Bohringer Christian, Copeland Daniel, Liu Hong
Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, California, USA.
Transl Perioper Pain Med. 2020;7(2):190-198. doi: 10.31480/2330-4871/112. Epub 2020 Feb 10.
The incidence of asthma is increasing, and the ageing of the United States population is leading to an increase in the prevalence of patients living with chronic obstructive pulmonary disease. This has led to an increased need to manage bronchospasm in the perioperative period. Very effective methods to treat bronchospasm like intravenous dexmedetomidine, lidocaine, magnesium, ketamine and steroids as well as inhalational sevoflurane are available but are currently underused. Inhaled beta-2 agonists like albuterol are instead often relied upon as the sole therapeutic agent - often with limited response. Just like with pain management, the successful treatment of perioperative bronchospasm requires a multimodal approach. The diagnosis of intraoperative bronchospasm must be rapid, and the treatment must be effective to prevent the dreaded "dynamic hyperinflation syndrome". This article reviews the diagnosis of bronchospasm and the contemporary treatment methods that should be employed to prevent bronchospasm-related morbidity and mortality during the perioperative period.
哮喘的发病率正在上升，而美国人口老龄化导致慢性阻塞性肺疾病患者的患病率增加。这使得围手术期管理支气管痉挛的需求增加。虽然有非常有效的治疗支气管痉挛的方法，如静脉注射右美托咪定、利多卡因、镁、氯胺酮和类固醇以及吸入七氟醚，但目前这些方法未得到充分利用。相反，吸入性β-2激动剂如沙丁胺醇常常被依赖作为唯一的治疗药物——通常效果有限。就像疼痛管理一样，围手术期支气管痉挛的成功治疗需要多模式方法。术中支气管痉挛的诊断必须迅速，治疗必须有效以预防可怕的“动态肺过度充气综合征”。本文综述了支气管痉挛的诊断以及在围手术期应采用的当代治疗方法，以预防与支气管痉挛相关的发病率和死亡率。
