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[Bronchospasm during upper gastrointestinal endoscopy under sedation].

Ju Mizuno¹, Michiko Matsuki, Yoshinori Gouda

¹Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Tokyo 113-8665.

Masui. the Japanese Journal of Anesthesiology

|March 26, 2003

Summary

Bronchospasm during upper gastrointestinal endoscopy is a rare event. This case highlights the potential for vagal reflex stimulation by the endoscope, especially in patients with prior neck surgery.

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Area of Science:

Gastroenterology
Pulmonology
Anesthesiology

Background:

Upper gastrointestinal endoscopy is a common procedure for diagnosing gastrointestinal issues.
Sedation is frequently used to improve patient comfort and tolerance during endoscopy.
Complications, though rare, can occur and require prompt recognition and management.

Observation:

An 80-year-old male developed acute bronchospasm with expiratory stridor during an upper gastrointestinal endoscopy.
The event occurred as the endoscope reached the esophageal-gastrojunction under sedation and local anesthesia.
The patient required immediate intubation and mechanical ventilation.

Findings:

The patient had a history of extensive neck surgery involving recurrent laryngeal nerve resection and anastomosis.

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Bronchospasm was suspected to be triggered by vagal nerve stimulation, potentially exacerbated by gastric acid regurgitation during sedation.

Bronchoscopy post-extubation revealed no intrinsic airway abnormalities.

Implications:

This case underscores the importance of a thorough pre-procedure patient history, particularly regarding prior neck or laryngeal surgeries.
Awareness of potential vagal reflex pathways is crucial for anesthesiologists and endoscopists managing sedated patients.
Careful endoscopic technique and monitoring are essential to prevent and manage respiratory complications during gastrointestinal procedures.