• Postintubation hypotension may result from lung hyperinflation,

hypovolemia, and sedation. Significant lung hyperinflation mimics tension

pneumothorax. A trial of hypoventilation improves cardiopulmonary
status within 30–60 sec in former. Volume challenge is indicated for
hypotensive pts.
• Rising peak-to-plateau pressure gradient suggests increased airway
resistance
• Rising Pplat suggests worsening lung hyperinflation
• Consider keeping Pplat <30 cm H2O by prolonging expiratory time. May
need to accept hypercapnia
• Extubation may precipitate exacerbation. Inhaled β-agonists may be
needed more frequently post extubation.
• Muscle relaxants in addition to systemic corticosteroids may cause acute
myopathy
• Volatile anesthetics, propofol, and ketamine are bronchodilators
Regional Anesthesia
• Excellent alternative to avoid airway instrumentation
• Neuraxial blockade improves postop lung function due to improved pain
therapy and diaphragmatic function
• Neuraxial blockade may reduce vital capacity and FEV1 (negligible under
lumbar or low thoracic block and benefits of pulm function prevail)
• Concern for bronchial constriction due to sympathetic blockade is not
significant and unproven
• Overall pulm function and pain control are improved with neuraxial
blockade in pts with reactive airway disease.
Postoperative Period
• Consider deep extubation or lidocaine IV to suppress hyperreactive
airway reflexes
• Observe for postop bronchospasm
280