Intraoperative Bronchospasm - Guidelines for Crises in Anaesthesia



❶ Call for help and inform theatre team of problem.

❷ Give 100% oxygen.

❸ Stop surgery / other stimulation.

❹ Fully expose the chest and perform a rapid systematic examination:

  • Inspect, percuss, palpate, auscultate.

  • Absence of wheeze may indicate severe bronchospasm with no air movement.

❺ Deepen anaesthesia:

  • Bronchospasm may be a consequence of light anaesthesia.

  • Inhalational anaesthetic agents are bronchodilators.

  • Avoid isoflurane or desflurane if possible – airway irritant if increased rapidly.

❻ Exclude malpositioned or obstructed tracheal tube or supraglottic airway

  • Consider whether there could be endobronchial or oesophageal intubation.

❼ If anaphylaxis suspected → 3-1

❽ If airway soiling/aspiration suspected airway see Box A.

❾ Treat bronchospasm (Box B). First line is salbutamol by metered dose inhaler or by nebuliser; i.v. route is second line. Other drugs at clinician discretion.

❿ Consider alternate diagnoses causing or mimicking bronchospasm (Box C).

⓫ Use appropriate ventilation strategy (Box D).

⓬ If raised airway pressure and/or desaturation persists, consider → 2-2 Hypoxia/desaturation/cyanosis.

⓭ Obtain a chest X-ray as soon as clinically safe to do so.

⓮ Plan appropriate placement for post-procedure care. 



Drugs: Salbutamol, Ipratropium, Adrenaline, Magnesium, Ketamine, Aminophylline, Hydrocortisone



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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