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The patient was a 7-year-old boy with asthma and allergies to egg and dairy. A slow inhalation induction was initiated in preparation for removal of an odontoma under general anesthesia. During the initial administration of anesthesia, we were able to maintain ventilation. However, ventilation difficulty, decreased blood pressure, and tachycardia occurred immediately after the administration of rocuronium. During direct laryngoscopy via standard laryngoscope, hypopharyngeal or glottic edema was not noted. We suspected an asthma attack, and

Asthma is an episodic disease characterized by hyperreactive bronchi, chronic airway inflammation, and airflow obstruction during expiration. Bronchospasm is caused by spasmodic contraction of the bronchial smooth muscle. Status asthmaticus is bronchospasm that does not respond to standard treatments, which include intravenous (IV), inhaled, and subcutaneous (SQ) interventions. It is estimated that 9.6 million children in the USA have been diagnosed with asthma. This represents approximately 13% of the total pediatric population. 1 , 2 The

Adrenergic agonists, 159 Adrenergic antagonists, 159 Amnesia, 62 Anesthesia, 82 Anesthetics local, 57 Anticholinergic drugs, 159 Asthma, 123 Autonomic drugs, 159 Biocompatibility testing, 57 Bronchospasm, 123 Buffering, 127 Cholinergic drugs, 159 Complication, 82 Cost analysis, 147 Deep sedation, 107 Demand for services, 3 Dental anesthesia, 147 Dental anesthesiologist, 3 Dental caries, 143

. Allergy Asthma Immunol Res . 2016 ; 8 : 541 – 544 . 4.  Uyttebroek AP, Sabato V, Bridts CH, Ebo DG. In vitro diagnosis of immediate IgE-mediated drug hypersensitivity: warnings and (unmet) needs . Immunol Allergy Clin North Am . 2014 ; 34

asks about asthma, but many lack critical notations by the dentist of its severity. If your documentation does not include additional information on asthma ( How serious is it? E.R. visits? Hospital admissions? What triggers it? How do you manage it? When was your most recent attack? Are you clear now?Did you take your medication today? ), you will not be able to justify in court or at a dental board hearing your decision to proceed with administration of the anesthetic. The judge/jury/dental board hearing officer will have no way of knowing whether the patient had 4

increase in airway irritation. 1 Previous research has detailed negative health consequences of ETS to include increased likelihood of respiratory infections, middle ear infections, asthma onset and severity, sudden infant death syndrome, and even dental caries. 2 – 5 Jones and Bhattacharyya (2006) demonstrated that children who are exposed to ETS at home are more likely to experience adverse respiratory events while under or recovering from general anesthesia (GA) for a wide variety of procedures. 6 However, another study in 2006 noted that although healthy

management while providing dental care. PULMONARY DISEASE The respiratory system can be afflicted with a vast number of disorders, but asthma and diseases that contribute to chronic obstructive pulmonary disease (COPD) are most prevalent. Furthermore, these particular disorders have the most significant impact on patient management during dental care. Asthma Asthma is an inflammatory disease of the airways characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli. 2 It is an