1) The document evaluates clinical characteristics and methods of anesthesia relating to severe bronchospasm in ENT surgery. It analyzes 17 cases of severe bronchospasm during ENT surgery over 15 years. 2) The majority of cases (13/17) involved patients with tracheal stenosis undergoing tracheostomy under local anesthesia. Most cases (15/17) were caused by stimulation during surgery. 3) Emergency management involved general anesthesia, bronchodilators, and 100% oxygen. Later management included pleural drainage, ventilation, antibiotics, and sedation. Most patients (12/17) recovered fully but 3 died due to delays in management. Early and proper treatment led to full recovery in 2 cases without complications.

1. EVALUATION OF CLINICAL
CHARACTERISTICS AND METHODS
OF ANESTHESIES RELATING TO
SEVERE BRONCHOSPASM
IN SURGERY ENT
PRESENTATION: DR.Nguyen Phu Van
ENT Hospital National

2. Introduction
 Bronchospasm is caused by the spasmodic contraction of
the bronchial smooth muscle.
 Occur during periods of anesthesia
 Incidence: 1,7‰ in patients without a history of asthma
8 ‰ in patients with a history of asthma
30% in patients with severe asthma
 Incidence decreases with age
Pedersen,ActaAnaesthesiol Scand2001

3. Introduction
 Risk of bronchospasm increase10 times when a
respiratory infection.
- Patients with ENT infections : flu, allergic rhinitis…
- Tracheal stenosis, dyspnea, accumulation of sputum,
pneumonia …
Olsson, ActaAnaesthesiol Scand 2007
 Severe bronchospasm may be at risk of hypoxic brain,
cause brain damage or brain death.
 In cases of severe bronchospasm :
70% death
18% hypoxic brain
Cheney, Anesthesiology 1991

4. For these reasons that we do this research aims :
1.Evaluate the clinical characteristics related to severe
bronchospasm in ENT surgery.
2.Methods of anesthesia-related bronchospasm
3.Evaluate the results of treatment of bronchospasm
severe.

5. Obstructing air exhaled
Gas trapping
Excessive alveolar stretch
alveolar increased pressure
Literature review
Pneumothorax alveolar rupture

6. Obstructing air exhaled
gas trapping
Excessive alveolar stretch
Reduced lung compliance
alveolar increased pressure
Reduced
circulation
back to the heart
Disorders of
blood-gas distribution Increased pulmonary
artery pressure
literature review
Pneumothorax alveolar rupture

7. Obstructing air exhaled
gas trapping
Excessive alveolar stretch
Reduced lung compliance
alveolar increased pressure
Mobilization of auxiliary
respiratory muscles
Increased
respiratory activity
Increased production of CO2
Reduced
circulation
back to the heart
Disorders of
blood-gas distribution
Hypotension
Hypoxemia
Acute heart failure
Increased pulmonary
artery pressure
Increased right ventricular load
Increased oxygen consumption
literature review
Pneumothorax alveolar rupture

8. Sonde, tube
Mechanism of bronchospasm
General anesthesia
Central nervous system
Bronchial
smooth
muscle
Local anesthesia
The stimulation of surgery
Stimulate, traction,
The vagus nerve
Bronchial
parasympathetic
ganglion
rub Epithelium trachea
The gases,
exudates, blood
or bronchi
Increased bronchial
response
BRONCHOSPASM

9. DEEP ANAESTHESIA
Sonde, tube
Mechanism of bronchospasm
General anesthesia
Central nervous system
Bronchial
smooth
muscle
Local anesthesia
The stimulation of surgery
Stimulate, traction,
The vagus nerve
Bronchial
parasympathetic
ganglion
rub Epithelium trachea
The gases,
exudates, blood
or bronchi
Increased bronchial
response
BRONCHOSPASM

