The Effect of Albuterol Spray on Hypoxia and Bronchospasm in Patients with Chronic Obstructive Pulmonary Disease (COPD) under General Anesthesia: A bouble-Blind Randomized Clinical Trial.

Background: Patients with chronic obstructive pulmonary disease (COPD) experience an increased risk of perioperative pulmonary complications. The aim of this study was to evaluate the effect of albuterol spray on hypoxia and bronchospasm in patients with COPD under general anesthesia. Methods: This single-center, double-blind, parallel-group, randomized clinical trial was performed on 120 smoking patients with COPD who were referred to 5 Azar Educational Hospital in Gorgan, Northern Iran, in 2021. Twenty minutes before general anesthesia and also after completion of surgery and before extubation, 60 patients in the intervention group were inhaled with 2 puffs of albuterol spray. In the control group, patients were inhaled with 2 puffs of placebo spray. In perioperative period, the occurrence of wheezing, bronchospasm, coughing, hemodynamic changes, postoperative shivering, dyspnea, and nausea and vomiting were evaluated in all patients. The Consolidated Standards of Reporting Trials (CONSORT) checklist was used to report important aspects of this study. Results: The mean age of the patients was 52.34 ±8.95 years, and 115 (95.8%) of them were males while the rest were females. The difference between systolic blood pressure before induction of anesthesia (after administration of albuterol spray) between the group receiving albuterol spray and the group not receiving it was statistically significant (p=0.04). Also, the difference between the mean arterial oxygen saturation before tracheal extubation (after re-administration of albuterol spray) between the albuterol spray group and the non-albuterol group was statistically significant (p = 0.03). Wheezing and recurrent cough after induction of anesthesia and after extubation (after albuterol spray administration) was lower in the albuterol group than in the control group (p<0.05). No significant side effects were detected in the albuterol-treated group. Conclusion: According to the results of this study, it seems that the prophylactic use of albuterol spray is useful in reducing the incidence of wheezing and recurrent cough before induction of anesthesia in COPD patients with smoking.

Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis.

PURPOSE: Nebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP. MATERIALS AND METHODS: We performed a search in Web of Science, PubMed, Embase, and the Cochrane Library to retrieve randomized controlled trials (RCTs) and observational studies published at any time until February 6, 2023. The primary outcome was clinical response. Secondary outcomes included microbiological eradication, overall mortality, length of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), nephrotoxicity, neurotoxicity, and bronchospasm. RESULTS: Seven observational studies and three RCTs were included. Despite exhibiting a higher microbiological eradication rate (OR,2.21; 95%CI, 1.25-3.92) and the same nephrotoxicity risk (OR,0.86; 95%CI, 0.60-1.23), NC was not significantly different in clinical response (OR,1.39; 95%CI, 0.87-2.20), overall mortality (OR,0.74; 95%CI, 0.50-1.12), MV length (mean difference (MD),-2.5; 95%CI, -5.20-0.19), and the ICU-LOS (MD,-1.91; 95%CI, -6.66-2.84) than by the intravenous antibiotic. Besides, the risk of bronchospasm raised significantly (OR, 5.19; 95%CI, 1.05-25.52) among NC. CONCLUSION: NC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.

Anesthetic considerations in children with asthma.

Due to the high prevalence of asthma and general airway reactivity, anesthesiologists frequently encounter children with asthma or asthma-like symptoms. This review focuses on the epidemiology, the underlying pathophysiology, and perioperative management of children with airway reactivity, including controlled and uncontrolled asthma. It spans from preoperative optimization to optimized intraoperative management, airway management, and ventilation strategies. There are three leading causes for bronchospasm (1) mechanical (eg, airway manipulation), (2) non-immunological anaphylaxis (anaphylactoid reaction), and (3) immunological anaphylaxis. Children with increased airway reactivity may benefit from a premedication with beta-2 agonists, non-invasive airway management, and deep removal of airway devices. While desflurane should be avoided in pediatric anesthesia due to an increased risk of bronchospasm, other volatile agents are potent bronchodilators. Propofol is superior in blunting airway reflexes and, therefore, well suited for anesthesia induction in children with increased airway reactivity.

Bronchospasm and Kidney Injury Associated With Salvaged Blood Reinfusion During Pediatric Neurosurgical Procedure: A Case Report.

