ORIGINAL ARTICLE

Crisis management during anaesthesia: bronchospasm

R N Westhorpe¹, G L Ludbrook² and S C Helps³

¹ Deputy Director, Department of Paediatric Anaesthesia and Pain Management, Royal Children’s Hospital, Parkville, Victoria, Australia
² Professor, Department of Anaesthesia and Intensive Care, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
³ Department of Medical Biochemistry, School of Medicine, Flinders University, Bedford Park, South Australia, Australia

Correspondence to:
Correspondence to:
Professor W B Runciman
President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia 5001, Australia; research{at}apsf.net.au

Background: Bronchospasm in association with anaesthesia may appear as an entity in its own right or be a component of another problem such as anaphylaxis. It may present with expiratory wheeze, prolonged exhalation or, in severe cases, complete silence on auscultation.

Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for bronchospasm, in the diagnosis and management of bronchospasm occurring in association with anaesthesia.

Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by anaesthetists involved.

Results: There were 103 relevant incidents among the first 4000 AIMS reports, 22 of which were associated with allergy or anaphylaxis. Common presenting signs, in addition to wheeze, were decreased pulmonary compliance and falling oxygen saturation. Of the non-allergy/anaphylaxis related incidents, 80% occurred during induction or maintenance of anaesthesia. Of these, the principal causes of bronchospasm were airway irritation (35%), problems with the endotracheal tube (23%), and aspiration of gastric contents (14%). It was considered that, properly used, the structured approach recommended would have led to earlier recognition and/or better management of the problem in 10% of cases, and would not have harmed any patient had it been applied in all of them.

Conclusion: Bronchospasm may present in a variety of ways and may be associated with other life threatening conditions. Although most cases are handled appropriately by the attending anaesthetist, the use of a structured approach to its diagnosis and management would lead to earlier recognition and/or better management in 10% of cases.

Keywords: bronchospasm; wheeze; airway irritation; endobronchial intubation; oesophageal intubationl crisis management; anaesthesia complications

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• Runciman, W B, Kluger, M T, Morris, R W, Paix, A D, Watterson, L M, Webb, R K (2005). Crisis management during anaesthesia: the development of an anaesthetic crisis management manual. Qual Saf Health Care 14: e1-e1 [Abstract] [Full Text]  
• Visvanathan, T, Kluger, M T, Webb, R K, Westhorpe, R N (2005). Crisis management during anaesthesia: obstruction of the natural airway. Qual Saf Health Care 14: e2-e2 [Abstract] [Full Text]