Article Type : Research Article
Authors : Dalamagka MI
Keywords : Astma; Anesthesia; Bronchospasm; Sevoflurane; Ketamine; Corticosteroids
Asthma in children is associated with significant morbidity.
Children with severe asthma are at increased risk for adverse outcomes including
medication-related side effects, life-threatening exacerbations, and impaired
quality of life. In the study, an asthmatic child with a recent cold, received
general anesthesia for emergency surgery centered on sevoflurane,
corticosteroids and ketamine. The purpose of this study is to demonstrate the
beneficial effects of the combination of sevoflurane, ketamine and
corticosteroids in asthmatic children and to prevent complications when they
are given general anesthesia for emergency surgery.
Asthma is a chronic
respiratory disease that affects people of all ages and is characterized by
episodic and reversible attacks of wheezing, chest tightness, shortness of
breath, and coughing. According to the ATS/ERS guideline, severe asthma is
defined as asthma which requires treatment with high dose inhaled corticosteroids
(ICS) plus a second controller (and/or systemic corticosteroid) to prevent it
from becoming “uncontrolled” or remains “uncontrolled” despite this therapy [1-10].
A 6-year-old child
weighing 30 kg with a recent cold, nasal congestion and hearing of both
amphibians and with a known history of frequent asthma attacks underwent
emergency appendectomy. It was given intravenously before the introduction of
anesthesia solu medrol 60 mg, Dexaton 3 mg, onda 3 mg. Introduction to anesthesia
was by intravenous administration of Fentanyl 60 mcg, Propofol 120 mg, Esmeron
30 mg. After intubation, intrabronchial aspiration was performed,
intrabronchial Flixotide 50 mcg Aerolin 100 mcg was given and mechanically
ventilated with 50% N2O and 2% sevoflurane. Ketamine 6 mg was given
intravenously, plus 30 mcg Fentanyl, Apotel 350 mg, and morphine 1.5 mg. The
monitoring included ECG, NBP, SpO2 and the ventilation model in
Drager machine was Volune Control. Towards the end of the operation and with
pure inhaled oxygen he was put in a Pressure Control model and the awakening
was done smoothly after intravenous Bridium 0.6 mg.
The common denominator
underlined in all forms of asthma is bronchial hyperresponsiveness to various
stimuli. Inhaled glucocorticoids have long been used as a first-line treatment
for persistent pediatric asthma, as they are the most effective intervention
for the treatment of asthma. Thus Solu medrol (kg x 2), Dexaton (up to 0.1x kg)
and Flixotide 50 mcg and Aerolin 100 mcg were administered intravenously.
Ketamine also causes bronchodilation and was administered at its appropriate
titrated dose (0.2 x kg), as anesthesia was maintained with sevoflurane which
does not irritate the respiratory system.
Corticosteroids have
inhibitory properties in many effects on many stem cells and inflammatory
cells, which are activated in asthma. Inhaled steroids reduce the number and
activation of inflammatory cells in the epithelium and submucosa by clogging
the damaged epithelium and, potentially, inhibiting the production of
proinflammatory cytokines, and reducing the survival time of the epithelium.
This action of corticosteroids in combination with the ketamine which has a
bronchodilator effect and the property of sevoflurane as it does not irritate
the airway, they eliminate bronchospasm and prevent possible laryngospasm.
In conclusion, the
combination of Ketamine, corticosteroids and sevoflurane has been shown to
inhibit possible complications such as bronchospasm when asthmatic children
implied in general anesthesia.
Statement of informed
consent Written informed consent was obtained from the patient for publication
of this case report. A copy of the written consent is available.