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1

Asthma and bronchospasms

this is the first topic!!!!!!!!!!

2

what is asthma?

a chronic pulmonary disease characterized by airway inflammation, airflow obstruction, and bronchial hyper-reactivity

3

5 manifestations of asthma

dyspnea
wheezing
chest tightness
cough

4

2 types of asthma

Atopic
non-atopic

5

which asthma is the most common type?

atopic

6

Which asthma is:
type I IgE mediated hypersensitivity reaction
usually beings in childhood
triggered by environmental allergens
skin test with antigen shows wheel and flare reation

Atopic

7

Which type of asthma is:
viral respiratory infections are common trigger
inflammation associated hyperirritability
family hx less common
no evidence of allergen sensitization

non-atopic

8

Patho of atopic Asthma
big ass slide just read over be familiar with different phases and basic process!!!

-initial exposiure to the allergen stimulates the TH2 cells to:
----secrete inflammatory cytokins
---- trigger the B cells to produce IgE
- IgE coated mast cells
-repeated exposure to allergen triggers the mast cells to release granule contents and produce cytokines and other mediators
-EARLY PHASE
-bronchoconstriction, increased mucus production, vasodilation with increased vascular pearmeability
LATE PHASE
- epithelial damage and additional inflammation and airway constriction

9

You can do it!!

just a word of encouragement!!!!

10

Bronchoactive drugs!
give examples of each category
B2-adrenergic agonist?
Anticholinergics?
MastCell stabilizers?
Corticosteroids?
Luekotriene receptor antagonist?

B2-adrenergic agonist?
----albuterol; terbutaline; metaproternol
Anticholinergics?
---- ipratropium bromide
MastCell stabilizers?
---- cromolyn, nedocromil
Corticosteroids?
you know them there is a million
Luekotriene receptor antagonist?
----- Muontelukast, Zafirlukast, and Zileuton

11

Quickly how do each of the following drug categories work for asthma (should know incase our pt's get asthma attack in OR) don;t go deep (lol) please give it a try you'll surprise yourself!!!!
B2-adrenergic agonist?
Anticholinergics?
MastCell stabilizers?
Corticosteroids?
Luekotriene receptor antagonist?

B2-adrenergic agonist?
--directly relax smooth muscle of airway
Anticholinergics?
---- antimuscarinic bronchodilating effects in bronchial smooth muscle and blocking constriction of vagal efferent stimulation
MastCell stabilizers?
---- prevention and reduction of inflammation
Corticosteroids?
---- anti-inflammatory
Luekotriene receptor antagonist?
---- inhibits leukotriene production (part or thr arachidonic acid pathway)

12

GA implications with ASTHMA::

-GA may trigger asthma exacerbation
-alteration of diaphragmatic function
-impaired ability to cough
-decreased mucociliary function
-stimulation/irritation of airway by ETT

13

_______ and _______ of the most recent asthma attacks are the most significant predictors of bronchospasms!

proximity and severity

14

Changes in lung function can also leas to ______, _____ ______, and ________ postoperatively

atelectasis
mucus plugging
wheezing

15

Asthma exacerbation intra-op can also lead to what?

prolonged intubation
hypoxemia
pneumonia

16

Recent studies have found NO links between higher risks postop complications and pts with asthma? true or false

true

17

from a study!!!!
pt's with asthma who are well controlled and who have a peak flow measurement of > __% of predicted or personal best can proceed to surgery at average risk!!

80

18

preop assessment for asthma

inspection
auscultation
questions
-age of onset
-triggering events
-allergies
-cough sputum characteristics
Current meds (and effectiveness)
smoking HX
Anesthetic HX
-asthma related complications
Hospitalizations for asthma
-freq of ER visits
-Hx of intubation and mechanical ventilation

19

Preop management and interventions for the asthmatic

Chest PT
antibiotic therapy
Bronchodilator therapy (continue day of SX)
corticosteroids (stress dose if indicated)
----stress dose hydrocortisone 100mg IV

20

Asthma classifications
Intermittent asthma-
Mild persistent asthma-
mod persistent asthma-
severe persistent asthma-

really way to much for a slide!!!! see ppt slide 23 if you want

21

Intraop management for asthma

-regional if not contraindicated
- Avoid non-selective BB (propranolol and Labetalol)
- Avoid NSAIDs (toradol)
- Avoid histamine releasing drugs ( morphine, atricurium, suxs, mivacurium, demerol, thiopental)

22

Intraop agents (tell me their effects)
propofol-
Ketamine-
Lidocaine-
VAAs-

propofol- bronchodilator
Ketamine- smooth muscle relaxant and decreased airway resistance
Lidocaine-supress airway reflexes (inhaled can assist)
VAAs- all are potent bronchodilators (sevo least irritating)

23

Extubation for Asthma-

deep- controversal
bronchodilator- albuterol
IV lidocaine

24

S/S of bronchospasm

-high inflation pressures
-expiratory upsloping on ETCO2
-prolonged expiration
-decreased O2 sat
- expiratory wheezing
- decreased breath sounds

25

treatment for bronchospasm

100% O2
Increase anesthestic
beta agonist (terbutaline 0.25mg SQ; albuterol)
anticholinergic ( ipratropium bromide)
Lido IV
Epi-
corticosteroids

26

Next section is COPD!!!

Great job on the last section!!!!!!!!!

27

Name 5 common obstructive disorders

Emphysema
Chronic bronchitis
Asthma
Bronchiectasis
OSA

28

______ and ________ are often clinically grouped together and refered to as COPD

emphysema
chronic bronchitis

29

Emphysema and chronic bronchitits are often clinically grouped together and refered to as COPD, since many people have overlapping features of damage at both the acinar level and bronchial level, almost certainly because of the extensive trigger _______ _______ is common in both

cigarette smoking

30

about ___% of people with COPD are NON-smokers

10%