Sudden Preoperative Bronchospasm: A fatal complication!

Bronchial asthma is a reversible reactive airway disease amenable to treatment. It can be controlled on preoperative medication with beta-2 agonists (aerosol inhaler or nebulization and oral medication), theophyline derivatives and steroids (inhalers). We present a known case of bronchial asthma, well controlled on medication preoperatively and posted for elective laproscopic cholecystectomy. Immediately on transfer to the O.T (operation theatre) table, she developed severe acute bronchospasm with sudden oxygen desaturation, followed by loss of consciousness and bradycardia. Immediately, the patient was intubated with a portex 7 mm cuffed tubes under vision by direct laryngoscopy. But the patient was not able to be ventilated, neither by a bag nor by the ventilator. Mechanical ventilation of the patient was not possible, with no chest rise or fall. The bag felt very tight and the airway pressures were extremely high. The chest was silent on auscultation. Unfortunately, the patient could not be revived, even with simultaneous cardiac resuscitation. This case highlights that even well controlled bronchial asthma patients can develop uncontrolled sudden bronchospasm which can be fatal, if ventilation of a tight chest becomes impossible.