Perioperative Management of Asthmatic Patient: A Case Report
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Taufiq Gemawan
Salsabilla Widarosa
Adelia Handoko*
Nurfaizah Titisari Sulihah
Achmad Wahib Wahju Winarso
Achmad Hariyanto
Joice Anitta Evlin Manawan
Suparno Adi Santika
Haris Darmawan
Teguh Prastyo
Asthma is a chronic inflammatory disease of the airways, primarily manifested by recurrent episodes of wheezing, shortness of breath, and chest tightness during an acute exacerbation. In the perioperative, asthmatic patients require special consideration, particularly during surgical procedures. Specific anesthetic agents, along with the mechanical irritation of airway instrumentation, potentially trigger acute exacerbations or unexpected bronchospasms that could be fatal. This case report aims to describe the perioperative management and clinical response of an asthmatic patient who experienced unexpected acute exacerbation during anesthesia induction. A 30 year old woman with controlled asthma (ASA II) underwent excision and reconstruction surgery under general anesthesia. Preoperative evaluation included chest X ray and physical examination, both showing normal findings. Sedation was initiated with propofol, fentanyl, ketamine, and atracurium. Clinical manifestations and interventions during surgery were documented. Shortly after induction, the patient developed tachypnea, desaturation (<90%), and diminished breath sounds, indicating acute bronchospasm. Management included aminophylline, dexamethasone, nebulized salbutamol and ipratropium, followed by substitution of atracurium with rocuronium. The patient stabilized, surgery was completed uneventfully, and postoperative recovery was normal. This case highlights that acute asthma exacerbation may occur perioperatively despite long term control, emphasizing the need for vigilant anesthetic assessment, careful drug selection, and readiness to manage bronchospasm promptly.
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