Amiodarone and the Development of ARDS After Lung Surgery: Recommendations

In our retrospective evaluation, the incidence of ARDS after right-sided pneumonectomy was 7.4 percent compared with 1.6 percent in the other types of lung surgery. In the small group of 11 patients who received amiodarone after right-sided pneumonectomy in the prospective evaluation of prophylactic amiodarone therapy, ARDS occurred in 3 out of 11 patients.
Greenspan etal described ARDS occurring after cardiac surgery for malignant arrhythmias in three of a series of eight patients, when the surgery was performed immediately after the administration of amiodarone, 1,200 mg per day for 7 to 14 days, suggesting that recent administration of a high dose of amiodarone before major cardiac surgery is potentially pulmotoxic. Furthermore, 6 of 11 patients in their series who were preoperatively receiving longterm amiodarone therapy for malignant ventricular arrhythmias developed ARDS as well, immediately after cardiac surgery.
Kay et al reported ARDS with fatal evolution in 4 of 33 patients receiving prolonged amiodarone therapy without signs of preoperative pulmonary disease after cardiac and noncardiac surgery.
We are not aware of reports of increased amio-darone-induced pulmonary toxicity in patients treated for cardiac arrhythmias late after pneumonectomy. One of our patients in whom a left pneumonectomy was performed in October 1988, however, developed ARDS 5 months after initiation of amiodarone therapy for recurrent atrial fibrillation in December 1989.
Another patient, who survived ARDS after a right pneumonectomy in 1990, was treated afterwards with amiodarone for recurrent atrial fibrillation and after 2 weeks developed another episode of ARDS with fatal outcome.
The risk of amiodarone pulmonary toxicity may be related to the drug’s concentration in the lung. Canadian health mall so It is possible, when the amount of pulmonary tissue has decreased, which is the case after lung parenchyma resection, standard doses of amiodarone may cause higher concentrations in the remaining lung, increasing the risk of pulmonary toxicity.
In view of our findings and data from the literature, we suggest avoiding the use of amiodarone to treat cardiac arrhythmias after pulmonary surgery, and to observe carefully all patients requiring amiodarone treatment for serious cardiac arrhythmias after any type of thoracic or nonthoracic surgery.

This entry was posted in ARDS and tagged amiodarone therapy, arrhythmia, lung surgery, pneumonectomy, pulmonary toxicity.