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Anesthetic considerations in children with asthma

Adrian Regli1,2,3, Aine Sommerfield4,5, Britta S von Ungern-Sternberg4,5,6

  • 1Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia.

Paediatric Anaesthesia
|December 10, 2021
PubMed

Insights

Anesthesiologists can optimize care for children with asthma or airway reactivity by understanding its causes and management. Key strategies include preoperative optimization, careful airway management, and appropriate anesthetic agent selection to prevent bronchospasm.

Area of Science:

  • Pediatric Anesthesiology
  • Respiratory Medicine
  • Critical Care

Background:

  • Asthma and general airway reactivity are common in children, presenting frequent challenges for anesthesiologists.
  • Understanding the epidemiology and pathophysiology of pediatric airway reactivity is crucial for perioperative care.

Purpose of the Study:

  • To review the epidemiology, pathophysiology, and perioperative management of pediatric airway reactivity.
  • To provide guidance on optimizing anesthetic care for children with asthma or asthma-like symptoms.

Main Methods:

  • Comprehensive literature review focusing on pediatric asthma and airway reactivity.
  • Analysis of preoperative, intraoperative, and airway management strategies.
  • Evaluation of anesthetic agents and ventilation techniques.

Main Results:

  • Bronchospasm in children can stem from mechanical causes, non-immunological anaphylaxis, or immunological anaphylaxis.
  • Premedication with beta-2 agonists, non-invasive airway management, and deep extubation are beneficial.
  • Desflurane should be avoided; propofol is effective for induction; other volatile agents act as bronchodilators.

Conclusions:

  • Optimized perioperative management, including careful agent selection and airway handling, is essential for children with airway reactivity.
  • Anesthesiologists require specific knowledge to safely manage pediatric patients with asthma or reactive airways.

Keywords:
anesthesiaasthmabronchial hyperreactivitybronchoconstrictionbronchospasmincreased airway reactivitypediatricventilation

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