Bronchospasm Flashcards
What is bronchospasm?
Reversible spasm of the bronchial smooth muscle resulting in narrowing of the airways.
What are the clinical features of bronchospasm?
wheezing increased airway pressures decreased pulmonary compliance hypoxemia hypercarbia
What is the differential diagnosis for bronchospasm?
pulmonary aspiration laryngospasm pulmonary edema pulmonary embolism/fat embolism/AFE PTX anaphylaxis/anaphylactoid reaction ETT obstruction/endobronchial intubation
What is the management of bronchospasm?
maintain oxygenation and ventilation
listen to the chest
pass suction catheter down ETT to r/o kinking
deepen anesthesia (if not hypotensive)
administer inhaled beta 2 agonist
consider iv bronchodilator therapy
consider anticholinergic therapy
steroids are indicated for acute asthma but onset is slow
alter vent settings to decrease risk of airtrapping and barotrauma
consider possibility of status asthmaticus
What medications would you use initially for bronchospasm?
Increased anesthetic depth–>propofol
Inhaled beta-2 agonist–>albuterol 4 - 20 puffs/hr
If bronchospasm severe what IV medications would you use?
albuterol 5 mcg/kg over 20 minutes isoproterenol 1 - 3 mcg/min epinephrine 2 - 8 mcg/min atropine 20 mcg/kg glycopyrrolate 10mcg/kg IV
What anticholinergics could you give via inhalation to treat severe asthma?
ipratropium MDI 4 - 8 puffs q 15 min
atropine 2mg nebulized
glycopyrrolate 1mg nebulized
What steroid and dose would you use to treat acute asthma?
methylprednisolone 40mg IV q6hr
How would you adjust the ventilator settings in someone with bronchospasm?
adjust I:E ratio and RR to maximize expiratory time (start with rate 6 - 8/min)
maintain PIP < 50 cm H20
pressure control ventilation will allow for greater inspiratory flow, which permits a longer expiratory time and decreased dynamic hyperinflation
allow mild-moderate hypercapnia in order to achieve the above
How would you treat if the bronchospasm proves intractable to normal interventions (i.e., status asthmaticus)?
prolonged ventilation with isoflurane
heliox
ECMO if unable to adequately oxygenate
What dose of isoproterenol would you use to treat severe bronchospasm?
1 - 3 mcg/min IV
What dose of epinephrine would you use to treat severe bronchospasm?
2 - 8 mcg/min
What dose of atropine would you use to treat severe bronchospasm?
20 mcg/kg IV or 2mg via nebulizer
What dose of glycopyrrolate would you use to treat severe bronchospasm?
10mcg/kg IV or 1mg via nebulizer
What dose ipratropium would you use to treat severe bronchospasm?
4 - 8 puffs q 15 minutes
