Right place, no trace: A case report of postintubation bronchospasm

Evidence suggests obesity correlates with airway hyperreactivity, which can result in severe bronchospasm. This report presents a 31-year-old female with a high body mass index who presented for a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. She had no past medical or atopic history. After induction of anaesthesia and intubation, O₂ saturation fell with no CO₂ trace, breathing sounds or chest rise. Despite confirming endotracheal tube position by video laryngoscopy, the CO₂ trace remained flat and mechanical ventilation was difficult with high airway pressures. Blood pressure was stable with no mucocutaneous signs of anaphylaxis. Administration of 100% O₂, bronchodilators and steroids improved ventilation and oxygenation with a return of a CO₂ trace. The operation was postponed. Prior to her subsequent surgery, the patient was premedicated with inhaled steroids and long-acting beta agonist with an uneventful induction and intubation. Giving a rising obese population, this case report aims to educate anaesthetists and anaesthetic practitioners as to the presentation, risk factors, mechanisms and management of uncommon, life-threatening postintubation bronchospasm.