Introduction Bronchospasm is defined as a sudden, involuntary contraction of the smooth muscles surrounding the bronchi, resulting in airway narrowing and reduced airflow to and from the lungs. It is a common and potentially serious condition, especially in patients with asthma, allergies, chronic smokers, and individuals undergoing general anesthesia. Pathophysiology Bronchospasm occurs as a result of an inflammatory or allergic response that leads to: 1. Contraction of bronchial smooth muscles, triggered by the release of mediators such as histamine, leukotrienes, and prostaglandins. 2. Mucosal edema of the bronchial lining. 3. Increased production of thick mucus within the airways. Collectively, these mechanisms lead to: • Narrowing of the airway lumen • Increased airway resistance • Reduced ventilation • Difficulty in inhalation and exhalation Etiology 1. General Respiratory Causes • Asthma • Chronic Obstructive Pulmonary Disease (COPD) • Viral and bacterial respiratory infections • Exposure to dust, smoke, and strong odors • Strenuous physical activity 2. Allergic Triggers • Medications (NSAIDs, beta-blockers, certain antibiotics) • Pollen • Animal dander • Food allergens 3. Anesthesia-Induced Bronchospasm Important in anesthesia practice, it may result from: • Light or inadequate anesthesia • Allergic reactions to anesthetic agents • Airway irritation due to: suctioning, intubation, extubation, excessive secretions • Uncontrolled asthma • Chronic smoking Clinical Features Symptoms • Sudden shortness of breath • Chest tightness • Severe coughing • Wheezing Signs • Rapid, shallow breathing • Difficulty with both inspiration and expiration • Low oxygen saturation • Audible wheezing on auscultation • High peak airway pressures during anesthesia Diagnosis • Clinical examination and detection of wheezing • Pulse oximetry • Spirometry • Arterial Blood Gas (ABG) analysis in severe cases • Observing increased airway pressure on the anesthesia machine Management 1. Bronchodilators • Salbutamol (Ventolin): first-line therapy • Ipratropium bromide • Epinephrine in severe cases 2. Steroids • Hydrocortisone • Dexamethasone To reduce inflammation and prevent recurrence. 3. Oxygen Therapy To improve oxygen saturation and prevent hypoxemia. 4. In Anesthesia • Deepening anesthesia (e.g., Propofol) • Using Sevoflurane for its bronchodilatory effect • Suctioning secretions • Ensuring no tube kinking or obstruction • IV bronchodilators when needed Complications Untreated bronchospasm may lead to: • Hypoxemia • Hypercapnia • Apnea • Respiratory failure • Cardiac arrest in severe cases Prevention For Patients • Adequate asthma control • Avoidance of irritants (smoke, dust) • Regular use of prescribed inhalers In Anesthesia • Preoperative respiratory assessment • Administering bronchodilators when indicated • Minimizing airway irritation • Using appropriate drugs for allergic patients Conclusion Bronchospasm is a potentially life-threatening condition, especially in asthmatic patients or during general anesthesia. Early recognition, accurate diagnosis, and prompt management are essential to prevent complications and ensure patient safety. Hasan Najeh Al-Mustaqbal University The First University in Iraq.