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Severe Bronchospasm During Separation from Cardiopulmonary Bypass: Diagnosis, Etiology, and Treatment

      BRONCHOSPASM CAN be potentially one of the most life-threatening intraoperative respiratory complications. Airway hyperreactivity and parasympathetic overactivity can trigger bronchoconstriction and airway obstruction.
      • Morgan G
      • Mikhail MS
      • Murray M
      • et al.
      Anesthesia for patients with respiratory disease.
      The incidence of intraoperative bronchospasm is quite low (approximately 1.7%).
      • Woods BD
      • Sladen RN.
      Perioperative considerations for the patient with asthma and bronchospasm.
      In general, it occurs most commonly after induction of general anesthesia. Fulminant bronchospasm during cardiopulmonary bypass (CPB) is even more rare, with only a handful of case reports in the literature.
      • Neustein SM
      • Bronheim D.
      Severe bronchospasm following cardiopulmonary bypass in an asthmatic.
      • Ecoff SA
      • Miyahara C
      • Steward DJ.
      Severe bronchospasm during cardiopulmonary bypass.
      • Lin Z
      • Huang KA
      • Chen D
      • et al.
      Severe bronchospasm during aortic surgery for type a aortic dissection.
      • Shiroka A
      • Rah KH
      • Keenan RL.
      Bronchospasm during cardiopulmonary bypass.
      • Gallo P
      • Kirvassilis G.
      Use of endotracheal isoproterenol for severe bronchospasm while weaning from cardiopulmonary bypass.
      • Kawahito S
      • Kitahata H
      • Tanaka K
      • et al.
      Bronchospasm induced by cardiopulmonary bypass.
      The majority of these cases report severe bronchospasm episodes while re-establishing mechanical ventilation, before separation from CPB.
      • Ecoff SA
      • Miyahara C
      • Steward DJ.
      Severe bronchospasm during cardiopulmonary bypass.
      Here, the authors present a patient who experienced both mild bronchospasm after induction, as well as severe bronchospasm while weaning from CPB.

