Asthma and anesthesia

Describe the etiology of asthma
Describe the etiology of asthma
Lack of exposure to immunologic challenges early in life lead to:

1. TH2-type cytokine response predominance
2. General atopy

This is the most common chronic childhood disease, affecting up to 6 million children
Asthma. Up to 22M in the US have asthma

What is the pathophysiological change that occur with asthma? (2)
Airway inflammation
Nonspecific hyper-irritability of TB tree

What are the clinical features seen in asthma? (3)
What are the clinical features seen in asthma? (3)
1. Bronchoconstriction
2. Airway hyperresponsiveness
3. Airway edema

What are the clinical features of asthma?
Recurrent wheezing
dyspnea
cough
recurrent labored respirations
Accessory muscle use
tachypnea
recurrent chest tightness
prolonged expiratory phase of respiration
fatigue

What conditions can exacerbate symptoms?
Exercise
Viral infections
Allergens
Irritants
Changes in weather
Stress
Menstrual cycles

Asthma drug therapy
Long-acting and short-acting Beta-agonists
Inhaled corticosteroids
Deep anesthesia
Cromolyn/Nedocromil
Immunomodulators
Leukotriene modifiers
Methylxanthines

What VA would the anesthetist need to avoid in patients with asthma and why?
Isoflurane and Desflurane are airway irritants

What anesthesia technique is considered safer in patients with asthma?
Regional is considered safer than GA

Respiratory implications of a midthoracic or higher spinal or epidural?
Respiratory implications of a midthoracic or higher spinal or epidural?
At these levels, FRC, ERV, and ability to cough decrease and should be avoided

If the anesthetist had no other choice but to use Isoflurane or Desflurance in an asthmatic patient, what can he/she administer to blunt the airway irritant effects of these VA’s?
Opiates can blunt the airway irritant effects of Des or Iso

What volatile anesthetic is LEAST irritating to the airway?
Sevoflurane

Why should the anesthetist avoid Atracurium and Morphine in asthmatic patients?
Due to histamine release

If the anesthetist needed to use Beta-blockers, what factors would guide his/her selection?
Beta-1 selective drugs such as Esmolol can be used

Why should prostaglandins (F2alpha subtype to stop obstetric bleeding) and ergot derivatives be avoided in asthmatic patients?
They increase the risk for bronchospasm

Why would the anesthetist want to avoid Pancuronium in asthmatic patients?
Use of long acting muscle relaxants can cause residual muscle weakness that can precipitate respiratory failure

What is the reasoning behind some clinician’s preference on deep extubation?
Earlier is better to prevent mechanical bronchial stimulation

What medications would you use to decrease airway sensitivity?
IV lidocaine
deep anesthesia
opiates

A Proposal for the Improvement of Asthma Care Practices


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Improving asthma nursing care

As documented by MEngr, Zhao& Winders (2017, pp.86), effective application of the National Asthma Council Australia 2015 and execution of the NSW Chest Pain Pathway will depend on a number of factors. It is important to increase the competencies of the attending physicians, nurses, and paramedics offering healthcare to asthmatic patients towards the breathing and chest pain management. It is also important to educate the concerned, including the family members, of the signs and symptoms of an asthma attack to improve diagnosis and management of this condition (“National Asthma Council Australia 2015 ”). Such awareness will help patients and family members to recognize the symptoms and seek medical treatment, early, since awareness has been proven to be the best control measure for any disease. The education will also entail first aid skills that are essential in preventing complications of asthma attack and its complications associated to breathing and chest pain management. Appropriate training will also equip the nurses and the asthmatic experts with skills to diagnose asthmatic conditions, control of chest pain even at primary assessment stage, with a clear knowledge of the appropriate treatment. Such training will also provide the medical facilities with a strategic approach to curb asthma (Woods et al., 2012, pp. 465-472).

Equipping the health centers with appropriate facilities is equally as important as administering the right treatment to asthmatic and chest pain patients. Such facilities can include the use of “e-health technologies to deliver information and services to those in rural areas “where access is problematic” (“National Asthma Strategy”). The facilities should also provide a wide range of medications to cover various forms of asthmas (Masoli et al., 2004, pp. 469-478). Any medical facilities who do not use an existing Chest Pain Pathway must implement the standard NSW Chest Pain Pathway together with the facilities which merge with this policy.

Finally, asthma and chest pain is a health threat that requires a professional approach. Acute nursing care is the savior of human beings from breathing complications and chest pain associated to asthma as a consequence of proper diagnosis and correct medication. However, this requires a professional and strategic approach, based more on control (in the case of asthma attack-breathing complications) and proper diagnosis and treatment in the case of chest pain. A step by step medical approach should, therefore, be followed to ensure that the cause and scope of the two complications is determined. Public awareness is equally as essential in ensuring diagnosis and treatment of asthma at early stages before it results to breathing and chest pain complications. Acute nursing care for asthma attacks can also be addressed from two perspectives: breathing and pain management. A strategic implementation of National Asthma Council Australia 2015 and execution of the NSW Chest Pain Pathway stands out as the best practices to curb these complications. However, the two concepts can be made effective by competent health personnel equipped with modern skills and facilities. As asthma and chest pain remains a health concern affecting over 26 million people across America, it is a social responsibility to improve the strategies to fight asthma and chest pain as a way of achieving a healthy nation.

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