Bronchospasm

Case Synopsis

A 6-year-old boy with a history of mild intermittent asthma is scheduled for urgent laparoscopic appendectomy. After preoxygenation and a rapid-sequence induction, the patient is easily intubated. There is no sign of aspiration. After intubation, peak inspiratory pressure increases from 18 to 35 cm H ₂ O, accompanied by a decrease in oxygen saturation from 100% to 82%, a decrease in blood pressure from 98/64 to 68/34 mm Hg, and an increase in heart rate from 80 to 130 beats per minute. Chest auscultation reveals diffuse bilateral expiratory wheezes. The carbon dioxide trace on the capnogram is sharply upsloping.