Preoperative Preparation for Patients with Asthma
Patients with asthma require thorough preoperative assessment and optimization of lung function to reduce the risk of perioperative respiratory complications during surgery.
Assessment of Asthma Control
- Review the level of asthma control, medication use (especially oral systemic corticosteroids within the past 6 months), and pulmonary function before surgery 1
- Patients with suspected COPD should have spirometric parameters checked before procedures, and if severe (FEV1 <40% predicted and/or SaO2 <93%), arterial blood gas tensions should also be measured 1
- For patients with poorly controlled asthma, consider postponing elective procedures until better control is achieved 1
Medication Optimization
- Provide medications before surgery to improve lung function if not well controlled; a short course of oral systemic corticosteroids may be necessary 1
- Continue regular asthma medications through the perioperative period, including on the day of surgery 1
- Asthmatic patients should be premedicated with a bronchodilator before procedures 1
- For patients receiving oral systemic corticosteroids during the 6 months before surgery and for selected patients on long-term high-dose inhaled corticosteroids (ICS), administer 100 mg hydrocortisone every 8 hours intravenously during the surgical period, and reduce the dose rapidly within 24 hours after surgery 1
Risk Reduction Strategies
- Avoid sedation where pre-procedure arterial CO2 is raised and provide oxygen supplementation only with extreme caution in patients with severe COPD 1
- Consider regional anesthesia techniques when appropriate, as major conduction anesthesia (spinal/epidural) should be considered for peripheral procedures 1
- For superficial procedures, consider local anesthesia or peripheral nerve blocks with or without moderate sedation 1
- General anesthesia with a secure airway is preferable to deep sedation without a secure airway, particularly for procedures that may mechanically compromise the airway 1
Intraoperative Management
- Monitor oxygen saturation continuously via pulse oximetry during procedures 1
- Provide supplemental oxygen to maintain saturation of at least 90% to reduce the risk of significant arrhythmias 1
- Unless medically contraindicated, patients with asthma should be extubated while awake 1
- Ensure full reversal of neuromuscular blockade before extubation 1
- When possible, perform extubation and recovery in the lateral, semiupright, or other nonsupine position 1
Postoperative Care
- Continue monitoring oxygen saturation in the recovery period 1
- Consider incentive spirometry, chest physiotherapy, and early mobilization to prevent pulmonary complications 1
- Maintain appropriate pain control, as inadequate analgesia can lead to shallow breathing and atelectasis 1
- Consider postoperative albuterol therapy for patients with asthma 1
- Maintain intravenous hydration until oral intake is fully re-established 1
Common Pitfalls and Caveats
- Avoid hypothermia at all costs in the postoperative setting, as it can trigger bronchospasm 1
- Recognize that patients with asthma may have difficult airways and should be managed according to difficult airway protocols 1
- Be aware that sedatives, opioids, and inhaled anesthetics can cause respiratory depression and airway effects, particularly in patients with respiratory conditions 1
- Understand that poor asthma control increases the risk of perioperative complications including bronchospasm, hypoxemia, hypercapnia, atelectasis, and respiratory infections 1
By following these guidelines, the risk of perioperative respiratory complications in patients with asthma can be significantly reduced, leading to better surgical outcomes and patient safety.