Westhorpe R N, Ludbrook G L, Helps S C
Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia.
Qual Saf Health Care. 2005 Jun;14(3):e7. doi: 10.1136/qshc.2002.004457.
Bronchospasm in association with anaesthesia may appear as an entity in its own right or be a component of another problem such as anaphylaxis. It may present with expiratory wheeze, prolonged exhalation or, in severe cases, complete silence on auscultation.
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for bronchospasm, in the diagnosis and management of bronchospasm occurring in association with anaesthesia.
The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by anaesthetists involved.
There were 103 relevant incidents among the first 4000 AIMS reports, 22 of which were associated with allergy or anaphylaxis. Common presenting signs, in addition to wheeze, were decreased pulmonary compliance and falling oxygen saturation. Of the non-allergy/anaphylaxis related incidents, 80% occurred during induction or maintenance of anaesthesia. Of these, the principal causes of bronchospasm were airway irritation (35%), problems with the endotracheal tube (23%), and aspiration of gastric contents (14%). It was considered that, properly used, the structured approach recommended would have led to earlier recognition and/or better management of the problem in 10% of cases, and would not have harmed any patient had it been applied in all of them.
Bronchospasm may present in a variety of ways and may be associated with other life threatening conditions. Although most cases are handled appropriately by the attending anaesthetist, the use of a structured approach to its diagnosis and management would lead to earlier recognition and/or better management in 10% of cases.
与麻醉相关的支气管痉挛可能本身就是一种独立的病症，也可能是诸如过敏反应等其他问题的一个组成部分。其表现可能为呼气性哮鸣、呼气延长，严重时听诊完全无呼吸音。
探讨先前描述的核心算法“COVER ABCD - A SWIFT CHECK”，辅以针对支气管痉挛的特定子算法，在诊断和处理与麻醉相关的支气管痉挛中的作用。
将这种结构化方法对澳大利亚事件监测研究（AIMS）报告的前4000例相关事件中每一例的潜在处理情况，与参与的麻醉师报告的实际处理情况进行比较。
在AIMS报告的前4000例中，有103例相关事件，其中22例与过敏或过敏反应有关。除哮鸣外，常见的表现体征还有肺顺应性降低和氧饱和度下降。在与非过敏/过敏反应无关的事件中，80%发生在麻醉诱导或维持期间。其中，支气管痉挛的主要原因是气道刺激（35%）、气管内导管问题（23%）和胃内容物误吸（14%）。据认为，正确使用推荐的结构化方法，在10%的病例中可使问题得到更早识别和/或更好处理，并且如果对所有病例都应用该方法，不会对任何患者造成伤害。
支气管痉挛可能有多种表现方式，且可能与其他危及生命的情况相关。尽管大多数病例由主治麻醉师妥善处理，但采用结构化方法进行诊断和处理，在10%的病例中可实现更早识别和/或更好处理。
