ABSTRACT
Bronchospasm is a potentially serious perioperative problem for those undergoing general anesthesia. Bronchospasm likely occurs when the respiratory tract is still sensitive to inhalation after an infection, or due to the release of histamine after the administration of atracurium. In developing countries all over the world, the incidence of trauma due to traffic accidents remains high, especially limb and head trauma in addition to multiple other traumas. A boy aged 13 years old and weighing 48 kg suffered a left thighbone fracture due to a traffic accident, and doctors planned to install plates and screws through surgery under general anesthesia. The preoperative examination was obtained: GCS 15, history of accidents 4 days prior, history of respiratory tract infections that had healed 2 days prior, history of asthma (−), history of drug allergy (−), family history of asthma (+). The physical examination found: BP 115/74 mmHg, pulse 84 x/min, respiration 18 x/min, and temperature afebrile. The laboratory blood tests were within normal limits. A pulmonary X-ray was normal. Induction was carried out by giving Fentanyl 50 mcg iv, Propofol 100 mg iv, and Atracurium 20 mg iv, and the patient was manually ventilated using O2, N2O, and sevoflurane gas. After 1 minute, the ventilation felt heavy, 20% SpO2, BP 50/30 mmHg, pulse 130 x/min, acral appeared cyanotic, and the patient was immediately intubated with ETT no 6.5. Manual ventilation still felt severe, so 2 minutes later, the patient was given a bronchodilator Ventolin spray through ETT, Methylprednisolone 125 mg iv, Ephedrine 10 mg iv, and Dexamethasone 4 mg iv. Manual ventilation continued, gradually becoming lighter; after 15 minutes, BP 90/60 mmHg, pulse 120 x/min, SpO2 95–97%, acral cyanosis (−). Conditions returned to normal and the operation continued with good results.