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      References

        • Morgan G
        • Mikhail MS
        • Murray M
        • et al.
        Anesthesia for patients with respiratory disease.
        in: Butterworth IVJFMD Wasnick JD Morgan and Mikhail's Clinical Anesthesiology. McGraw Hill, New York, New York2018
        • Woods BD
        • Sladen RN.
        Perioperative considerations for the patient with asthma and bronchospasm.
        Br J Anaesth. 2009; 103: i57-i65
        • Neustein SM
        • Bronheim D.
        Severe bronchospasm following cardiopulmonary bypass in an asthmatic.
        J Cardiothorac Vasc Anesth. 1992; 6: 609-611
        • Ecoff SA
        • Miyahara C
        • Steward DJ.
        Severe bronchospasm during cardiopulmonary bypass.
        Can J Anaesth. 1996; 43: 1244-1248
        • Lin Z
        • Huang KA
        • Chen D
        • et al.
        Severe bronchospasm during aortic surgery for type a aortic dissection.
        Heart Surg Forum. 2021; 24: e575-e577
        • Shiroka A
        • Rah KH
        • Keenan RL.
        Bronchospasm during cardiopulmonary bypass.
        Anesth Analg. 1982; 61: 538-540
        • Gallo P
        • Kirvassilis G.
        Use of endotracheal isoproterenol for severe bronchospasm while weaning from cardiopulmonary bypass.
        J Cardiothorac Vasc Anesth. 2019; 33: S121-S122
        • Kawahito S
        • Kitahata H
        • Tanaka K
        • et al.
        Bronchospasm induced by cardiopulmonary bypass.
        Ann Thorac Cardiovasc Surg. 2001; 7: 49-51
        • Hemmingsen C
        • Nielsen PK
        • Odorico J.
        Ketamine in the treatment of bronchospasm during mechanical ventilation.
        Am J Emerg Med. 1994; 12: 417-420
        • Stoelting RK.
        Allergic reactions during anesthesia.
        Anesth Analg. 1983; 62: 341-356
        • Hepner DL
        • Castells MC.
        Anaphylaxis during the perioperative period.
        Anesth Analg. 2003; 97: 1381-1395
        • Unsel M
        • Mete N
        • Ardeniz O
        • et al.
        Diagnostic value of specific IgE analysis in latex allergy.
        Int Arch Allergy Immunol. 2012; 158: 281-287
        • Balogh AL
        • Petak F
        • Nevery K
        • et al.
        Bronchoconstriction and alveolar derecruitment following cardiopulmonary bypass.
        Eur Respir J. 2014; 44: P1820
        • Chenoweth DE
        • Cooper SW
        • Hugli TE
        • et al.
        Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins.
        N Engl J Med. 1981; 304: 497-503
        • Kirklin JK
        • Westaby S
        • Blackstone EH
        • et al.
        Complement and the damaging effects of cardiopulmonary bypass.
        J Thorac Cardiovasc Surg. 1983; 86: 845-857
        • Harper NJN
        • Cook TM
        • Garcez T
        • et al.
        Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6).
        Br J Anaesth. 2018; 121: 159-171
        • Harper NJN
        • Cook TM
        • Garcez T
        • et al.
        Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6).
        Br J Anaesth. 2018; 121: 172-188
        • Cook TM
        • Harper NJN
        • Farmer L
        • et al.
        Anaesthesia, surgery, and life-threatening allergic reactions: protocol and methods of the 6th National Audit Project (NAP6) of the Royal College of Anaesthetists.
        Br J Anaesth. 2018; 121: 124-133
        • Vanden Hoek TL
        • Morrison LJ
        • Shuster M
        • et al.
        Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S829-S861
        • Fisher M
        • Baldo BA.
        Anaphylaxis during anaesthesia: current aspects of diagnosis and prevention.
        Eur J Anaesthesiol. 1994; 11: 263-284
        • Fisher MM
        • Baldo BA.
        The incidence and clinical features of anaphylactic reactions during anesthesia in Australia.
        Ann Fr Anesth Reanim. 1993; 12: 97-104
        • Harper NJ
        • Dixon T
        • Dugué P
        • et al.
        Suspected anaphylactic reactions associated with anaesthesia.
        Anaesthesia. 2009; 64: 199-211
        • Mertes PM
        • Lambert M
        • Guéant-Rodriguez RM
        • et al.
        Perioperative anaphylaxis.
        Immunol Allergy Clin North Am. 2009; 29: 429-451
        • Mertes PM
        • Laxenaire MC
        • Alla F
        Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000.
        Anesthesiology. 2003; 99: 536-545
        • Laroche D
        • Lefrançois C
        • Gérard JL
        • et al.
        Early diagnosis of anaphylactic reactions to neuromuscular blocking drugs.
        Br J Anaesth. 1992; 69: 611-614
        • Ring J
        • Messmer K.
        Incidence and severity of anaphylactoid reactions to colloid volume substitutes.
        Lancet. 1977; 1: 466-469
        • Kroigaard M
        • Garvey LH
        • Gillberg L
        • et al.
        Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia.
