Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000600010
Brazilian Journal of Anesthesiology
Clinical Information

Condutas no tratamento do broncoespasmo no peri-operatório

Management of perioperative bronchospasm

Cássio Campello de Menezes; Joaquim Edson Vieira

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Resumo

JUSTIFICATIVA E OBJETIVOS: Anestesiologistas podem se deparar com mais freqüência com pacientes portadores de asma dada a prevalência crescente dessa doença. O objetivo deste estudo foi investigar a diversidade de tratamentos utilizados durante o broncoespasmo no período peri-operatório. MÉTODO: Questionário enviado por correio para uma amostra estratificada originalmente composta de 108 anestesiologistas do estado de São Paulo, através da mala direta da Sociedade de Anestesiologia do Estado de São Paulo (SAESP). Perguntas versaram sobre a estatística individual e tratamento do broncoespasmo, a evolução clínica, a experiência profissional do anestesiologista, bem como sua conduta frente a um paciente portador de infecção de vias aéreas (IVAS). RELATO DO CASO: Setenta e três questionários retornaram após envio de três amostras estratificadas (324 questionários). A incidência de broncoespasmo situou-se em 0,90%. As condutas adotadas foram: corticóides (90,41%), halogenados (68,49%), aminofilina (50,68%), beta2-agonista inalatório (47,95%) e epinefrina (41,10%). A maioria dos anestesiologistas suspenderia a anestesia geral (84,93%) ou a regional (64,38%) quando o paciente apresentasse IVAS. CONCLUSÕES: A diversidade dos tratamentos registrados deve indicar a necessidade da divulgação de protocolos internacionais sobre tratamento e controle da asma, enfatizando os usos distintos dos beta2-agonistas inalatórios e corticóides.

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COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: The prevalence of asthma is increasing and anesthesiologists may start seeing this clinical manifestation more often in the perioperative period. This study aimed at investigating different bronchospasm management techniques during anesthesia. METHODS: A questionnaire was mailed to a stratified sample of 108 anesthesiologists from the Anesthesiology Society of State of São Paulo (SAESP). Questions involved individual bronchospasm statistics and management, clinical evolution, professional experience and the management of patients with upper airway infection (UAI). RESULTS: After mailing three stratified samples (324 questionnaires), 73 questionnaires were returned with a reported bronchospasm incidence of 0.90%. Management techniques were: steroids (90.41%), halogenates (68.49%), teophylline (50.68%), inhalational beta2-agonists (47.95%) and epinephrine (41.10%). Most anesthesiologists would discontinue general (84.93%) or regional anesthesia (64,38%) in UAI patients. CONCLUSIONS: The diversity of reported treatments indicate the need for spreading international protocols on asthma treatment and control, emphasizing the specific use of inhalational beta2- agonists and steroids.

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COMPLICATIONS

References

Murphy S, Bleecker ER. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. 1997.

Cabana MD, Rand CS, Powe NR. Why don’t physicians follow clinical practice guidelines?: A framework for improvement. JAMA. 1999;282:1458-1465.

Campos HS. Como pneumologistas tratam a asma no Brasil: Resultados de um inquérito realizado em 1996. J Pneumologia. 1998;24(^s1):S7(028).

Braga VCM, Caramez MPR, Morano SR. The effect of a training program on the quality of care of asthma patients by resident and attending physicians in an emergency department of a teaching hospital. Am J Respir Crit Care Med. 2000;161:A457.

Olsson GL. Bronchospasm during anesthesia: A computer-aided incidence study of 136,929 patients. Acta Anaesthesiol Scand. 1987;31:244-252.

Pizov R, Brown RH, Weiss YS. Wheezing during induction of general anesthesia in patients with and without asthma: A randomized, blinded trial. Anesthesiology. 1995;82:1111-1116.

Watts FW, Sullivan TJ. In my opinion: silent obstruction in asthma is unrecognized problem. J Clin Monit Comput. 1998;14:219-220.

Sunyer J, Anto JM, Tobias A. Generational increase of self-reported first attack of asthma in fifteen industrialized countries: European Community Respiratory Health Study. Eur Respir J. 1999;14:885-891.

Cerveri I, Locatelli F, Zoia MC. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Study. Eur Respir J. 1999;14:288-294.

Menezes CC, Angelis RMC, Vieira JE. Incidência e condutas no broncoespasmo per-operatório. Rev Bras Anestesiol. 2000;50(^s25).

