An Unexpected Case of Perioperative Recurrent Bronchospasm: A Case Report and Review of the Literature

Bronchospasm is a condition commonly encountered in the perioperative setting and represents an airway emergency that requires immediate identification and management. While multiple factors increase the risk for bronchospasm, it can still appear in patients who are otherwise well. Of note, once treatment has been administered, it is important to continue monitoring the patient after the event to ensure full resolution. A 58-year-old medically well woman presented for an emergent laparoscopic cholecystectomy. Soon after intubation, she developed a sudden oxygen desaturation with hypotension and notable bilateral wheeze on auscultation. A rapid assessment was performed, considering issues with the endotracheal tube, airway obstruction, her depth of anaesthesia, bronchospasm, and anaphylaxis. Following this, she was treated for bronchospasm and supported briefly with metaraminol, with improvement in her vital signs and subsequent uneventful extubation. However, while in recovery, she had another episode of oxygen desaturation with a normal chest radiograph and a blood gas analysis suggesting a high A-a gradient, likely a further reactive airways event that required further treatment with bronchodilators and led to an overnight admission to the high-dependency unit for close monitoring and resolution of her hypoxia. A follow-up procedure in the next few days was pre-treated with nebulised bronchodilators, with an uneventful procedure and subsequent discharge home. A review of the literature shows the differential for bronchospasm remains broad, and multiple factors must be considered while ensuring patient safety. While treatment may be similar, it is paramount to ensure full resolution of symptoms prior to any consideration of discharge, as bronchospasm may recur in the short term with poor outcomes if not promptly addressed.