Bronchospasm during Anesthesia Induction in A Patient with Undiagnosed Asthma

In large study of 9287 children undergoing general anesthesia, the incidence of perioperative bronchospasm is 2.1 percent. During anesthesia in patients with well-controlled asthma, airway complications such as bronchospasm are rare. However, poorly controlled asthma is closely related to the pathophysiologic mechanisms of nonallergic and allergic bronchospasm. More than 80% of asthma patients have allergic rhinitis, and 10-40% of allergic rhinitis patients have asthma.  We report a case of a 10-year-old male with undiagnosed asthma who developed bronchospasm during induction of anesthesia. This patient had been treated for allergic rhinitis before surgery. Unexpected bronchospasm occurred immediately after induction of anesthesia and was treated with salbutamol nebulizer and intravenous dexamethasone. In addition, a massive hypotension-suspected anaphylactic reaction occurred and was treated with intravenous epinephrine, after which airway pressure and vital signs improved. For safety, the operation was canceled, anesthesia was discontinued, and the patient was discharged without specific complications. Asthma was diagnosed upon further evaluation two weeks after discharge. Because this patient had been treated for allergic rhinitis before surgery, asthma should have been diagnosed before surgery. If asthma symptoms before anesthesia were well-controlled using a bronchodilator, steroid, etc., bronchospasm could have been prevented during anesthesia in the current case. This case suggests that, when possible, asthma should be diagnosed before surgery in allergic rhinitis patients. This case also suggests that anesthesia should be performed after good control of asthma symptoms before surgery to prevent life-threatening perioperative events.