Related Experiment Video
Updated: May 1, 2026
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Anesthesia and ventilation strategies in children with asthma: part II - intraoperative management
Adrian Regli1, Britta S von Ungern-Sternberg
1aDepartment of Intensive Care, Fremantle Hospital bSchool of Medicine and Pharmacology, The University of Western Australia cSchool of Medicine, The University of Notre Dame dDepartment of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Insights
Optimizing anesthesia management is crucial for children with asthma undergoing surgery. This involves managing acute bronchospasm and asthma exacerbations to minimize perioperative respiratory risks.
Area of Science:
- Anesthesiology
- Pediatric Pulmonology
- Respiratory Medicine
Background:
- Asthma is a prevalent childhood condition requiring surgical intervention.
- Anesthetists manage both elective and urgent surgical cases in children with varying asthma control.
- Perioperative respiratory adverse events are a significant concern in pediatric asthma patients.
Purpose of the Study:
- To detail medical and ventilatory management for children with asthma during the perioperative period.
- To address perioperative management of acute bronchospasm and asthma exacerbations.
- To optimize lung function and minimize bronchial hyperreactivity in asthmatic children undergoing anesthesia.
Main Methods:
- Review of multiple observational trials on perioperative respiratory adverse events.
- Analysis of animal experiments and clinical data on anesthetic agents' effects on bronchial smooth muscle.
- Evaluation of current evidence on perioperative management and mechanical ventilation strategies.
Main Results:
- Observational trials identify risk reduction strategies for perioperative respiratory events.
- Understanding of anesthetic agents' impact on bronchial smooth muscle tone and reflex bronchoconstriction is growing.
- Evidence for perioperative management and ventilation strategies in asthmatic children is fair, necessitating further research.
Conclusions:
- Perioperative management for asthmatic children requires optimizing asthma treatment preoperatively.
- Optimization of anesthesia management is key to minimizing risks.
- Focus on optimizing lung function and reducing bronchial hyperreactivity during the perioperative period is essential.
Purpose Of Review:
As asthma is a frequent disease especially in children, anesthetists are increasingly providing anesthesia for children requiring elective surgery with well controlled asthma but also for those requiring urgent surgery with poorly controlled or undiagnosed asthma. This second part of this two-part review details the medical and ventilatory management throughout the perioperative period in general but also includes the perioperative management of acute bronchospasm and asthma exacerbations in children with asthma.
Recent Findings:
Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk reduction strategies. Mainly, animal experiments and to a small extent clinical data have advanced our understanding of how anesthetic agents effect bronchial smooth muscle tone and blunt reflex bronchoconstriction. Asthma treatment outside anesthesia is well founded on a large body of evidence.Perioperative prevention strategies have increasingly been studied. However, evidence on the perioperative management, including mechanical ventilation strategies of asthmatic children, is still only fair, and further research is required.
Summary:
To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, perioperative management should be based on two main pillars: the preoperative optimization of asthma treatment (please refer to the first part of this two-part review) and - the focus of this second part of this review - the optimization of anesthesia management in order to optimize lung function and minimize bronchial hyperreactivity in the perioperative period.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Inhalational Anesthetics: Overview
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Asthma-IV: Nursing Management
First, in...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...