Asthme et anesthesie (generale)

"L'asthmatique est à risque de déclencher un bronchospasme pendant une anesthésie, d'autant plus fréquemment qu'il est atteint d'un asthme sévère. Le mauvais contrôle de l'asthme est le facteur de risque principal. C'est ainsi que la consultation d'anesthésie devra s'attacher à évaluer le contrôle et, si possible, à organiser une préparation préopératoire permettant de l'optimiser, en utilisant bronchodilatateurs et stéroïdes. L'anesthésie locorégionale doit être préférée à l'anesthésie générale au cours de laquelle l'intubation peut provoquer le bronchospasme. Les agents inhalés sont bien tolérés en étant bronchodilatateurs. La kétamine et les benzodiazépines peuvent être utilisées. Le propofol et les morphiniques sont en règle générale bien tolérés chez l'asthmatique. Parmi les curares, on préfèrera ceux qui sont dépourvus d'effet histaminolibérateur. Lors d'une anesthésie locale, la lidocaïne peut être utilisée. Ses vertus bronchodilatatrices sont alors mises à profit. L'utilisation de bronchodilatateurs bêta-2 mimétiques systématiquement et, a fortiori, en cas de bronchospasme à l'induction sont le traitement de choix, associés aux corticoïdes."

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