Surgery and Asthma

Am I At Increased Risk?

Surgery and Asthma
Surgery and Asthma. Getty Images: OJO Images

Are you at increased risk if you are having surgery and also have asthma?

Yes, asthmatics are at risk for certain complications as a result of their asthma. However, your actual risk depends on the severity of your asthma, the amount of hyperresponsiveness, how much airway obstruction you have, and the type of anesthesia being used. If your asthma is well controlled than you can likely undergo surgery without much trouble.

However, if you have steroid dependent asthma or poorly controlled asthma (moderate persistent or severe persistent), you will need to see your asthma doctor before surgery. The earlier the better, but at least a week in advance in case your medication needs adjustment.. Unfortunately, your asthma control does not always predict the risk of complications during surgery as a number of patients with what appears to be good control may develop complications intraoperatively.

However, at least some authors have wondered if asthma is still a risk factor for general anesthesia? Their thought is with a changing focus from treatment to prevention many previous studies discussing the risks and complications are not as valid today. While most patients will undergo general anesthesia without problem, it is still worth discussing with your doctor before surgery and considering the content outlined here.

The key is prior planning and identification of risk.

What Are The Risks

Bronchospasm, surprisingly to me, occurs in just under 2% of cases where general anesthesia is required. It is most likely to occur during induction, the time when the anesthesiologist (doctor who administers anesthesia) begins your anesthesia.

However, the potential complications can be devastating and result in severe brain injury or death.

Severe wheezing can result from intubation (when the tube is inserted into your lungs to allow for breathing during your procedure). This can also result in low oxygen saturation

Others risks include pneumonia and atelectasis. While you are under anesthesia and the effects from medication you have an impaired cough that can result in aspiration and possible infection.

Asthma is not thought to increase your risk of post operative pulmonary complications significantly. However, for some procedures poorly controlled asthma associated with significant coughing can lead to increased postoperative risks for some procedures such as increased risk of a surgical wound reopening.

If you are allergic to latex you need to make sure your surgeon and all the operative personnel are aware of this. You will want to ask and review with your operative team how they will avoid exposing you to latex.

The Preoperative Visit

You should see your asthma doctor for a thorough evaluation before surgery.

Your doctor will preform a history, physical exam, and review your recent medication use. If your asthma is not optimally controlled it may require that any elective, non-emergent surgery be postponed. If your surgeon is not sure about your asthma control they may want to perform testing. While a peak expiratory flow rate of greater than 80% predicted is good, one time peak flow testing is not optimal. If your doctor feels testing needs to be done, spirometry will likely be ordered. FEV1 is commonly used to monitor asthma in the office setting and some surgeons will request the test for higher risk procedures of upper abdominal, thoracic, or cardiac surgery. A FEV1 of greater than 80% of predicted generally indicates good asthma control.

Your doctor may sometimes want to order specific lab tests due to your asthma. High doses of some asthma meds can lead to alterations of glucose, potassium, or magnesium that will need to be checked. While chest x-rays are commonly ordered, they are not often useful if you do not have symptoms of cough or infection.

You may also want to talk with your anesthesiologist (the doctor that puts you to sleep during the procedure) about options for regional versus general anesthesia. In general anesthesia you are put totally to sleep while regional anesthesia does not. The main benefit is that regional anesthesia avoids the potential risk for for airway complications when your airway is manipulated.

If your asthma is not optimally controlled, expect intensive treatment before your surgery. This could include a short does of oral steroids and other treatments. This is one of the reasons that it is best to see your asthma doctor as early as possible before surgery. The goal is that your FEV1 or peak flow be at their predicted levels or personal best before surgery.

Certain aspects of your medical history increase the risk of bronchospasm during surgery and should be mentioned including:

  • Atopy
  • Eczema
  • Allergic rhinitis
  • Family history of asthma or atopy

 

Recent Steroid Use

Of particular concern (so it is very important to let the anesthesiologist know) are patients who are on chronic oral steroids and those having needed oral steroids in the last 6 months. Sometimes these patients will receive IV steroids during the surgical procedure.

Should I Quit Smoking?

While the answer to this is almost always yes, some patients (whether you have asthma or not) who quit smoking just before surgery put themselves at increased risk for some complications after surgery. If you quit at least 2 weeks before surgery this is generally not a problem. While smoking and asthma are not a good combination, make sure you talk with your doctor before quitting before your surgery.

Sources

  1. National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma
  2. Li J, McPherson R. Is asthma still a risk factor for general anesthesia? Journal of Anesthesiology 2014; 2(1): 8–12

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