2020 Volume 48 Issue 2 Pages 81-83
Factors resulting in difficult ventilation during general anesthesia induction include bronchospasm, laryngeal spasm, lead pipe phenomenon, and anaphylaxis. Here, we report a case of difficult ventilation caused by an asthmatic attack during the induction of anesthesia.
The patient was an 8-year-old girl with a previous history of bronchial asthma. Nine months earlier, the patient had undergone general anesthesia for the extraction of an excess medial impacted tooth, but the operation was discontinued because of a ventilation impairment immediately after tracheal intubation. We planned to perform general anesthesia once again for the extraction of the same tooth.
A slow induction with sevoflurane at a higher concentration than that used previously was performed, but prior to intubation we had difficulty with the mask ventilation and intubation and requested support from medical anesthesiologists. Intubation was successfully performed and the difficult airway was improved by tracheal aspiration and the administration of adrenaline and β2-agonist, but the operation was postponed. The patient was brought to the SICU under intubation, extubated after confirming that her respiratory condition was stable, and then returned to the general ward on the following day. She was discharged on the second day after anesthesia.
This ventilation disorder may have been caused by an asthmatic attack brought on by residual airway hyper-responsiveness caused by a history of asthma. Another possible cause was anaphylaxis. Based on the previous anesthesia experience, we may have been able to prevent difficulties by administering corticosteroids and β2 agonists before induction.
