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Anesthesia and ventilation strategies in children with asthma: Part i - Preoperative assessment

机译：哮喘患儿的麻醉和通气策略：第一部分-术前评估

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Purpose of Review: Asthma is a common disease in the pediatric population, and anesthetists are increasingly confronted with asthmatic children undergoing elective surgery. This first of this two-part review provides a brief overview of the current knowledge on the underlying physiology and pathophysiology of asthma and focuses on the preoperative assessment and management in children with asthma. This also includes preoperative strategies to optimize lung function of asthmatic children undergoing surgery. The second part of this review focuses on the immediate perioperative anesthetic management including ventilation strategies. RECENT FINDINGS: Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk factors in the patientês (family) history that aid the preoperative identification of at-risk children. Asthma treatment outside anesthesia is well founded on a large body of evidence. Optimization and to some extent intensifying asthma treatment can optimize lung function, reduce bronchial hyperreactivity, and minimize the risk of perioperative respiratory adverse events. SUMMARY: To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, a good understanding of the underlying physiology is vital. Furthermore, a thorough preoperative assessment to identify children who may benefit of an intensified medical treatment thereby minimizing airflow obstruction and bronchial hyperreactivity is the first pillar of a preventive perioperative management of asthmatic children. The second pillar, an individually adjusted anesthesia management aiming to reduce perioperative adverse events, is discussed in the second part of this review.
机译：审查目的：哮喘是小儿人群中的常见疾病，麻醉师正越来越多地接受正在接受择期手术的哮喘儿童。这篇由两部分组成的综述中的第一篇简要概述了有关哮喘的基本生理学和病理生理学的最新知识，并着重于哮喘儿童的术前评估和治疗。这也包括术前策略，以优化接受手术的哮喘儿童的肺功能。这篇综述的第二部分着重于围手术期的即时麻醉管理，包括通气策略。最近的发现：评估健康和哮喘儿童围手术期呼吸不良事件的多项观察性试验，为确定患者（家庭）病史中的危险因素提供了基础，这些危险因素有助于在术前识别高危儿童。麻醉外的哮喘治疗基于大量证据。优化并在某种程度上加强哮喘的治疗可以优化肺功能，降低支气管高反应性，并最小化围手术期呼吸不良事件的风险。摘要：为了最大程度地降低哮喘儿童围手术期呼吸不良事件的风险，对基本的生理学有很好的了解至关重要。此外，全面的术前评估以识别可能受益于强化药物治疗的儿童，从而最大程度地减少气流阻塞和支气管高反应性是哮喘儿童预防性围手术期管理的第一支柱。本评价的第二部分讨论了第二个支柱，即旨在减少围手术期不良事件的单独调整的麻醉管理。

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