review · Annals of Medicine and Surgery
Asthma is a prevalent respiratory condition in elderly surgical patients, causing expiratory airflow resistance, positive end-expiratory alveolar pressures, lung and thorax hyperinflation, and altered respiratory muscle function. Managing these physiological challenges requires detailed preoperative assessment, targeted pharmacotherapy, and tailored anaesthetic strategies to minimise perioperative complications. Evidence compiled through a systematic review identifies specific drugs best suited across each stage of surgical care. For premedication before induction, low-dose intravenous ketamine, midazolam, and intravenous lidocaine, either alone or paired with salbutamol, are advised. Propofol and ketamine serve as effective induction agents, while halothane, isoflurane, and sevoflurane are optimal for anaesthesia maintenance. Regarding neuromuscular blockade, vecuronium provides a safe muscle relaxant choice. Additionally, succinylcholine and pancuronium, which release minimal levels of histamine, can be deployed safely in asthmatic patients with low rates of morbidity.
Asthma significantly alters breathing mechanics during surgery, increasing risks of respiratory complications such as air-trapping and lung hyperinflation, particularly in older patients. Outlining safe, specific combinations of premedication, induction agents, and muscle relaxants helps clinicians reduce perioperative morbidity through informed anaesthetic choices.
The findings can inform clinical guidelines, hospital anaesthesia protocols, and perioperative drug selection by medical practitioners managing asthmatic patients. Because the review synthesises existing, approved pharmaceuticals rather than developing novel products, the insights are already at the stage of clinical practice. The abstract does not indicate a distinct commercial application pathway.
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Asthma is one of the commonest respiratory illnesses among elderly patients undergoing surgery. Detailed preoperative assessment, pharmacotherapy and safe anaesthetic measures throughout perioperative period are the keys to decrease complications. Resistance to expiratory airflow results in positive alveolar pressures at the end of expiration, which causes air-trapping and hyperinflation of the lungs and thorax, increased work of breathing, and alteration of respiratory muscle function. This systematic review was conducted according to the Preferred Reporting Items for systematic review and metanalysis (PRISMA) statement. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find evidences. Low-dose IV ketamine, midazolam, IV lidocaine or combined with salbutamol are recommended to be used as premedication before induction. Propofol, ketamine, halothane, isoflurane and sevoflurane are best induction agents and maintenance for asthmatic surgical patients respectively. Among the muscle relaxants, vecuronium is safe for use in asthmatics. In addition, Succinylcholine and pancronium which releases low levels of histamine has been used safely in asthmatics with little morbidity.
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DOI: 10.1016/j.amsu.2021.102874
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