Adverse events associated with salvaged blood reinfusion are common, but bronchospasm has been rarely reported, especially in pediatrics. We report the case of a child undergoing epileptogenic focus resection, who experienced bronchospasm and kidney injury associated with reinfusion of salvaged blood, presumably related to excessive free hemoglobin.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region.

OBJECTIVE: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. METHODS: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. RESULTS: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. CONCLUSION: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

Severe Bronchospasm During Aortic Surgery for Type A Aortic Dissection.

Severe bronchospasm during cardiopulmonary bypass is an unusual but potentially fatal event. No literature previously has reported such an event observed during surgery for type A aortic dissection. Herein, we report on a case of severe bronchospasm following cardiopulmonary bypass, during aortic surgery for type A aortic dissection. Bronchospasm did not respond to any conventional therapy, necessitating extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation thus serves as an alternative and effective therapy for refractory bronchospasm.

Computed Tomography Scan Evidence of Bronchospasm and Its Resolution During Computed Tomography Coronary Angiogram in a Child With Kawasaki Disease: A Case Report.

Bronchospasm in children is common; however, due to its sudden nature, radiographic correlation is uncommon. We planned a computed tomography (CT) coronary angiogram for a 5-year-old child for evaluation of Kawasaki disease. The child started to desaturate during the CT scanning after intravenous contrast injection under conscious sedation. CT scan documented spasm of trachea and bronchi, as well as crowding of ribs and elevated diaphragm during the event. Repeat CT scan documented well-aerated lung fields. The development of acute bronchospasm under anesthesia results in definite changes in the CT scan of the thoracic cavity as evidenced by this incident.

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients.

OBJECTIVES: Although the flexible laryngeal mask airway (FLMA) provides considerable advantages in head and neck procedures, little is known about its safety and efficacy in functional endoscopic sinus surgery (FESS). We conducted a retrospective study to evaluate the success rate of FLMA and relevant airway complications in FESS under general anaesthesia. METHODS: A retrospective review of consecutive patients who underwent FESS for chronic rhinosinusitis was performed from 2015 to 2019. All patients scheduled for FLMA ventilation were identified. Patient characteristics, length of the surgery, FLMA size, failed FLMA cases requiring endotracheal intubation, immediate adverse airway events and delayed airway injuries were recorded. The primary outcomes included the FLMA success rate, which was defined as primary success after induction and final success after the whole surgical procedure. The secondary outcomes were specific clinical factors associated with FLMA failure and airway complications related to FLMA usage. RESULTS: Of the 6661 patients included in our study, primary success was achieved in 6572 (98.7%), and final success was achieved in 6512 (97.8%). Failure occurred in 89 patients (1.3%) during induction, in 14 (0.2%) during surgical preparation and in 46 (0.7%) during the intraoperative procedure. All patients with failed FLMA ventilation were successfully switched to endotracheal intubation. Male sex, advanced age, higher American Society of Anesthesiologists grade (ASA) and higher body mass index (BMI) were independent risk factors associated with failed FLMA. Immediate adverse respiratory events were observed in 0.85% of the patients, and delayed airway injuries associated with use of FLMA were observed in 0.07%. CONCLUSION: This retrospective study demonstrates a high success rate for FLMA (97.8% in 6661 patients undergoing FESS). Adverse airway events and injuries associated with FLMA are rare, but clinicians should remain vigilant so that early diagnosis and prompt treatment can be provided.

Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region / Influência de alterações climáticas sobre a ocorrência do broncoespasmo induzido por exercício em adolescentes de uma região semiárida

ABSTRACT Objective: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. Methods: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. Results: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. Conclusion: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

RESUMO Objetivo: Verificar a influência das alterações climáticas sobre o broncoespasmo induzido por exercício, nos períodos chuvoso e seco de uma região do semiárido brasileiro. Métodos: Foram submetidos à avaliação do broncoespasmo em esteira ergométrica, em ambiente externo, nos períodos chuvoso e seco, 82 adolescentes, com idades de 15 a 18 anos. Foram avaliadas as variáveis antropométricas, a maturação sexual e o volume expiratório forçado no primeiro segundo. Para comparação da temperatura e umidade, queda do volume expiratório forçado no primeiro segundo (%) e frequência do broncoespasmo entre os períodos, foram utilizados o teste t de Student independente, o teste de Wilcoxon e o teste de McNemar, respectivamente. O nível de significância adotado foi p<0,05. Resultados: A média de idade foi 15,65±0,82 anos. A temperatura, a umidade e a queda do volume expiratório forçado no primeiro segundo (%) diferiram entre os períodos, com valores de temperatura e umidade maiores no período chuvoso (29,6ºC±0,1 e 70,8%±0,6 versus 28,5ºC±0,2 e 48,4%±0,6; p<0,05). A queda do volume expiratório forçado no primeiro segundo (%) foi maior no período seco (9,43%±9,97 versus 12,94%±15,65; p<0,05), e não foi encontrada diferença da frequência do broncoespasmo entre os períodos. Conclusão: O período seco influenciou negativamente no volume expiratório forçado no primeiro segundo de adolescentes, observando maior percentual de queda dessa variável nesse período. De acordo com os achados, propõe-se uma maior gravidade do broncoespasmo induzido por exercício em condições de baixa umidade.

