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Refractory Intraoperative Bronchospasm — FRCA Final MCQ

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HardGeneral AnaesthesiaRefractory Intraoperative BronchospasmFRCA Final

A 50-year-old woman (ASA II) develops bronchospasm during general anaesthesia for an abdominal hysterectomy. Despite deepening anaesthesia with sevoflurane, IV salbutamol 250 mcg, and IV hydrocortisone 200 mg, she remains wheezy with peak pressures of 45 cmH2O. Her SpO2 is 88%. What is the next most appropriate step?

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Correct answer: D — IV magnesium sulphate 2 g over 20 minutes

In refractory bronchospasm under general anaesthesia that has not responded to deepening anaesthesia (volatile agents are bronchodilators), IV salbutamol, and steroids, IV magnesium sulphate 2 g (40 mg/kg in children) over 20 minutes is the next step. Magnesium acts as a smooth muscle relaxant by inhibiting calcium influx. IV aminophylline is another option but has a narrower therapeutic index and more side effects. Nebulised ipratropium via the ETT circuit may also be attempted but IV administration is more reliable under anaesthesia. If all measures fail, consider whether this is actually anaphylaxis rather than bronchospasm.

Reference: BTS/SIGN – 2019 – Asthma management guidelines; RCOA – 2023 – Respiratory disease and anaesthesia