The child with asthma for anaesthesia

Abstract

Asthma is one of the most common coexisting diseases in children, and a major cause of mortality and morbidity in children. Morbidity is measured by school absences, emergency department visits and hospitalisations. Asthma continues to take the lives of children at an alarming rate and there is evidence that its mortality has increased over the last 20 years. Asthma severity has increased with urbanisation and exposure to cigarette smoke. Proper diagnosis, education, and appropriate management are essential to decrease morbidity and mortality. This review article provides an understanding of the disease process, differences in physiology compared with adults and the use of a stepwise treatment of asthma according to level of control. Asthma can be controlled, partially controlled or uncontrolled. Control can be determined by assessment of daytime symptoms, limitation of activities, nocturnal symptoms, need for reliever, pulmonary function tests, and the frequency of exacerbations. Discussion follows with the pre-operative assessment of a child with asthma, the timing of the anaesthetic, and management of the asthma patient in theatre. Intra-operative bronchospasm is one of the most difficult situations that an anaesthesiologist must handle and this article serves to provide tools in order to avoid this. It concludes with an approach to the management of intra-operative bronchospasm.