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Anesthesia and ventilation strategies in children with asthma: part I – preoperative assessment

Regli, Adriana,b,c; von Ungern-Sternberg, Britta S.b,d

Current Opinion in Anesthesiology: June 2014 - Volume 27 - Issue 3 - p 288–294
doi: 10.1097/ACO.0000000000000080
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Purpose of review Asthma is a common disease in the pediatric population, and anesthetists are increasingly confronted with asthmatic children undergoing elective surgery. This first of this two-part review provides a brief overview of the current knowledge on the underlying physiology and pathophysiology of asthma and focuses on the preoperative assessment and management in children with asthma. This also includes preoperative strategies to optimize lung function of asthmatic children undergoing surgery. The second part of this review focuses on the immediate perioperative anesthetic management including ventilation strategies.

Recent findings Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk factors in the patient's (family) history that aid the preoperative identification of at-risk children. Asthma treatment outside anesthesia is well founded on a large body of evidence. Optimization and to some extent intensifying asthma treatment can optimize lung function, reduce bronchial hyperreactivity, and minimize the risk of perioperative respiratory adverse events.

Summary To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, a good understanding of the underlying physiology is vital. Furthermore, a thorough preoperative assessment to identify children who may benefit of an intensified medical treatment thereby minimizing airflow obstruction and bronchial hyperreactivity is the first pillar of a preventive perioperative management of asthmatic children. The second pillar, an individually adjusted anesthesia management aiming to reduce perioperative adverse events, is discussed in the second part of this review.

aDepartment of Intensive Care, Fremantle Hospital

bSchool of Medicine and Pharmacology, The University of Western Australia

cSchool of Medicine, The University of Notre Dame

dDepartment of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia

Correspondence to Professor Britta von Ungern-Sternberg, Chair of Pediatric Anesthesia, Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA 6008, Australia. Tel: +61 8 9340 8109; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.