SEVERE BRONCHOSPASM DURING ANESTHETIC INDUCTION: IMMEDIATE MANAGEMENT, DIFFERENTIAL DIAGNOSIS, AND OUTCOME. CASE REPORT
Keywords:
Bronchospasm; General anesthesia; Anesthetic induction; Perioperative anaphylaxis; Epinephrine; CapnographyAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0808
Abstract
Perioperative bronchospasm is a time-critical emergency that may lead to severe hypoxemia, hypercapnia, abrupt increases in airway pressures and hemodynamic instability, particularly during induction and airway instrumentation. Its differential diagnosis is broad and includes mechanical causes (endotracheal tube or circuit obstruction), endobronchial intubation, aspiration, tension pneumothorax, cardiogenic or non-cardiogenic pulmonary edema, and bronchoconstriction due to airway hyperreactivity or perioperative anaphylaxis. We report a 56-year-old male scheduled for elective laparoscopic cholecystectomy under general anesthesia who developed severe bronchospasm immediately after tracheal intubation, with markedly elevated peak inspiratory pressures, reduced tidal volume, oxygen desaturation and a classic "shark-fin" capnogram. Concomitant hypotension occurred without obvious skin signs, prompting high clinical suspicion of perioperative anaphylaxis. Initial management included 100% oxygen, manual ventilation to assess compliance, systematic exclusion of mechanical problems, deepening anesthesia, inhaled bronchodilators and hemodynamic support. Because of incomplete response and circulatory compromise, titrated intravenous epinephrine was administered, resulting in progressive improvement of ventilation and perfusion. Serial serum tryptase samples were obtained and the patient was referred for allergy work-up to identify the culprit agent and plan safe future anesthesia. This case highlights a structured, reproducible approach to severe bronchospasm during induction, prioritizing early recognition, rapid identification of reversible causes and timely epinephrine when anaphylaxis is suspected.
Keywords: Bronchospasm; General anesthesia; Anesthetic induction; Perioperative anaphylaxis; Epinephrine; Capnography.
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