        Acta Anaesthesiol Scand. 2007; 51: 655-670
        • Cox L
        • Larenas-Linnemann D
        • Lockey RF
        • et al.
        Speaking the same language: the world allergy organization subcutaneous immunotherapy systemic reaction grading system.
        J Allergy Clin Immunol. 2010; 125 (574.e561-7): 569-574
        • Maqsood U
        • Patel N.
        Extracorporeal membrane oxygenation (ECMO) for near-fatal asthma refractory to conventional ventilation.
        BMJ Case Rep. 2018; 2018 (bcr2017223276)
        • Yeo HJ
        • Kim D
        • Jeon D
        • et al.
        Extracorporeal membrane oxygenation for life-threatening asthma refractory to mechanical ventilation: analysis of the extracorporeal life support Organization registry.
        Crit Care. 2017; 21: 297
        • Carelli M
        • Seco M
        • Forrest P
        • et al.
        Extracorporeal membrane oxygenation support in refractory perioperative anaphylactic shock to rocuronium: a report of two cases.
        Perfusion. 2019; 34: 717-720
        • Allen SJ
        • Gallagher A
        • Paxton LD.
        Anaphylaxis to rocuronium.
        Anaesthesia. 2000; 55: 1223-1224
        • Lafforgue E
        • Sleth JC
        • Pluskwa F
        • et al.
        Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium [article in French].
        Ann Fr Anesth Reanim. 2005; 24: 551-555
        • Huffmyer JL
        • Groves DS.
        Pulmonary complications of cardiopulmonary bypass.
        Best Pract Res Clin Anaesthesiol. 2015; 29: 163-175
        • Tuman KJ
        • Ivankovich AD.
        Bronchospasm during cardiopulmonary bypass. Etiology and management.
        Chest. 1986; 90: 635-637
        • Rajesh MC.
        Bronchospasm under general anaesthesia.
        BMH Med J. 2018; 5: 98-103
        • Mondoñedo JR
        • McNeil JS
        • Amin SD
        • et al.
        Volatile anesthetics and the treatment of severe bronchospasm: a concept of targeted delivery.
        Drug Discov Today Dis Models. 2015; 15: 43-50
        • Durant PA
        • Joucken K.
        Bronchospasm and hypotension during cardiopulmonary bypass after preoperative cimetidine and labetalol therapy.
        Br J Anaesth. 1984; 56: 917-920
        • Salter B
        • O’Donnell T
        • Weiner M
        • et al.
        Adenosine and bronchospasm: vigilance in the electrophysiology suite.
        J Cardiothorac Vasc Anesth. 2015; 29: 410-411
        • Dewachter P
        • Mouton-Faivre C
        • Emala CW
        • et al.
        Case scenario: bronchospasm during anesthetic induction.
        Anesthesiology. 2011; 114: 1200-1210
        • Levy JH
        • Adkinson Jr., NF
        Anaphylaxis during cardiac surgery: implications for clinicians.
        Anesth Analg. 2008; 106: 392-403
        • Dewachter P
        • Savic L.
        Perioperative anaphylaxis: pathophysiology, clinical presentation and management.
        BJA Educ. 2019; 19: 313-320
        • Mills AT
        • Sice PJ
        • Ford SM.
        Anaesthesia-related anaphylaxis: investigation and follow-up.
        Contin Educ Anaesth Crit Care Pain. 2013; 14: 57-62
        • Dribin TE
        • Schnadower D
        • Spergel JM
        • et al.
        Severity grading system for acute allergic reactions: a multidisciplinary Delphi study.
        J Allergy Clin Immunol. 2021; 148: 173-181
        • Sampson HA
        • Muñoz-Furlong A
        • Campbell RL
        • et al.
        Second symposium on the definition and management of anaphylaxis: summary report–second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.
        J Allergy Clin Immunol. 2006; 117: 391-397
        • Dewachter P
        • Mouton-Faivre C
        • Emala CW.
        Anaphylaxis and anesthesia: controversies and new insights.
        Anesthesiology. 2009; 111: 1141-1150
        • Garvey LH
        • Dewachter P
        • Hepner DL
        • et al.
        Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations.
        Br J Anaesth. 2019; 123: e50-e64

      Linked Article

      • Reduction of Pulmonary Arterial Blood Flow as a Possible Mechanism for Bronchospasm During Cardiopulmonary Bypass
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 11
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          I READ the interesting case report that reviewed a severe bronchospasm during the separation from a cardiopulmonary bypass (CPB).1 As previously reported, a reduction in blood flow along the branches of the pulmonary artery can lead to a decrease in ventilation in the corresponding areas of the lungs, largely due to reflex (hypocapnic) bronchoconstriction.2,3 With the local disorders of pulmonary blood flow, this mechanism prevents the formation of excess deadspace.4 Because of the marked decrease in blood flow in the pulmonary artery during CPB, a bronchospasm also can be considered as an expected complication.
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