Risk factor analysis of bronchospasm after tracheobronchial foreign body removal: Cases report and literature review (STROBE).

ABSTRACT: This retrospective study aimed to investigate bronchospasm after tracheobronchial foreign body removal. Bronchoscopy is the main clinical treatment for removing airway foreign bodies, but postoperative airway spasm is very common. In our study, we perform a risk factor analysis of bronchospasm after tracheobronchial foreign body removal. The sample was composed of 261 children with airway foreign bodies who had undergone clinical bronchoscopy for foreign body removal under general anesthesia were enrolled from the department of otolaryngology, the First Hospital of Jilin University from 2014 to 2019, of which 78 in the left bronchus, 107 in the right bronchus, 51 in the main bronchus, and 25 in the subglottis. All patients were confirmed by radiographic examination or pulmonary auscultation. All their medical records and clinical data were retrospectively analyzed; single factor and multiple factor analyses of bronchospasm were performed. The logistic regression analysis showed that age, foreign body retention time and operation time were independent risk factors for postoperative airway spasm. A history of pneumonia was not an independent risk factor for postoperative airway spasm. We should pay more attention in the preoperative period according to the specific situation of child; the right means of anesthesia and appropriate hormonal drugs should be chosen to prevent the occurrence of postoperative airway spasm.

Negative results for ketamine use in severe acute bronchospasm: a randomised controlled trial.

BACKGROUND: Ketamine has bronchodilation properties. The aim of the single-centre, evaluator-blinded, randomised clinical trial study was to evaluate whether continuous infusion of ketamine is associated with improvement in respiratory mechanics correlated with bronchospasm relief, as compared with continuous infusion of fentanyl. METHODS: Adult patients submitted to invasive mechanical ventilation were included if they had an acute severe bronchospasm, due to status asthmaticus or COPD exacerbation. They were randomised to ketamine or a standard IV analgesia with fentanyl, both in bolus and continuous infusion. Measurements of respiratory mechanics (airway resistance - Rsmax, dynamic compliance - Cdyn and intrinsic PEEP - PEEPi) both at baseline and 3 and 24 h after randomisation were performed. The main outcome of this study was to evaluate the improvement of Rsmax in 3 h of continuous infusion of the study drugs. RESULTS: Ketamine use was not associated with greater reduction in Rsmax when compared with fentanyl, either after 3 h (0 cm H2O L-1 s-1 ± 6 vs. -3 cm H2O L-1 s-1 ± 7.7, respectively; P = 0.16) or after 24 h (-3 cm H2O L-1 s-1 ± 17 vs. -3.5 cm H2O L-1 s-1 ± 13.7, respectively; P = 0.73). Patients randomized to the ketamine group did not have better improvements in delta PEEPi as compared with fentanyl in 3 h (P = 0.77) or in 24 h (P = 0.72). CONCLUSIONS: In this study, ketamine use was not associated with improvement in ventilatory variables associated with bronchospasm.

Is it safe to SCUBA dive with asthma?

Introduction: Internationally it is estimated that six million people participate in self-contained underwater breathing apparatus (SCUBA) diving each year. Registries suggest a significant proportion of divers have a current or historical diagnosis of asthma. Previously individuals with asthma were prohibited from diving, however, several contemporary guidelines suggest a select population of patients with asthma may be able to dive with an acceptable degree of risk. Areas covered: Divers with asthma may be at an increased risk of a variety of diving-related medical injuries including; pulmonary barotrauma (PBT), pneumothorax, pneumomediastinum, arterial gas embolism (AGE), reduction in pulmonary function, bronchospasm and decompression sickness (DCS). This article will discuss the latest evidence on the incidence of adverse events in diving with a focus on those caused by asthma. Expert opinion: Physicians can be faced with the difficult task of counseling patients with asthma who wish to dive. This review article will aim to explore the current guidelines which can assist a physician in providing a comprehensive dive safety assessment.

