Perioperative Management of Inhaled Corticosteroids in Asthma Patients
Asthma patients should continue using their chronic corticosteroid (CCS) inhalers before surgery to maintain optimal respiratory function and reduce the risk of perioperative complications. 1
Preoperative Assessment and Medication Management
The American Academy of Allergy, Asthma, and Immunology recommends reviewing the level of asthma control, medication use, and pulmonary function before surgery, especially for patients with a history of oral systemic corticosteroids within the past 6 months 1
Patients with poorly controlled asthma should consider postponing elective procedures until better control is achieved, as poor asthma control increases the risk of perioperative complications 1
Regular asthma medications, including inhaled corticosteroids, should be continued throughout the perioperative period, including on the day of surgery 1
Modern inhaled corticosteroids including budesonide, fluticasone, and mometasone are safe to use at recommended doses and do not have the clinically important adverse effects on bone mineral density, cortisol production, and glucose metabolism caused by equivalently effective doses of oral glucocorticoids 2
Benefits of Continuing Inhaled Corticosteroids
Continuing inhaled corticosteroids helps maintain control of the underlying airway inflammation, which is essential for preventing bronchospasm during the perioperative period 1, 3
Preoperative optimization of lung function with regular medications improves outcomes, with studies showing that even short-term administration of inhaled drugs immediately before surgery can improve respiratory function 4
The frequency of perioperative bronchospasm and laryngospasm is increased in patients with active asthma, making medication adherence crucial 5
Bronchodilator Administration Before Surgery
In addition to continuing inhaled corticosteroids, asthmatic patients should be premedicated with a bronchodilator before procedures to prevent procedure-related bronchospasm 3
Short-acting β2-agonists (SABAs) such as albuterol are the preferred bronchodilators for pre-procedure use, providing rapid bronchodilation with minimal side effects, and should be administered 15-20 minutes before the procedure 3
SABAs are effective for 2-4 hours in protecting against bronchospasm, making them suitable for pre-procedure administration 3
Intraoperative Considerations
The American Society of Anesthesiologists recommends considering regional anesthesia techniques when appropriate, as major conduction anesthesia should be considered for peripheral procedures 1
For superficial procedures, local anesthesia or peripheral nerve blocks with or without moderate sedation may be considered 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
Oxygen saturation should be monitored continuously via pulse oximetry during procedures 1
Postoperative Management
Monitoring of oxygen saturation should continue in the recovery period 1
Incentive spirometry, chest physiotherapy, and early mobilization should be considered to prevent pulmonary complications 1
Appropriate pain control should be maintained, as inadequate analgesia can lead to shallow breathing and atelectasis 1
Common Pitfalls and Considerations
Patients with asthma may have difficult airways and should be managed according to difficult airway protocols 1
Hypothermia should be avoided in the postoperative setting, as it can trigger bronchospasm 1
For patients with severe asthma or poor control, ensuring they continue their regular controller medications and potentially adding a short course of oral corticosteroids if lung function is not well controlled before the procedure may be necessary 3
All asthmatics who have needed systemic or aerosolized corticosteroids within 6 months prior to surgery should receive appropriate perioperative corticosteroid therapy to prevent adrenal insufficiency 6