Management of Intraoperative Asthma Attacks in Emergency Appendectomy Surgery

I Wayan Wahyu Giana Permana, Veronika Susanty Siampa

Abstract: Introduction: Asthma is defined as a chronic inflammatory disease of the respiratory tract due to airway hyper responsiveness with clinical manifestations such as: shortness of breath, chest pain and/or cough with typical physical examination found wheezing in the lungs. Appendectomy is a surgical procedure performed to remove an infected appendix, which can cause pain. ? In this case, we will discuss the management of asthma during emergency appendectomy surgery. Case: It has been reported that a 19-year-old female patient with a diagnosis of acute appendicitis with a physical status of the patient is ASA II E was planned to have an emergency appendectomy with a type of regional anesthesia and subarachnoid block technique + deep sedation. The patient was premedicated with paracetamol 1 g IV and dexamethasone 10 mg IV, then spinal anesthesia was performed with bupivacaine 20 mg and given midazolam sedation 2 mg IV, fentanyl 50 mcg IV and O2 2 lpm nasal cannula. In this case the patient brought the fenoterol inhaler reliever drug as the first line during an intraoperative asthma attack and was given aminophylline 5mg/kgbb IV when the complaint had not improved. Epinephrine 0.5 mg SC is given when other drugs fail to relieve symptoms during an attack. Discussion: Intraoperative asthma therapy is with beta agonist groups such as fenoterol inhalers which can relieve asthma at the start of an attack. Giving premedication such as benzodiazepines is important to make the patient calmer. Aminophylline is a xanthine class of drugs that causes bronchodilation due to inhibition of phosphodiesterase isoenzymes. Low-dose epinephrine is given if all other asthma medications don't work. Conclusion: The choice of a regional anesthetic technique in asthma is the best option to avoid overresponsiveness to the airway. Emotional pressure, inadequate premedication and post-spinal pain can trigger intraoperative asthma. Beta agonist and methylxanthine drugs are often used as intraoperative asthma therapy. Key findings: Successful management of intraoperative was achieved using fenoterol, aminophylline, and epinephrine.

Keywords: Asthma Management, Regional Anesthesia, Appendectomy, Intraoperative Asthma, Emergency Surgery