On doing laparoscopic cholecystectomy patient developed wheezing. Which of the following is used in the treatment?
Ans. d. Deepen the plane of anesthesia (Ref: Yao and Artusio's Anesthesiology: Problem oriented Patient Management, 7th edition, by Fun-Sun F. Yao. Vinod Malhotra, and Manuel L. Fontes)On doing laparoscopic cholecystectomy patient developed wheezing, which should be treated by deepening of the plane of anesthesia.The most common cause of asthmatic attack during surgery is inadequate depth of anesthesia. First, deepen the level of anesthesia and increase FIO2. Remember that the patient is under anesthesia and undergoing surgery. Therefore, medical intervention, such as B-agonist administration, is not the first choice of treatment. - Yao and Artusio's AnesthesiologyIn the middle of surgery, the patient developed a severe wheezing attack. How do you manage it?First, deepen the level of anesthesia and increase FIO2, Remember that the patient is under anesthesia and undergoing surgery. Therefore, medical intervention, such as B-agonist administration, is not the first choice of treatment.The most common cause of asthmatic attack during surgery is inadequate depth of anesthesia.The patient with asthma has an extremely sensitive tracheobronchial tree. When the level of anesthesia is too light, the patient may develop bucking, straining, or coughing as a result of the foreign body (endotracheal tube) in the trachea and then bronchospasm.First, the blood pressure is taken to ensure it is normal or high, and then anesthesia is deepened by increasing the concentration of inhalation agents, such as sevoflurane, halothane, or isoflurane. which are direct bronchodilators as well.An incremental dose of ketamine maybe a quick way of maintaining blood pressure, rapidly deepening anesthesia, achieving bronchodilation, and avoiding the problem of delivering an inhaled anesthetic to a patient with poor ventilation.At the same time, oxygenation can be improved by increasing the inspired oxygen concentration and decreasing nitrous oxide. The patient should be continuously ventilated with a volume-cycled ventilator.Second, relieve mechanical stimulation. Pass a catheter through the endotracheal tube to suction secretions and determine whether there is an obstruction, kinking of the tube, or overinflation of the endotracheal tube cuff.The cuff of the endotracheal tube can be deflated, the tube moved back 1 to 2 cm, and the cuff reinflated. Occasionally, the endotracheal tube slips down and stimulates the carina of the trachea, causing severe bronchospasm during light anesthesia.Surgical stimulation, such as traction on the mesentery, intestine, or stomach, should be stopped temporarily, because it causes vagal reflex and can cause bronchospasm.Third, medical intervention is necessary if the previously mentioned treatment cannot break the bronchospasm or the anesthesia cannot be increased because of hypotension.The cornerstone of the treatment of the intraoperative bronchospasm is inhalation of B2-agonists such as albuterol, which induce further bronchodilation even in the presence of adequate inhalational anesthesia.Fourth, bring in an intensive care unit (ICU) ventilator. Anesthesia ventilators are not designed for patients with high airway resistance. An ICU ventilator can generate inspiratory pressures as high as 120 cm H2O. With low tubing compliance, little ventilation is wasted into the circuit.
IV ketamine
IV lignocaine
Administration of beta agonist
Deepen the plane of anesthesia
Complications Of Anaesthesia