Department of Chest Diseases, Division of Pneumology and Allergology, High Specialty A. Cardarelli Hospital, Naples, Italy.
Curr Opin Anaesthesiol. 2012 Feb;25(1):30-7. doi: 10.1097/ACO.0b013e32834e7b2e.
The aim of this review is to underline the need for an adequate clinical and functional evaluation of respiratory function and asthma control in patients undergoing surgical procedures requiring general anesthesia to obtain useful information for an adequate preoperative pharmacological approach.
It has been shown that baseline uncontrolled clinical/functional conditions of airways represent the most important risk factors for perioperative bronchospasm. In nonemergency conditions, asthma patients should undergo clinical/functional assessment at least 1 week before the surgery intervention to obtain, the better feasible control of asthma symptoms in the single patient. Some simple preoperative information given by the patient in preoperative consultation may be sufficient to identify individuals with uncontrolled or poor controlled asthmatic conditions. Spirometric evaluation is essential in individuals with poor control of symptoms, as well as in those patients with uncertain anamnestic data or limited perception of respiratory symptoms, and in those requiring lung resection.
A better control of asthma must be considered the 'gold standard' for a patient at 'a reasonable low risk' to develop perioperative/postoperative bronchospasm. International consensus promoted by pulmonologists, anesthesiologists, and allergists might be useful to define a better diagnostic and therapeutic approach.
本文旨在强调在需要全身麻醉的外科手术中，对呼吸功能和哮喘控制进行充分的临床和功能评估的必要性，以获得有用的信息，从而为术前的药理学方法提供依据。
研究表明，气道未得到控制的基础临床/功能状况是围手术期支气管痉挛的最重要危险因素。在非紧急情况下，哮喘患者应在手术干预前至少 1 周进行临床/功能评估，以便在单个患者中获得更好的哮喘症状控制。患者在术前咨询时提供的一些简单的术前信息可能足以识别出那些未得到控制或控制不佳的哮喘患者。在症状控制不佳的患者、那些病史不确定或对呼吸症状感知有限的患者，以及那些需要进行肺切除术的患者中，肺量计评估是必不可少的。
对于“合理低风险”发生围手术期/术后支气管痉挛的患者，更好地控制哮喘必须被视为“金标准”。由肺科医生、麻醉师和过敏症专家推动的国际共识可能有助于定义更好的诊断和治疗方法。
