This study has highlighted the need for appropriate airway support as the depth of anesthesia increases, even if spontaneous ventilation is maintained. At each anatomical level, airway caliber fell as the depth of propofol anesthesia increased, an effect that was completely reversed by continuous positive airway pressure. In a prospective study in nine infants undergoing elective MRI scanning of the brain, spin echo magnetic resonance images of the airways were acquired during different stages of propofol anesthesia (80 and 240 micrograms/kg/minute) with and without 10 mmHg continuous positive airway pressure. General anesthesia can cause airway compromise. Drug lymphocyte stimulation tests were weakly positive for propofol. Four weeks later, she underwent intradermal skin tests that were negative for propofol, vecuronium, and other anesthetic drugs. She received methylprednisolone 80 mg and aminophylline 125 mg preoperatively, but still went on to develop bronchospasm that eventually responded to sevoflurane. She had taken oral aminophylline and inhaled fluticasone for 6 years and had a raised eosinophil count (17%). Ī 45-year-old woman with sick building syndrome developed bronchospasm after induction of anesthesia with propofol.In one case it seems to have been exacerbated by propofol. Sick building syndrome associated bronchial hyper-reactivity is thought to be due to volatile organic compounds such as formaldehyde, toluene and xylene. From a clinical perspective, the major consideration is whether any more serious problem, such as asthma, may have also developed. When the source is remediated, most building occupants typically experience symptomatic improvement. In every instance, a search for a specific allergen or irritant is worth undertaking ( Chapter 235), but the most remedial sources are poor overall ventilation and dampness in which molds fester. The cause is unknown, but recent evidence suggests that microbial materials may be the most common culprits. Many occupants are typically affected, especially those who spend the most time in one place. The effort to reduce the influx of “fresh” air into buildings to save heating and air-conditioning costs has resulted in upper airway and dermal irritation as well as vague central nervous system symptoms such as headache and fatigue, occurring shortly after beginning work and clearing minutes to hours after leaving the affected building. Lee Goldman MD, in Goldman-Cecil Medicine, 2020 Sick Building Syndrome and Nonspecific Building-Related Illness
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