Table 4.

Summary on perioperative anaesthetic management of asthma.

Premedication	Midazolam (Oral/IV)	0.5 mg/kg oral or IV to alleviate anxiety
	Lidocaine (IV)	1.5–2 mg/kg IV lidocaine 90 s before laryngoscopy suppress the cough reflex and attenuates increases in HR and MAP
	Salbutamol (inhalational)	Salbutamol puff 5–10 min before induction.
Preemptive analgesia	Ketamine	0.15 mg/kg IV for analgesia and prevent fentanyl induced cough.
	Fentanyl	1-2mcg/kg Iv for analgesia
Anaesthetic agents(IV)	Propofol	Recommended in thermodynamically stable patient
	Ketamine	Recommended in thermodynamically unstable patients
Volatile anesthetics	Sevoflurane and Halothane	Depresses airway reflexes and produce direct bronchial smooth muscle relaxation.
	Desflurane and isoflurane	irritant to airway apparatus and increases airway resistance
Muscle relaxants and reversal agents	Suxamethonium	Choice for rapid sequence induction.
	Vecuronium, Pancuronium	Safe to use in asthmatic patients
	Neostigmine	Safe to use as reversal agents.
Airway management	•Warm, humidified gases should be provided at all times. •If the surgery allowed use noninvasive airway intervention, Face mask > LMA > ETT. •Optimal depth of anesthesia
Extubation	•Adequate suctioning under optimal depth of anesthesia. •Deep and smooth extubation is recommended if difficult intubation were not encountered during induction.
Post-operative	•Immediate oxygen supplementation and CPAP. •Meticulous monitoring of SPO2, Oxygen supplementation via nasal prongs. •Adequate hydration and analgesia.