During anesthesia, a patient develops bronchospasm not responsive to inhaled bronchodilators. Immediate management includes:

During anesthesia, a patient develops bronchospasm not responsive to inhaled bronchodilators. Immediate management includes:

• A. Deepen anesthesia (increase volatile agent or IV propofol), give a fast-acting bronchodilator (nebulized albuterol), provide 100% oxygen, and consider systemic steroids.
• B. Stop the procedure and awaken the patient.
• C. Administer a systemic antibiotic and wait.
• D. Intubate immediately without any therapy.

Answer: (C)

When intraoperative bronchospasm remains unresponsive to inhaled bronchodilators, the priority is to aggressively optimize airway patency and oxygenation while reducing bronchial smooth muscle tone. Deepening anesthesia with a volatile anesthetic agent (or a deeper IV propofol infusion) can directly help by reducing airway reactivity and providing bronchodilation, making it easier to ventilate. Simultaneously, give a fast-acting bronchodilator again, typically via nebulized albuterol, to relax the bronchial smooth muscle. Ensure 100% oxygen delivery to correct hypoxemia from V/Q mismatch and the obstructive process. Early systemic steroids can help mitigate the inflammatory component and reduce ongoing bronchospasm, even though their effects are not immediate, they are a useful part of the overall strategy. If airway edema or ongoing obstruction persists despite these measures, prepare for careful airway management and consider facilitating intubation with adequate depth of anesthesia and hemodynamic support. Antibiotics do not address the acute bronchospasm and are not part of the immediate treatment unless there is a concurrent infection to be treated. Stopping the procedure or waking the patient is not the fastest way to resolve the bronchospasm, and intubating without prior optimization of bronchodilation and oxygenation can be dangerous and less effective.

When intraoperative bronchospasm remains unresponsive to inhaled bronchodilators, the priority is to aggressively optimize airway patency and oxygenation while reducing bronchial smooth muscle tone. Deepening anesthesia with a volatile anesthetic agent (or a deeper IV propofol infusion) can directly help by reducing airway reactivity and providing bronchodilation, making it easier to ventilate. Simultaneously, give a fast-acting bronchodilator again, typically via nebulized albuterol, to relax the bronchial smooth muscle. Ensure 100% oxygen delivery to correct hypoxemia from V/Q mismatch and the obstructive process. Early systemic steroids can help mitigate the inflammatory component and reduce ongoing bronchospasm, even though their effects are not immediate, they are a useful part of the overall strategy. If airway edema or ongoing obstruction persists despite these measures, prepare for careful airway management and consider facilitating intubation with adequate depth of anesthesia and hemodynamic support.

Antibiotics do not address the acute bronchospasm and are not part of the immediate treatment unless there is a concurrent infection to be treated. Stopping the procedure or waking the patient is not the fastest way to resolve the bronchospasm, and intubating without prior optimization of bronchodilation and oxygenation can be dangerous and less effective.