Warner DO, Warner MA, Barnes RD. Perioperative respiratory complications in patients with asthma. Anesthesiology. 1996;85:460-467.

Groeben H, Silvanus MT, Beste M. Combined lidocaine and salbutamol inhalation for airway anesthesia markedly protects against reflex bronchosconstriction. Chest. 2000;118:509-515.

Groeben H, Silvanus MT, Beste M. Combined intravenous lidocaine and inhaled salbutamol protect against bronchial hyperreactivity more effectively than lidocaine or salbutamol alone. Anesthesiology. 1998;89:862-868.

Maslow AD, Regan MM, Israel E. Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma. Anesthesiology. 2000;93:1198-1204.

Groeben H, Silvanus MT, Beste M. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations. Am J Respir Crit Care Med. 1999;159:530-535.

Rooke GA, Choi JH, Bishop MJ. The effect of isoflurane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology. 1997;86:1294-1299.

Habre W, Scalfaro P, Sims C. Respiratory mechanics during sevoflurane anesthesia in children with and without asthma. Anesth Analg. 1999;89:1177-1181.

Choi JH, Rooke GA, Wu SC. Reduction in post-intubation respiratory resistance by isoflurane and albuterol. Can J Anesth. 1997;44:717-722.

Jones KA. Effects of halothane on the relationship between cytosolic calcium and force in airway smooth muscle. Am J Physiol. 1994;266:L199-L204.

Wiklund CU, Lim S, Lindsten U. Relaxation by sevoflurane, desflurane and halothane in the isolated guinea-pig trachea via inhibition of cholinergic neurotransmission. Br J Anaesth. 1999;83:422-429.

Eisenkraft JB, Cohen E, Kaplan JA. Anesthesia for Thoracic Surgery. Clinicial Anesthesia. 1989:905-946.

Zaidan JR. Electrocardiography. Clinical Anesthesia. 1989:587-623.

Cummins RO, Hazinski MF. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Currents in Emergency Cardiovascular Care. 2000;11:3-27.

Redden RJ. Possible theophylline toxicity during anesthesia. Anesth Prog. 1996;43:67-72.

Celli BR, Snider GL. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 1995;152:S84-S96.

Rogers RM, Owens GR, Pennock BE. The pendulum swings again: toward a rational use of theophylline. Chest. 1985;87:280.

Empey DW, Laitinen LA, Jacobs L. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis. 1976;113:131-139.

Laitinen LA, Elkin RB, Empey DW. Bronchial hyperresponsiveness in normal subjects during attenuated influenza virus infection. Am Rev Respir Dis. 1991;144:1422-1423.

Kharitonov SA, Yates D, Barnes PJ. Increased nitric oxide in exhaled air of normal human subjects with upper respiratory tract infections. Eur Respir J. 1995;8:295-297.

Gaston B, Drazen JM, Loscalzo J. The biology of nitrogen oxides in the airways. Am J Respir Crit Care Med. 1994;149:538-551.

Kharitonov SA, Yates D, Robbins RA. Increased nitric oxide in exhaled air of asthmatic patient s. Lancet. 1994;343:133-135.

Lemanske Jr RF, Dick EC, Swenson CA. Rhinovirus upper respiratory infection increases airway hyperreactivity and late asthmatic reactions. J Clin Invest. 1989;83:1-10.

Nascimento Jr P, Neves LBJ, Módolo NSP. Complicações respiratórias em crianças submetidas a anestesia geral. Rev Bras Anestesiol. 2000;50:345-349.

Mallampati SR. Bronchoespasm during spinal anesthesia. Anesth Analg. 1981;60:839-840.

McGough EK, Cohen JA. Unexpected bronchoespasm during spinal anesthesia. J Clin Anesth. 1990;2:35-36.

Groeben H, Schwalen A, Irsfeld S. High thoracic epidural anesthesia does not alter airway resistance and attenuates the response to an inhalational provocation test in patients with bronchial hyperreactivity. Anesthesiology. 1994;81:868-874.

Agertoft L, Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med. 1994;88:373-381.

Vieira JE, Cukier A, Stelmach R. Internal Medicine Residency improves asthma guidelines knowledge compared to Medical School. São Paulo Med J. 2001;119:97-100.

Littenberg B. Aminophylline treatment in severe, acute asthma: A meta-analysis. JAMA. 1988;259:1678-1684.

Littenberg B, Gluck EH. A controlled trial of methylprednisolone in the emergency treatment of acute asthm. N Engl J Med. 1986;314:150-152.

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