Severe Intraoperative Bronchospasm Treated with a Vibrating-Mesh Nebulizer
Bronchospasm and status asthmaticus are two of the most dreaded complications that a pediatric anesthesiologist may face. With the occurrence of severe bronchospasm and the inability to ventilate, children are particularly vulnerable to apnea and ensuing hypoxia because of their smaller airway size, smaller lung functional residual capacity, and higher oxygen consumption rates than adults. Nebulized medication delivery in intubated children is also more difficult because of smaller endotracheal tube internal diameters. This case demonstrates the potentially lifesaving use of a vibrating-mesh membrane nebulizer connected to the anesthesia circuit for treating bronchospasm.

Assembly of conventional anesthesia circuit with APN and size-specific connectors. A indicates the universal adapter (Intersurgical Incorporated, #1969, Liverpool, NY) with a 22-mm outer diameter (OD) and a 15-mm inner diameter (ID); B, the APN chamber; C, the straight connector (Intersurgical Incorporated, #1962, Liverpool, NY) with a 15-mm OD and 22-mm ID; and D, the APN control module, which connects to the APN chamber via a cable.
Contributor Notes