10. Management of bronchospasm
Stop all stimulation on patients
Ventilate the patient with 100% oxygen
Assess whether anaphylaxis is not? Yes Management of
anaphylaxis
Deep anesthesia Not
Normotensive:
Propofol IV
Sevofluran
Hypotension:
Ketamine IV
Optimal ventilation
Control of the airway
by intubation
pressure control ventilation
with prolonged exhalation
time : I/E= 1/3, 1/4
Manual ventilation
with 100% oxygen
Use bronchodilators
Salbutamol spray
Intravenous
bronchodilator :
Salbutamol,
Diaphyline
If shock or use of
bronchodilators failure:
Adrenalin IV
Solu-medrol IV

11. Research Methodology
- Study design :
Retrospective, descriptive, cross-sectional. At the
Department of Anesthesiology and Resuscitation
Emergency Department, ENT Hospital National, within 15
years, the period from January 1999 to January 2014.
- Subjects of study :
The patient had been diagnosed with severe bronchospasm

12. RESULTS
Clinical characteristics and type of anesthesia
Characteristics
Age <18 years old: 1 18-60years old: 13 > 60years old : 3
Sex Males: 12 Females: 5
Period Intraoperative: 15 Intubation: 1 Extubation: 1
Diseases need
surgery
Tracheal stenosis: 13 Sinusitis: 1 Neck abscess: 1 Open glottis
paralysis: 2
Type of
anesthesia
Local anesthesia: 15 General anesthesia:2
Cause Stimulation of surgery: 14 Reflux: 2 Drug reactions: 1

13. Symptoms Signal Quantity Ratio %
Subjective symptom
Intense dyspnea 17 100%
Tachypnea 3
Bradypnea 15 88,2%
Stiffened body 12 70,5%
Objective
symptom
Auscultation
Murmur decreased alveolar 17 100%
Wheezing 13 76,4%
Lung silence 4
Perception
Vague 12 41,2%
Tumbledown 5 29,4%
Heart rate
Tachycardia 10 58,8%
Bradycardia 7 41,2%
Blood pressure
Normotensive 2
Hypotension 15 88,2%
SpO2
>90% 2 47%
50-90% 10
<50% 5 29,4%
Pneumothorax
Unilateral 3
Bilateral 12 70,5%

14. Results of treatment
Emergency Management
General anesthesia, using bronchodilators, support 100% oxygen
through the tube (17/17), tracheostomy set canuyl 14/17 patients, 3/17
patients intubation..
After the emergency management
Pleural drainage and continuous suction, 15/17 patients.
Sedation, pressure control ventilation, antibiotics, anti-inflammatory
Outcome
•12/17 patients recover completely and do not leave sequelae
•2/17 patients were treated early and properly position the principle has
recovered immediately.
•3/17 patients died.

15. DISCUSSION
Clinical characteristics and type of anesthesia
-13/17 (76.5%) tracheal stenosis scarring need to tracheostomy for
airway control under local anesthesia.
-According to Nathalie Schutz, the incidence rate of bronchospasm met
80% of the patients with airway obstruction and surgery without
anesthesia.
-Study on 31 patients who had surgical tracheostomy under local
anesthesia by the author Rohail Ahmed, Muhammad Faheem Malik, the
2 patients with pneumothorax, 2 patients with cardiac arrest due to
bronchospasm.

16. The stage and cause of bronchospasm
The stages R N Westhorpe Our
Induction 48 1
Perioperative 66 15
Postoperative 11 1
Total 125 17
Causes
Stimulates airway 23 15
Drug reactions 8 1
Early extubation 6 1
Other causes 5 0
Total 42 17

17. Results of treatment
-2/15 patients received early treatment were stable and
without complications
- 70% (12/17 patients) were pneumothorax were treated
for pleural drainage continuous suction with negative
pressure, pressure control ventilation, sedative,
analgesic, antibiotic, anti-inflammatory and has stable
after 5- 7 days.
-3/17 patients died.

18. CONCLUSIONS
- Complications severe bronchospasm in ENT surgery met
the majority of patients with tracheal stenosis scarring
require surgery tracheostomy under local anesthesia
(accounting for 76.5%).
- 88.2% (15/17) patients with severe bronchospasm were
pneumothorax and 3/17 patients died due to delays and
improper management principles.
- 2/17 patients received timely and proper management
principles, has recovered completely without complications.

19. Thanks for your attention!