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Severe Bronchospasm Ventilation Strategy — FRCA Final MCQ

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HardGeneral AnaesthesiaSevere Bronchospasm Ventilation StrategyFRCA Final

A 60-year-old man (ASA III) develops severe bronchospasm during general anaesthesia. He is being ventilated with sevoflurane 3% and has received IV salbutamol, IV hydrocortisone, and IV magnesium. Peak pressures are 55 cmH2O. SpO2 is 78%. He is now in extremis. What ventilatory adjustment is most critical?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Switch to high-frequency oscillatory ventilation

In severe bronchospasm, the critical ventilatory strategy is: low respiratory rate (6-8/min) with prolonged expiratory time (I:E ratio 1:4 or 1:5) to allow complete expiration and prevent air trapping (dynamic hyperinflation/breath stacking). Increasing RR worsens air trapping, causing auto-PEEP, cardiovascular compromise, and barotrauma. Permissive hypercapnia is accepted. Tidal volumes should be moderate (6-8 mL/kg). If cardiovascular collapse occurs from severe dynamic hyperinflation, temporarily disconnecting the patient from the ventilator (allowing passive expiration) can be life-saving.

Reference: BTS/SIGN – 2019 – Asthma guidelines; RCOA – 2023 – Respiratory emergencies under anaesthesia