Intraoperative bronchospasm

Etiology:
Underlying airway reactivity →
Airway irritation →
Reversible reflex constriction of bronchial smooth muscle
Signs / symptoms:
Wheezing on chest auscultation
Upsloping, decreasing, or absent end-tidal carbon dioxide end-tidal carbon dioxide waveform
Oxygen desaturation
High peak inspiratory pressures with minimal to no change in plateau pressures
Decreasing tidal volumes
Management:
Increase FiO2 to 100%
Begin hand ventilation
If mild, can deepen anesthesia (increase inhaled gas or bolus propofol/ketamine)
If persistent → nebulized SABA albuterol
If severe:
Epinephrine IV bolus or gtt
Anticholinergics: glycopyrrolate, atropine, ipratropium (give with albuterol), maybe cause high HR
IV magnesium sulfate
Glucocorticoids (take 4-6 hrs)