Amiodarone and the Development of ARDS After Lung Surgery: Methods

The treatment routinely used after a pulmonary operation, ie, prophylactic antibiotics, subcutaneous low molecular weight heparin, and an H2 antagonist IV, was given as usual. Other forms of treatment were given as required.
The prophylactic antiarrhythmic treatment was interrupted when side effects occurred, which were thought to be related to the antiarrhythmic drug such as rhythm or conduction disturbances and hypotension, or when other and more effective antiarrhythmic therapy seemed needed.
After the recognition of severe complications in some of the patients treated with amiodarone, it was decided to make a retrospective evaluation of the incidence of adult respiratory distress syndrome (ARDS) after pulmonary surgery in our institution from January 1987 until September 1991.
Adult respiratory distress syndrome was defined as extensive newly occurring patchy alveolar consolidation in the remaining lung parenchyma not caused by an infection, cardiac decompensation, or pulmonary embolism, leading to acute respiratory failure with severe hypoxemia for which artificial ventilation with high oxygen concentration was necessary.
The prospective study was interrupted on July 29, 1992, because of severe life threatening side effects in three postpneumonectomy patients in the amiodarone treatment group. At that time, 64 patients had been included after lobectomy and 32 patients after pneumonectomy.
The results are summarized in Table 1. Buy proventil Systemic hypotension occurred shortly after the start of the infusion of verapamil in nine patients and subsided rapidly after the cessation of verapamil therapy and fluid replacement.
Adult respiratory distress syndrome developed after right pneumonectomy in three patients in the amiodarone group, two occurrences on the second postoperative day, and the third one at the end of the third postoperative day.

Table 1—Incidence of Atrial Fibrillation and Side Effects in Patients After Lobectomy (n=64) or Pneumonectomy (n=32) During the 3 Days of Postoperative Treatment

Lobectomy Pneumonectom у
No. of patients 22 21 21 10 11 11
AF 6 1 0 1 0 0
H 0 1 3 1 0 0
ARDS 0 0 0 0 3 0
This entry was posted in ARDS and tagged amiodarone therapy, arrhythmia, lung surgery, pneumonectomy, pulmonary toxicity.