[Live-threatening bronchospasm during anesthesia induction : when pure routine becomes a nightmare]

Area of Science:

• Anesthesiology
• Pulmonology
• Emergency Medicine

Background:

• A young female with a history of asthma and milk protein allergy presented for abscess incision.
• A prior event, initially thought to be an asthmatic attack, was retrospectively identified as cardiac arrest requiring mechanical ventilation.

Observation:

• During anesthesia induction, the patient experienced sudden, severe bronchospasms, rendering ventilation impossible.
• Oxygen saturation plummeted to critically low levels (below 80%, nadir 13%) over 12 minutes.

Findings:

• The patient received emergency treatment including epinephrine, corticosteroids, antihistamines, beta-agonists, ketamine, and methylxanthines.
• Oxygen saturation normalized within 15 minutes of treatment initiation.
• Mechanical ventilation was required for a total of 4 days post-event, following 24 hours of therapeutic hypothermia.

Implications:

• The event was ultimately diagnosed as near-fatal asthma, not anaphylactic shock to propofol.
• Patient's underreporting of asthma history, due to a desire for independence, potentially contributed to the severity of the event.
• Highlights the importance of thorough patient history and recognizing severe asthma exacerbations in perioperative settings.