Patients who undergo elective surgery who are not under good control should postpone their procedures to allow proper administration of medication. In emergencies, this delay may not be possible, so asthma therapy may have to be given intravenously during and after surgery.
Preparing for Surgery Preparing for surgery may include a course of oral corticosteroids in patients who are symptomatic or show significant reductions in flow rates on spirometry. In stable patients the medication regimen should continue right up to the time of surgery. To avoid reflex bronchoconstriction, B2-agonists may be given by inhalation just before surgery. Because all oral intake is usually stopped for several hours before surgery, patients receiving theophylline may be affected, although long-acting preparations may maintain blood levels for up to twelve hours. In patients who must maintain a therapeutic blood level for good control of their asthma, intravenous aminophylline may ensure a constant level. Patients with moderate to severe asthma who have required daily doses or frequent courses of oral corticosteroids should receive intravenous injections of corticosteroids at the time of surgery to prevent exacerbation of their condition and possible adrenal insufficiency. Steroids should also be given in the postoperative period. Inhalation therapy with bronchodilators such as B-agonists and anticholinergic medication should also be continued after surgery. After Surgery Once the asthma patient has stabilized after surgery, an attempt should be made to resume the patient's maintenance asthma medication as soon as possible. In patients whose asthma has worsened, an oral steroid course may be given with gradual lowering of dosage. With careful preparation that identifies patients at greater risk, surgery complications can be avoided. Newer anesthesia techniques that avoid intubation may also prevent serious complications. Even in the mildest asthmatic patient, preparation is needed before surgery.
