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Crisis management during anaesthesia: bronchospasm.
R N Westhorpe1, G L Ludbrook, S C Helps
1Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia.
Quality & Safety in Health Care
|June 4, 2005
Summary
A structured approach to diagnosing and managing bronchospasm during anesthesia can improve patient outcomes. This method, applied to anesthesia incidents, showed potential for earlier recognition and better treatment in 10% of cases.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Respiratory Medicine
Background:
- Bronchospasm during anesthesia presents variedly, from isolated incidents to complications like anaphylaxis.
- Key signs include expiratory wheeze, prolonged exhalation, or absent breath sounds in severe cases.
Purpose of the Study:
- To evaluate a structured diagnostic and management algorithm, "COVER ABCD-A SWIFT CHECK" with a specific bronchospasm sub-algorithm.
- To assess its effectiveness in managing perioperative bronchospasm.
Main Methods:
- A retrospective analysis of 4000 Australian Incident Monitoring Study (AIMS) reports.
- Compared the proposed algorithm's performance against actual anaesthetist management in 103 relevant bronchospasm incidents.
Main Results:
- Bronchospasm was linked to allergy/anaphylaxis in 22 incidents; common signs included wheeze, decreased pulmonary compliance, and hypoxia.
- Non-allergy related bronchospasm (80% during induction/maintenance) stemmed from airway irritation (35%), ETT issues (23%), and aspiration (14%).
- The structured approach could have improved recognition/management in 10% of cases without causing harm.
Conclusions:
- Bronchospasm during anesthesia has diverse presentations and can be life-threatening.
- While anaesthetists generally manage cases appropriately, a structured approach offers a 10% improvement in early recognition and management.