Anesthésie et hyperréactivité bronchique

Asthma and atopy are the main causes of bronchial hyperactivity. Tracheobronchial infection and active and passive smoking increase bronchial hyperactivity. Cessation of smoking for more than 48 hours decrease the risk. A careful preoperative assessment of asthma is required; corticosteroids and β2-adrenergic agonists are given in case of severe asthma. Regional anaesthesia is indicated whenever possible. Facial mask spontaneous ventilation should be maintained during general anaesthesia, when appropriate. Propofol or sevoflurane should be used for anaesthetic induction. In case of bronchospasm, it is recommended to increase anaesthesia depth, to adapt controlled ventilation, and to administer β2-adrenergic agonists via the anaesthetic circuit and then by the intravenous route if bronchial constriction persists. In that case, intravenous epinephrine is also indicated.