Children with bronchial hyperreactivity:: is it a problem for the anaesthetist?

Identification of the patients with hyperreactivity and understanding the underlying physiopathological mechanisms are crucial to prevent the occurrence of peri-operative respiratotry adverse events in these patients. Preoperative assessment and preparation is based on the maintenance of any long-term anti-inflammatory treatment, especially the inhaled steroids. Furthermore, premedication is based on the administration of a beta(2)-agonist, antihistamine and anticholinergic drugs that are able to prevent against lung constriction induced by either vagal stimuli or endogenous mediators such as histamine. Anaesthesia management is primarily based on the use of inhalation agents and especially, isoflurane, which has both a protective and a potent bronchodilation effect. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.