International Journal of Health Sciences & Research (www.ijhsr.org) 406 Vol.5; Issue: 11; November 2015 International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Bronchospasm Under Spinal Anesthesia : A Report of Two Cases, with a Literature Review Sneha Arun Betkekar 1 , Udita Naithani 2 , Sandeep Sharma 3 , Indra Kumari 4 1 Junior Registrar, 2 Associate Professor, 3 Assistant Professor, 4 Senior Professor and Head, Department of Anesthesia, R.N.T. Medical College, Udaipur, Rajasthan, India. Corresponding Author: Sneha Arun Betkekar Received: 04/10/2015 Revised: 23/10/2015 Accepted: 28/10/2015 ABSTRACT Bronchospasm in spinal anesthesia is uncommon. We are reporting two cases of bronchospasm under spinal anesthesia in patients with hyper-reactive airways who had no respiratory signs or symptoms preoperatively. Case 1: A 50 yr old male, known case of bronchial asthma on treatment underwent emergency fasciotomy for cellulitis on his left leg under spinal anesthesia, after receiving steroid prophylaxis for his asthma. Case 2: A 27 year old male, underwent debridement and k wire fixation of his right medial malleolus under spinal anesthesia. This patient had a history of allergic rhinitis which was not revealed on preanesthetic evaluation. Both of them received subarachnoid block with 10 mg 0.5% hyperbaric bupivacaine and a block height of T8 and T10 was achieved in case 1 & 2 respectively. In these cases severe bronchospasm (coughing, wheezing, desaturation) occurred 15 min and 5 min after spinal injection in the respective cases. Both were successfully treated with bronchodilators and steroids. Bronchial asthma and allergic rhinitis share a common immunopathogenesis, with hyper-reactive airways. These patients have a dominant parasympathetic tone which maybe unmasked after sympathetic blockade occurring in spinal anesthesia. This could be the possible mechanism of bronchospasm in the reported cases. Keywords: bronchospasm, spinal anesthesia, complications, allergic rhinitis, bronchial asthma, hyperactive airways. INTRODUCTION Bronchial asthma and allergic rhinitis have a common immunopathogenesis with hyperactive airways and should be considered a single respiratory disease. [1] Regional anesthesia is the preferred method in these patients since it avoids manipulation of the airway. Neuraxial blockade produces minimal alterations in pulmonary variables in healthy and even in elderly patients. It has no effect on inspiratory function but may produce a decrease in expiratory capacity owing to paralysis of abdominal muscles. [2] Adverse pulmonary complications following neuraxial block are rare. A few cases of bronchospasm following neuraxial blockade have been reported. [3-6] The causes in these cases have been attributed mainly to high spinal blockade. [3-4] In mid spinal block where bronchospasm has occurred, the causes documented were anxiety, [4] parasympathetic stimulation during surgical manipulation [5] and blockade of sympathetic supply to the adrenal medulla