Safety and reproducibility of nasal allergen challenge.

BACKGROUND: The nasal allergen challenge (NAC) is a useful tool for the diagnosis of allergic rhinitis (AR) and local allergic rhinitis (LAR) and might serve to design and monitor allergen immunotherapy. Nevertheless, data about its safety and reproducibility are scarce. OBJECTIVE: To investigate the safety and reproducibility of NAC in pediatric and adult rhinitis patients with/without asthmatic symptoms, and in healthy controls. METHODS: A retrospective evaluation of the NACs conducted in our Unit for 2005-2017 and monitored by acoustic rhinometry and nasal-ocular symptoms was performed to analyze the safety of two methods for allergen application (metered spray & micropipette) and NAC protocols (NAC with single or multiple allergens/session [NAC-S & NAC-M]). The adverse events (AEs), spirometry values, and rescue medication required for AE were recorded. The reproducibility was examined by a prospective analysis of three repeated NAC-S performed at 1-2-month interval in AR, LAR and nonallergic rhinitis patients, and in healthy controls. RESULTS: A total of 11 499 NACs were performed in 518 children and 5830 adults. Only four local AE occurred, and 99.97% of NACs were well tolerated. The reproducibility and positive and negative predictive values of three consecutive NAC-S performed in 710 subjects were 97.32%, 100%, and 92.91%, respectively. There were no false-positive results in the 710 analyzed subjects. Safety and reproducibility were comparable between the methods of allergen application and the rhinitis phenotypes. CONCLUSION: The NAC is a safe and highly reproducible diagnostic test ready to be used in the clinical practice in both children and adults with or without asthma.

FEATURES OF NITRIC OXIDE METABOLISM AND RISK OF DEVELOPING ENDOTHELIAL DYSFUNCTION IN CHILDREN WITH e-NOS GENE 4a/4b POLYMORPHISM UNDER LONG-TERM ENTERING 137Cs TO BODY. / OSOBLYVOSTI METABOLIZMU OKSYDU AZOTU TA RYZYK ROZVYTKU ENDOTELIAL'NOÏ DYSFUNKTsIÏ U DITEI Z 4a/4b POLIMORFIZMOM GENA eNOS PRY TRYVALOMU NADKhODZhENNI 137Cs DO ORGANIZMU.

OBJECTIVE: To determine the features of the nitrogen oxide metabolism and risk of developing endothelial dysfunc-tion in children with e-NOS 4a/4b gene polymorphism, who live under prolonged enter 137Cs to the body. MATERIALS AND METHODS: There were examined 117 children-residents of radioactively contaminated territories and50 children of control group. The level of stable metabolites was defined in blood serum (NO2- and NO3-). The ther-mographic method was used to register the endothelium dependent reaction of the vascular bed to changes in theblood supply. The ventilation capacity of the lungs was evaluated using this method of pneumotachography.Polymorphism in intron 4 of the gene e-NOS was studied by the method of polymerase chain reaction. The contentof 137Cs in the body of children was determined using a human radiation counter Skrynner M-3. RESULTS AND CONCLUSIONS: In children-residents of radioactively contaminated territories with genotype 4a/4b com-paring to children who had genotype 4b/4b, the decrease in the nitric content of in the blood serum, the increase inthe thermographic index of the recovery period of blood circulation to the baseline level after occlusion test werenoted, that is indicative of the decreased NO-synthase active of vascular endothelium in the carriers of the minorallele a in the 4th intron of gene eNOS (genotype 4a/4b), and is a risk factor for development of endothelial dysfunc-tion. It was proved a decrease in the index of lung tissue elasticity and stretchability - FVC / NFVC of the lungs com-paring to children with genotype 4b/4b, there was a reduction of integral index of respiratory tract permeability -FEV1/NFEV1. The inverse correlation dependence between the presence of allele a in the genotype and the values ofFVC/NFVC of the lungs (r = -0.259; p <0.05) and FEV1/NFEV1 (r = -0.2267; p <0.05) was found. Signs of bron-chospasm were found in the carriers of the allele a in 1.5 times more often than in children-carriers of homozy-gotes from allele b.