Perioperative Bronchospasm Risk Factors and Initial Management

Perioperative bronchospasm is an acute increase in lower-airway resistance that can impair ventilation, produce dynamic hyperinflation, and progress to cardiovascular collapse. It may arise from airway stimulation in a susceptible patient or accompany aspiration, anaphylaxis, and other critical events. This narrative review examines risk factors, prevention, recognition, differential diagnosis, and initial management in adults and children. Targeted PubMed searches and relevant professional guidance were reviewed through November 9, 2026. Evidence was synthesized descriptively, distinguishing bronchospasm-specific outcomes from composite respiratory adverse events and separating prevention trials from emergency-treatment evidence. Active asthma, recent respiratory symptoms or infection, smoking exposure, younger pediatric age, airway instrumentation, and the anesthetic context identify clinically important risk. Randomized pediatric studies support selected preventive interventions, including albuterol before tonsillectomy and intravenous propofol induction in children at increased respiratory risk, but their composite outcomes should not be interpreted as isolated bronchospasm effects. Initial treatment requires calling for assistance, administering oxygen, stopping avoidable stimulation, manually assessing ventilation, and rapidly excluding airway-device or circuit obstruction. Bronchodilator delivery and adequate anesthetic depth should be established while expiratory time is increased to limit gas trapping. Hypotension with severe obstruction requires immediate consideration of anaphylaxis, tension pneumothorax, and dynamic hyperinflation. Epinephrine is essential when anaphylaxis is suspected; corticosteroids provide delayed anti-inflammatory benefit and cannot replace immediate bronchodilation or resuscitation. Evidence for adjunctive magnesium and ketamine is less direct and should be interpreted cautiously. Recovery planning must account for recurrence, residual respiratory dysfunction, and the cause of the event. A structured response combines treatment of bronchoconstriction with repeated reassessment of ventilation, circulation, and alternative diagnoses.