Asthma is a chronic inflammatory lung disease characterized by symptoms of cough,

wheezing, dyspnea and chest tightness, partially or completely reversible airway narrowing,
and increased airway responsiveness to a variety of stimuli. Increased airway responsiveness
is also seen in children with recurrent acute wheezing due to causes other than asthma (eg,
allergies, viral infections). Asthma and recurrent wheezing are common childhood illnesses;
pediatric patients with these conditions commonly present for anesthesia and surgery and can
pose challenges for the anesthesiologist. Children with these conditions are at increased risk
for perioperative respiratory adverse events, including laryngospasm and bronchospasm.

Wheezing can occur at any time during anesthesia, most commonly during induction of
general anesthesia after endotracheal intubation. If it occurs, it is usually transient and
without sequelae if treated. However, bronchospasm can be severe and can result in
significant morbidity and mortality.

This topic will discuss preoperative assessment and preparation of pediatric patients with
asthma and recurrent wheezing, as well as intraoperative management. Evaluation and
management of asthma in children is discussed in more depth separately. (See "Asthma in
children younger than 12 years: Initiating therapy and monitoring control" and "Asthma in
children younger than 12 years: Initial evaluation and diagnosis" and "Virus-induced
wheezing and asthma: An overview" and "Evaluation of wheezing in infants and children".)

PREOPERATIVE EVALUATION

When possible, we prefer to assess patients with asthma one to two weeks prior to elective
surgery to allow time for modification of treatment, if necessary. The goal of preoperative
preparation is optimization of therapy to reduce the risk of perioperative respiratory adverse
events (PRAE).

Asthma severity and control The history given by the patient or caregiver at the time of
preoperative evaluation can help determine the severity and level of medical control of
asthma and predict the likelihood of perioperative bronchospasm. Important historical points
to emphasize during preoperative evaluation, in addition to a complete preoperative history,
include: