Amiodarone and the Development of ARDS After Lung Surgery

Amiodarone and the Development of ARDS After Lung SurgeryAtrial dysrhythmias—fibrillation, flutter, or paroxysmal atrial tachycardias—are frequently occurring arrhythmias after thoracic surgery. Besides the hemodynamic consequences and the need for immediate treatment, atrial fibrillation has severe prognostic implications for patients after pneumonectomy, of which a postoperative mortality of 25 percent has been reported.
Several prophylactic strategies with antiarrhyth-mic drugs, mostly digitalis or beta-blocking agents, have been evaluated for the prophylaxis of atrial fibrillation after coronary artery bypass surgery and were not found superior to placebo.
In the last 4 years, 242 pneumonectomies and 310 lobectomies have been performed in our hospital, and postoperative atrial dysrhythmias were regularly seen with sometimes important hemodynamic consequences for the patient.
We, therefore, decided to prospectively evaluate a prophylactic regimen consisting of amiodarone or verapamil, since either one has been reported safe and effective in the prevention of postoperative atrial arrhythmias other online antibiotics.
A prospective open randomized study was planned for 100 consecutive pneumonectomy and 200 consecutive lobectomy cases, comparing amiodarone, verapamil, or placebo as prophylactic treatment for atrial fibrillation.
All patients in whom a pulmonary resection was performed were considered for the study, within 1 h of return from surgery to the ICU. Exclusion criteria consisted of a heart rate of less than 50 beats per minute, systolic blood pressure below 100 mm Hg, atrial dysrhythmias, heart failure, or thyroid dysfunction. Amiodarone was administered in a bolus of 150 mg IV over 2 min, followed by a continuous infusion of 1,200 mg over 24 h for 3 consecutive days. Serial blood samples for amiodarone and de-sethylamiodarone were taken before the administration of the amiodarone bolus and every 12 h for 60 h. Verapamil was administered as a bolus of 10 mg IV for 2 min followed by a 30-min infusion of 0.375 mg per min and afterwards 0.125 mg per min for 3 days.

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