Awake thoracic epidural anaesthesia for laparotomy: A safer alternative to general anaesthesia in asthmatic patients

Abstract

Asthma is a common obstructive lung disease with a hallmark of airway inflammation and hyper-reactivity in response to a variety of stimuli. The morbidity and mortality in asthma is directly related to reversible airway obstruction and bronchospasm in response to specific triggers. The goal of the anaesthetist is to avoid eliciting triggering stimuli that can incite bronchospasm. Neuromuscular blocking agents and invasive airway procedures like endotracheal intubation are known triggering factors for bronchospasm in asthmatics. It is therefore prudent to use regional, as oppose to general, anaesthesia whenever possible. We describe the use of an awake thoracic epidural anaesthesia for laparotomy in an asthmatic patient. We recommend that, where possible, epidural anaesthesia should be preferred to general anaesthesia in asthmatic patients.