Bronchospasm
Bronchospasm is a medical term that describes the cramping of the muscles that span the airways. Bronchospasm occurs with bronchial asthma, but also when inhaling fumes and smoke. Surgical or other manipulative interventions in the area of the airways, such as endotracheal intubation when the anesthesia is too shallow, can also be the cause.
In this case, the cramping of the muscles surrounding the bronchi narrows the diameter of the airways and increases breathing resistance ( obstruction ). Obstructive pulmonary diseases can be derived from this connection.
Possible causes
Bronchospasm can originate from mechanical or chemical irritation as well as various drugs (including opiates or antibiotics with histamine release ). Patients with bronchial asthma , acute respiratory tract infections , chronic obstructive pulmonary disease , nicotine abuse , allergic rhinitis or a tendency to allergic reactions are particularly prone to bronchospasm .
diagnosis
Signs of bronchospasm during ventilation are an increase in airway resistance and ventilation pressures as well as a decrease in the administered tidal volume. Wheezing and humming during expiration are also typical ( absent in the full screen silent chest ). There is a risk of hypercapnia (increased carbon dioxide content in the blood) and hypoxia (insufficient supply of the tissue with oxygen).
therapy
Manual ventilation with a high inspiratory oxygen concentration is possible. During an operation, the anesthesia can be deepened when bronchospasm begins, for example with the bronchodilatory anesthetic ketamine , and beta-2 mimetics can widen the bronchi again.
prophylaxis
Sufficient premedication, such as a beta-2 mimetic, can be carried out prophylactically before operations on predisposed patients. Regional anesthesia is preferable.
literature
- Franz-Josef Kretz, Karin Becke: Anesthesia and intensive care medicine in children. Thieme, 2007, ISBN 978-3-13-110232-4 . P. 185 f.
- Reinhard Larsen: Anesthesia and intensive care medicine for nurses and carers. Springer-Verlag, 2013, ISBN 978-3-662-21608-8 . P. 532.
- Reinhard Larsen, Thomas Ziegenfuß: Ventilation: Basics and Practice. Springer Science & Business Media, 2009, ISBN 978-3-540-88811-6 .
- Jürgen Schüttler: The anesthetic incident. Thieme, 2003, ISBN 3-13-125181-6 .
- Hans Walter Striebel: Anesthesia - Intensive Care Medicine - Emergency Medicine. Springer, 2012, ISBN 978-3-7945-2890-5 .