Intraoperative severe bronchospasm treatment with epinephrine puffing by using the MAD Nasal™ intranasal mucosal atomization device: a case report

Background: Perioperative bronchospasm remains a major concern in patients with asthma regardless of careful preoperative evaluation and management. Case: We present the case of a 77-year-old female with a history of asthma who underwent tumor resection under general anesthesia. The initial anesthesia induction and intubation were uneventful, with stable vital signs and normal respiratory parameters. Following an 11-h surgical procedure, during recovery with sevoflurane discontinuation and endotracheal tube suction, the patient developed a severe bronchospasm characterized by elevated airway pressure, decreased end-tidal Carbon dioxide (CO2) and diminished tidal volume. Initial treatment with albuterol via an endotracheal tube was ineffective. Subsequent administration of nebulized epinephrine (200 µg, 1:10,000) by using a MAD Nasal device promptly alleviated symptoms and improved ventilatory parameters. The patient required postoperative intensive care unit admission for ventilatory support but ultimately recovered without further bronchospasm episodes. This case underscores the unpredictable nature of perioperative bronchospasms and the critical need for preparedness to manage complications effectively. This highlights the potential role of the MAD Nasal™ Intranasal Mucosal Atomization Device as a practical and efficient alternative for delivering critical medications such as epinephrine in the perioperative setting, circumventing the challenges associated with intravenous administration during emergency situations. Enhancing healthcare provider training through structured simulations is essential for optimizing readiness and ensuring prompt intervention in similar clinical scenarios. Conclusions: We believe this case report contributes to the growing body of literature emphasizing the importance of tailored management strategies and innovative devices to mitigate the risks associated with perioperative bronchospasms, thereby improving patient outcomes.

Asthma; Albuterol; Bronchial spasm; Epinephrine

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