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Anesthesia and ventilation strategies in children with asthma: part II – intraoperative management

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

Current Opinion in Anesthesiology: June 2014 - Volume 27 - Issue 3 - p 295–302
doi: 10.1097/ACO.0000000000000075

Purpose of review As asthma is a frequent disease especially in children, anesthetists are increasingly providing anesthesia for children requiring elective surgery with well controlled asthma but also for those requiring urgent surgery with poorly controlled or undiagnosed asthma. This second part of this two-part review details the medical and ventilatory management throughout the perioperative period in general but also includes the perioperative management of acute bronchospasm and asthma exacerbations in children with asthma.

Recent findings Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk reduction strategies. Mainly, animal experiments and to a small extent clinical data have advanced our understanding of how anesthetic agents effect bronchial smooth muscle tone and blunt reflex bronchoconstriction. Asthma treatment outside anesthesia is well founded on a large body of evidence.

Perioperative prevention strategies have increasingly been studied. However, evidence on the perioperative management, including mechanical ventilation strategies of asthmatic children, is still only fair, and further research is required.

Summary To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, perioperative management should be based on two main pillars: the preoperative optimization of asthma treatment (please refer to the first part of this two-part review) and – the focus of this second part of this review – the optimization of anesthesia management in order to optimize lung function and minimize bronchial hyperreactivity in the perioperative period.

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, WA 6008, Australia. Tel: +61 8 9340 8109; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.