Anaesthetic management of patients with bronchospastic disease

This article presents a brief resume of airway anatomy, physiology and pharmacology, a disccussion of mechanisms underlying airway hyper-reactivity, preoperative assessment of the patient with bronchospasm and a critical evaluation of effects of anaesthetics in reactive airway disease. The airway of the patient with bronchospastic disease is a dynamic structure. Changes in airway calibre profoundly effect the distribution of gases within the lung. Therefore, the anaesthesiologist must attempt to prevent or reverse the occurrence of airway constriction. This may be accomplished by blocking parasympathetic irritant reflexes, by directly relaxing airway smooth muscle, by inhibiting mediator release and by augmenting β₂-adrenergic sympathetic activity.