If the patient cannot be extubated, what measures can you take to reduce the likelihood of bronchospasm with an endotracheal tube in place?
Answer:
Loading doses of lidocaine, followed by continuous infusion, as described in section C.5, may be administered intravenously to prevent bronchoconstriction induced by stimulation of the trachea by the endotracheal tube. 2-Agonists such as albuterol may be administered through MDI adapter to prevent bronchospasm. Dexmedetomidine, which has a favorable profile, including anxiolysis, sympatholysis, and drying of secretions without respiratory depression, can be used to sedate an agitated patient with asthma who does not meet extubation criteria. Alternatively, if there are no contraindications, a supraglottic airway may be used to replace the endotracheal tube for control of ventilation and to avoid tracheal stimulation.
Reference(s):
- Groeben H, Mitzner W, Brown RH. Effects of the alpha2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs. Anesthesiology. 2004;100:359-363.
- Hines RL, Marschall KE, eds. Stoelting’s Anesthesia and Co-existing Disease. 7th ed. Philadelphia, PA: Elsevier; 2018:21-22.
- Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103(suppl 1):i57-i65.