid administration.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 18
Why would a regional anesthetic be more desirable
than a general anesthetic in an asthmatic patient
undergoing surgery?
Manipulation of a hyperreactive airway is avoided, thus avoiding
bronchoconstriction.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 187.
Why would a deep extubation be advantageous in
the asthmatic patient?
Provided there are no contraindications to deep extubation,
removal of the endotracheal tube with deep anesthesia
decreases the risk for bronchospasm because airway reflexes
are suppressed.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 188.
What factors are associated with an increased risk
for perioperative complications due to asthma?
Excessive production of sputum, a prior history of asthmatic
complications during the perioperative peroid, continuous or
frequent corticosteriod use, recent ER visit or hospitalization
due to asthma, coexisting cardiovascular disease.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 362.
